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