An 81-year-old man with heart failure (HF), coronary artery disease, hypertension, diabetes, and chronic obstructive pulmonary disease presented to clinic for a follow-up appointment after a recent HF hospitalization. He had experienced 3 HF hospitalizations in the last year. Medications at discharge included albuterol, aspirin, atorvastatin, carvedilol, furosemide, lisinopril, metformin, and tiotropium. On discharge, he was instructed to weigh himself daily, double his furosemide dose if he gained 2 to 3 pounds (to convert to kg, multiply by 0.45) in 1 day or more than 5 pounds per week, and maintain a diet low in salt (<2000 mg of sodium/d). Notably, his understanding of these instructions was not assessed by the medical team prior to this discharge or others. Medical record review indicated that HF exacerbations were due to medication noncompliance and were treated with intravenous diuresis and resumption of his home medications. Social work notes revealed that he lived alone and was able to care for himself but struggled with HF self-care.
Identify all potential conflicts of interest that might be relevant to your comment.
Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
Err on the side of full disclosure.
If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.
Not all submitted comments are published. Please see our commenting policy for details.
Sterling MR, Silva AF, Charlson ME. Sensory Impairments in Heart Failure—Are We Missing the Basics? A Teachable Moment. JAMA Intern Med. 2018;178(6):843–844. doi:10.1001/jamainternmed.2018.1317
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: