Patrick O'Brien

Clinical Summary

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Patient Snapshot: Patrick O'Brien, DOB 07/02/1947, 79-year-old male with end-stage heart failure (HFrEF, EF 20%), NYHA class IV, on optimized medical therapy.
Narrative Summary: Ischemic cardiomyopathy with an EF of 20% and symptoms at rest despite maximally tolerated guideline-directed therapy. Not a candidate for advanced therapies (transplant/LVAD) per cardiology. Three heart-failure admissions in the past six months.
Recent Context: Discharged 05/01/2026 after an admission for acute decompensation; diuretics up-titrated and a palliative-care consult placed for symptom-focused management.
Social & Environmental: Lives alone; a son visits daily and manages medications. Home has stairs to the bedroom, which is increasingly difficult. Expresses a clear preference to avoid further hospitalizations.

Potential Decline: Recurrent decompensations on optimal therapy, worsening renal function with diuresis, and symptoms at rest indicate an advanced, poorly reversible course.
Key Events: Three HF admissions in six months (12/2025, 03/2026, 04/2026); progressive functional decline and reduced exercise tolerance between events.
Trend Clarification: Rising BNP and a creatinine that climbs with effective diuresis reflect the cardiorenal ceiling of medical management rather than a treatable, reversible process.

Potential Primary: Cardiac — end-stage heart failure (HFrEF, EF 20%), NYHA class IV — is the best-supported primary hospice diagnosis.
LCD Criteria Reference: Consistent with LCD guidance for hospice in heart disease: NYHA class IV symptoms at rest, optimally treated with diuretics and vasodilators, EF ≤ 20%, and not a candidate for advanced interventions — supporting a prognosis of six months or less.
Relevant imaging: Echocardiogram 04/2026: EF 20%, severe global hypokinesis, moderate mitral regurgitation, and dilated left ventricle.
Secondary conditions: Chronic kidney disease stage 3 (cardiorenal), atrial fibrillation on anticoagulation, and type 2 diabetes mellitus.

ADLs: Dyspnea and fatigue at rest; needs assistance with bathing and dressing and uses a walker for short distances. PPS 40%, and declining — a functional trajectory that supports hospice eligibility.