Clinical Crossroads Update |

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

Tom Delbanco, MD; Erin E. Hartman, MS
JAMA. 2000;283(8):1054. doi:10.1001/jama.283.8.1054.
Text Size: A A A
Published online


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.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles