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Perspectives on Care at the Close of Life: CODA
October 13, 2004

Palliative Care for Patients With Heart Failure

JAMA. 2004;292(14):1744. doi:10.1001/jama.292.14.1744

In May 2004, Drs Pantilat and Steimle1 introduced Mr R, a 74-year-old man with more than a decade’s history of idiopathic heart failure with New York Heart Association classification of II to III and type 2 diabetes mellitus. Through interviews of Mr R, his wife, and his cardiologist, Dr J, the authors explored the variety of medications and interventions that were brought to bear to control Mr R’s distressing symptoms. This included attending a shared medial appointment with other heart failure patients and a referral to hospice, from which Mr R ultimately “graduated,” after his medication adherence and self-monitoring regimens improved dramatically, greatly enhancing his quality of life. Two years after the initial interviews, Mr R is enjoying a quiet life. He continues to take his medicines, has not reenrolled in hospice, has kept to his do not attempt resuscitation order, and follows up regularly with Dr J. Dr J was reinterviewed by a Perspectives editor on July 1, 2004, shortly after a regularly scheduled visit with Mr R.

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