In Reply We welcome the reply by Robinson et al. We are excited to see generalizability of our results in a nonveteran and female population. Robinson et al used similar inclusion criteria to our cohort to analyze a sample of 37 270 patients (17 930 [48.1%] female) with severe heart failure from the Explorys registry. The authors found an overall rate of palliative care use (9.6%) similar to ours (7.6%), as well as a similar trend toward increased use of palliative care between 2007 and 2014. These findings reinforce the importance of palliative care in patients with severe heart failure. We look forward to the full results of the Palliative Care in Heart Failure trial,1 a randomized clinical trial of palliative care use in patients with heart failure. Presented as a late-breaking clinical trial at the 2016 Heart Failure Society of America Annual Meeting, preliminary results suggest that patients in the palliative care arm had a significant improvement in quality of life compared with those in the usual care arm.2
Mandawat A, Heidenreich PA, Bhatt DL. Trends in Palliative Care Use in Elderly Men and Women With Severe Heart Failure in the United States—Reply. JAMA Cardiol. 2017;2(3):344–345. doi:10.1001/jamacardio.2016.4522
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