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Clinical Crossroads Update
February 23, 2000

A 75-Year-Old Man With Congestive Heart Failure, 1 Year Later

Author Affiliations

From the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, LY318, Boston, MA 02215.

JAMA. 2000;283(8):1054. doi:10.1001/jama.283.8.1054

In January 1999, at Medicine Grand Rounds, Gordon Guyatt, MD, discussed care for a 75-year-old retired fisherman. Mr C had exertional dyspnea associated with congestive heart failure and chronic obstructive pulmonary disease,1 with a history of heavy smoking and hypertension and evidence of dilated cardiomyopathy. He subsequently developed diabetes and renal failure. He was treated with a complex regimen of medicines, oxygen, and attentive care from his family and visiting nurses. Dr Guyatt discussed an approach to managing the treatment of such a patient, noting the usefulness of "N-of-1 randomized control trials" and the importance of therapeutic recommendations based on the best available medical evidence. We asked the patient's physician to comment on the months that followed the rounds.