Has the patient been Resuscitated (Coded) since the last visit?: Yes/No Has the patient began a Hospice program?: Yes/No If Yes, Date Started: MM/DD/YYYY Has the patient experienced a Recovery of EF to > 40%?: Yes/No Major Infection: Was there a major infection? Yes/No Neurological Dysfunction: Was there a neurological dysfunction event? Yes/No Major Bleeding: Was there a major bleeding event? Yes/No Death: Is this patient deceased? Yes/No Physical Exam INTERMACS Patient Profile Select one. profiles will provide a general clinical description of the patients Patients who meet MedaMACS entry criteria must fall in INTERMACS Patient Profiles 4-7. INTERMACS 1: Critical cardiogenic shock describes a patient who is and burning”,in which a patient has life-threatening “crashing hypotension and rapidly escalating inotropic pressor support, with critical hypoperfusion often confirmed by worsening acidosis and lactate levels. This patient can have Modifier A (see below). ‘Modifiers’ INTERMACS 2: Progressive decline describes a patient who has been demonstrated on inotropic support but nonetheless shows “dependent” signs of continuing deterioration in nutrition, renal function, fluid retention, or other major status indicator. Patient profile 2 can also describe a patient with refractory volume overload, perhaps with evidence of impaired perfusion, in whom inotropic infusions cannot be maintained due to tachyarrhythmias, clinical ischemia, or other intolerance. This patient can have Modifier A. INTERMACS 3: Stable but inotrope dependent describes a patient who is clinically stable on mild-moderate of intravenous inotropes (or
Has the patient been Resuscitated (Coded) since the last visit?: Yes/No Has the patient began a Hospice program?: Yes/No If Yes, Date Started: MM/DD/YYYY Has the patient experienced a Recovery of EF to > 40%?: Yes/No Major Infection: Was there a major infection? Yes/No Neurological Dysfunction: Was there a neurological dysfunction event? Yes/No Major Bleeding: Was there a major bleeding event? Yes/No Death: Is this patient deceased? Yes/No Physical Exam INTERMACS Patient Profile Select one. profiles will provide a general clinical description of the patients Patients who meet MedaMACS entry criteria must fall in INTERMACS Patient Profiles 4-7. INTERMACS 1: Critical cardiogenic shock describes a patient who is “crashing and burning”,in which a patient has life-threatening hypotension and rapidly escalating inotropic pressor support, with critical hypoperfusion often confirmed by worsening acidosis and lactate levels. This patient can have Modifier A (see ‘Modifiers’ below). INTERMACS 2: Progressive decline describes a patient who has been demonstrated “dependent” on inotropic support but nonetheless shows signs of continuing deterioration in nutrition, renal function, fluid retention, or other major status indicator. Patient profile 2 can also describe a patient with refractory volume overload, perhaps with evidence of impaired perfusion, in whom inotropic infusions cannot be maintained due to tachyarrhythmias, clinical ischemia, or other intolerance. This patient can have Modifier A. INTERMACS 3: Stable but inotrope dependent describes a patient who is clinically stable on mild-moderate of intravenous inotropes (or