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From the Heart
September 18, 2019


Author Affiliations
  • 1Smidt Heart Institute, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
JAMA Cardiol. 2019;4(11):1063-1064. doi:10.1001/jamacardio.2019.3311

As a cardiologist specializing in advanced heart failure, I’m in the business of making predictions. Will this patient derive an improved quality of life and survival from a heart transplant? Will that patient fare worse from a transplant and is thus better suited for hospice? And if this patient will benefit, will we find a donor in time, or should the patient receive mechanical support as a bridge?

I’m generally pretty good at making these predictions. When there is a fork in the treatment road, based on my knowledge of the pathophysiology and natural history of the disease, I know which path my patient should take. But sometimes a questionable decision results in an acceptable outcome and at other times, the right decision ends in tragedy.