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September 28, 2011

Hospitalization for Acute Heart Failure Syndromes—Reply

Author Affiliations

Author Affiliations: Northwestern University Feinberg School of Medicine, Chicago, Illinois (Dr Gheorghiade) (m-gheorghiade@northwestern.edu); and Duke University Medical Center, Durham, North Carolina (Dr Peterson).

JAMA. 2011;306(12):1326-1327. doi:10.1001/jama.2011.1356

In Reply: Dr Simon and colleagues raise an important aspect of the management of patients hospitalized with acute HF syndromes. We agree that advanced care planning including psychological, social, and spiritual support should be addressed in all patients admitted with HF. We also agree that education and dialogue with patients and their families is essential to optimize acute HF syndrome therapy.

Our article emphasized that HF is often not a single disease but a manifestation of complex and diverse cardiac abnormalities and associated comorbid conditions, such as diabetes and renal insufficiency.1 Although one goal for acute HF syndromes should be to relieve symptoms of congestion, hospitalization can also be a time to conduct an in-depth assessment to identify all the potential targets, cardiac and noncardiac, and accordingly implement all evidence-based therapies that are potentially life-saving.2,3 Therefore, before considering end-of-life decisions, it is important to be certain that the patient admitted with HF has indeed reached an end-stage phase.

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