hospice worksheet for determining prognosis, heart disease

Introduction

Worksheet:

• Does the patient have signs & symptoms of congestive heart failure?
  • signs
    • diaphoresis, sweating
    • cachexia, profound weight loss
    • jugulovenous distension (JVD)
    • neck veins distended above clavicle
    • rales, wet crackles in lungs heard on inspiration
    • gallop rhythm; S3, S4
    • hepatomegaly
    • edema, pitting
  • symptoms
    • dyspnea at rest; 'short-winded', 'can't breathe'
    • dyspnea on exertion (DOE)
    • orthopnea
    • paroxysmal nocturnal dyspnea (PND)
    • swelling of ankle or feet (edema)
    • syncope
    • weakness
    • chest pain
• Is the patient on optimal diuretic or vasodilator therapy?
  • diuretics
    • furosemide (Lasix)
    • bumetanide (Bumex)
    • ethacrynic acid (Edecrin)
    • torsemide (Demadex)
    • metolazone (Zaroxolyn)
  • vasodilators
    • nitrate (nitro patch, Isordil) plus hydralazine (Apresoline)
    • ACE inhibitor
      • benazepril (Lotensin)
      • captopril (Capoten)
      • enalapril (Vasotec)
      • fosinopril (Monopril)
      • lisinopril (Prinivil, Zestril)
      • quinapril (Accupril)
      • ramipril (Altace)
• Does the patient have a left ventricular ejection fraction of < 20% ?
• Further indications of diminished survival time
  • symptomatic supraventricular or ventricular arrhythmias resistant to antiarrhythmic therapy
  • history of cardiac arrest & resuscitation in any setting
  • history of syncope or any cause, cardiac or otherwise
  • cardiogenic brain embolism, i.e. embolic CVA of cardiacorigin
  • concomitant HIV disease