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May 1, 2002

Treatment of Congestive Heart Failure—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(17):2209-2210. doi:10.1001/jama.287.17.2209

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.