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End-of-Life Care and Congestive Heart Failure
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The article by Jong et al1 examining mortality in patients with congestive heart failure concludes,
Despite recent advances in medical treatment, we found persistent high mortality rates in our contemporary cohort of heart failure patients. This finding should be a sobering note to the medical community that much more remains to be done to improve the outcomes of this seriously ill population than is currently believed.
There are 2 problems with this conclusion. First, until much more is done, end-of-life care will remain an integral but easily overlooked aspect of care for patients with heart failure. Second, given that the death rate was especially high in frail elderly patients, it is not completely obvious how much more needs to be done. The goal of medical treatments is to prevent premature death, not death itself.
Stephen Workman, MD, MSc, FRCPC
Halifax, Nova Scotia
1. Jong P, Vowinckel E, Liu PP, Gong Y, Tu JV. Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study. Arch Intern Med. 2002;162:1689-1694.
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Arch Intern Med. 2003;163:737.
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