Heart failure accounts for more hospitalizations among Medicare beneficiaries
than any other condition. Its symptoms, including shortness of breath, fatigue,
and edema, can be frightening and diminish quality of life. Although treatment
advances have allowed patients to live longer with a better quality of life,
heart failure remains a leading cause of death in the United States. Half
of heart failure patients die within 5 years of diagnosis, and for many patients,
death is sudden. Given the availability of effective treatments, the prevalence
of distressing symptoms, and a persistent high risk of death that may occur
suddenly, physicians must simultaneously treat the underlying condition while
helping patients plan for future needs and complete advance directives. Using
the case of Mr R, a 74-year-old man with heart failure, we illustrate ways
that physicians can address these issues to improve the care of patients with
heart failure, including symptom management and discussing advance directives,
prognosis, and hospice care. By combining optimal medical management with
palliative care, physicians can best care for heart failure patients and their
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