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Medicare Guidelines for Home Inotropic Therapy

I. Patient must have diagnosis of heart failure and must be classfied as ACCF/AHA Stage D Heart Failure or NYHA Class IV Heart Failure. This must be Documented in H&P or progress notes along with symptoms or tests performed to support the classification.
II. Remain symptomatic despite optimal dosages of diuretics, ACE inhibitors or ARB antagonists, beta blockers, aldosterone antagonists, hydralazine and isosorbide dinitrate, and statins, as appropriate. This must be documented in patient’s medication profile.
III. Therapy must be prescribed by a cardiologist with training in the management of advanced heart failure.
IV. There has been documented improvement of patient’s symptoms of heart failure while on the selected inotrope at time of discharge. This must be documented in H&P or progress notes.
V. Patient must return to prescribing cardiologist or heart failure team with oversight by a Cardiologist with training in the management of advanced heart failure every 3 months for an evaluation. There must be Documentation of the Patient’s cardiac symptoms and the continuing response and need for inotropic therapy in the visit record.