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Letters

Let’s talk chronic heart failure

Michael Slawnych, Nakul Sharma, Debra Isaac and Jessica Simon
CMAJ August 11, 2015 187 (11) 828; DOI: https://doi.org/10.1503/cmaj.1150052
Michael Slawnych
Division of Cardiology, Libin Cardiovascular Institute (Slawnych, Sharma, Isaac); Division of Palliative Medicine (Simon), Department of Oncology, University of Calgary, Calgary, Alta.
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Nakul Sharma
Division of Cardiology, Libin Cardiovascular Institute (Slawnych, Sharma, Isaac); Division of Palliative Medicine (Simon), Department of Oncology, University of Calgary, Calgary, Alta.
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Debra Isaac
Division of Cardiology, Libin Cardiovascular Institute (Slawnych, Sharma, Isaac); Division of Palliative Medicine (Simon), Department of Oncology, University of Calgary, Calgary, Alta.
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Jessica Simon
Division of Cardiology, Libin Cardiovascular Institute (Slawnych, Sharma, Isaac); Division of Palliative Medicine (Simon), Department of Oncology, University of Calgary, Calgary, Alta.
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We applaud CMAJ’s efforts at medical education via their “Five things to know about …” series. However, we believe that a recent paper by Moayedi and Kobulnik1 falls somewhat short.

Specifically, heart failure is predominantly a disease of the elderly.2 Elderly patients are often not candidates for mechanical circulatory support or cardiac transplantation. Although there are options such as cardiac resynchronization devices and implantable cardioverter defibrillators, the benefits of these therapies may be attenuated in the elderly.3 Therefore, we are generally left with medical management options for this patient population.

Although the authors point out that there are some promising new medications on the horizon, at present, patients with heart-failure face five-year mortality rates of about 50%.2 This prognosis is worse than that of many patients with cancer.4 Despite this, physicians rarely encourage advance-care planning or discuss goals of care with their patients with heart failure.5 The Choosing Wisely Canada initiative recommends not delaying these conversations.6 We need to start having these discussions with our patients with heart failure. What better way to do this than to include it in your “five-things-to-know-about-heart-failure” list?

References

  1. ↵
    1. Moayedi Y,
    2. Kobulnik J
    . Chronic heart failure with reduced ejection fraction. CMAJ 2015;187:518.
    OpenUrlFREE Full Text
  2. ↵
    1. Go AS,
    2. Mozaffarian D,
    3. Roger VL,
    4. et al
    . Heart disease and stroke statistics — 2013 update: a report from the American Heart Association. Circulation 2013;127:e6–e245.
    OpenUrlFREE Full Text
  3. ↵
    1. Hess PL,
    2. Al-Khatib SM,
    3. Han JY,
    4. et al
    . Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients. Does age matter? An analysis of pooled data from 5 clinical trials. Circ Cardiovasc Qual Outcomes. 2015;8:179–86.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Adler ED,
    2. Goldfinger JZ,
    3. Kalman J,
    4. et al
    . Palliative care in the treatment of advanced hart failure. Circulation 2009;120:2597–606.
    OpenUrlFREE Full Text
  5. ↵
    Doctors reluctant to discuss end-of-life care with heart failure patients. American Heart Association meeting report, abstract 352. Dallas: American Heart Association; 2014. Available: http://newsroom.heart.org/news/doctors-reluctant-to-discuss-end-of-life-care-with-heart-failure-patients?preview=5988.
  6. ↵
    Palliative care: five things physicians and patients should question. Toronto: Choosing Wisely Canada; 2015. Available: www.choosingwiselycanada.org/recommendations/palliative-care/.
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Canadian Medical Association Journal: 187 (11)
CMAJ
Vol. 187, Issue 11
11 Aug 2015
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Let’s talk chronic heart failure
Michael Slawnych, Nakul Sharma, Debra Isaac, Jessica Simon
CMAJ Aug 2015, 187 (11) 828; DOI: 10.1503/cmaj.1150052

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Let’s talk chronic heart failure
Michael Slawnych, Nakul Sharma, Debra Isaac, Jessica Simon
CMAJ Aug 2015, 187 (11) 828; DOI: 10.1503/cmaj.1150052
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