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
Cancer patients who require hospice or palliative care generally suffer from advanced disease, which is defined as metastatic spread of the malignancy from the primary site to other areas of the body and/or massive tumor growth at the primary site.
The malignant illness are divided into five categories as follows:
A decline in a patient’s nutritional status is another key indicator of poor prognosis. This is best expressed as an unintentional weight loss of 10 percent of normal body weight over a period of about 6 months, with the loss of weight usually due to the patient’s life-limiting condition.
Reversible cause of weight loss, such as depression and metabolic disturbances (diabetes, thyroid disease), should be excluded prior to assuming that the weight loss is due to the terminal illness and a true indicator of the patient’s prognosis.
However, terminally ill patients may still have reversible cause of weight loss. Thus, for terminally ill patients with reversible cause of weight loss, weight loss will be less helpful in determining prognosis.