HPNA study guide

Question 1

ACCF/AHA Class A Heart failure

Answer 1

At high risk for HF, but no structural heart disease or symptoms of HF

Question 2

ACCF/AHA Class B Heart failure

Answer 2

Structural heart disease but without signs or symptoms of heart failure.

Corresponds to NYHA functional class I

Question 3

ACCF/AHA class C heart failure

Answer 3

Structural heart disease with prior or current symptoms of HF.

Corresponds to NYHA functional class I, II, III, or IV

Question 4

ACCF/AHA class D heart failure

Answer 4

Refractory HF requiring specialized interventions. Unable to carry on activity without symptoms of HF or symptoms at rest.

Corresponds to NYHA class IV

Question 5

hospice criteria for cardiac referral

Answer 5

• NYHA class IV
• Symptomatic despite max management with diuretics and vasodilators (nitroglycerine, isosorbide)
• oxygen need
• EF < 20%
• Hx cardiac arrest
• resting tachycardia
• cachexia

Question 6

hospice referral for oncology patients

Answer 6

• metastatic cancer
• not seeking cure or control of cancer
• ongoing decline despite treatment
• PPS 70 or less
• Dependence for 2 or more ADLs

Question 7

hospice referral for pulmonary disease

Answer 7

• O2 dependent
• unresponsive to bronchodilators
• FEV1 less than 30% after bronchodilator
• A few steps without tiring
• multiple acute care visits for COPD in a year
• Resting Pco2 >50
• )2 on RA <88%
• cor pulmonale
• resting tachycardia
• recurrent respiratory infections
• dyspnea at rest