Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
In Reply: We appreciate these perspectives.
As Dr Brumley suggests, the increasing population of patients with truly end-stage
disease mandates more thoughtful approach to their suffering, which can certainly
be alleviated by oral opiates. Drs de Denus and Spinler note that recent information
regarding ACE inhibitors does raise considerable concern that these agents
may not be indicated for patients with a history of angioedema from ACE inhibitors.
Dr Jerant describes the success of his program for managing heart failure.
The majority of patients with heart failure are indeed followed up in primary
care practices. The clinicians in these settings have by far the most challenging
responsibility to provide comprehensive ongoing care for heart failure while
managing multiple other complex chronic illnesses.
Stevenson LW. Treatment of Congestive Heart Failure—Reply. JAMA. 2002;287(17):2209-2210. doi:10.1001/jama.287.17.2209