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Determining Prognosis: Patients with End-Stage Cardiac Disease (Reading & Sharing)

The principles for determining when patients with end-stage cardiac disease require end-of -life care, are actually similar to those for determining prognosis of patients with advanced pulmonary disease.

Disabling Dyspnea or Chest Pain

    • Dyspnea or chest pain with rest or minimal exertion and can therefore classified as New York Heart Association class IV (NYHA class IV)
    • Ejection fraction less or equal 20%, if available
    • Persistent symptoms despite optimal medical management with vasodilators and dialectics, or
    • Inability to tolerate optimal medical management due to hypotension and/or renal failure

Other comorbid condition association with a poor prognosis:

  • Symptomatic arrhythmias resistant to antiarrhythmic therapy
  • History of cardiac arrest and resuscitation
  • History of syncope, regardless of etiology
  • Cardiogenic brain embolism
  • Concomitant HIV disease



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