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Perspectives on Care at the Close of Life: CODA |

Palliative Care for Patients With Heart Failure

Amy J. Markowitz, JD; Michael W. Rabow, MD
JAMA. 2004;292(14):1744. doi:10.1001/jama.292.14.1744.
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In May 2004, Drs Pantilat and Steimle1 introduced Mr R, a 74-year-old man with more than a decade’s history of idiopathic heart failure with New York Heart Association classification of II to III and type 2 diabetes mellitus. Through interviews of Mr R, his wife, and his cardiologist, Dr J, the authors explored the variety of medications and interventions that were brought to bear to control Mr R’s distressing symptoms. This included attending a shared medial appointment with other heart failure patients and a referral to hospice, from which Mr R ultimately “graduated,” after his medication adherence and self-monitoring regimens improved dramatically, greatly enhancing his quality of life. Two years after the initial interviews, Mr R is enjoying a quiet life. He continues to take his medicines, has not reenrolled in hospice, has kept to his do not attempt resuscitation order, and follows up regularly with Dr J. Dr J was reinterviewed by a Perspectives editor on July 1, 2004, shortly after a regularly scheduled visit with Mr R.

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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.
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For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
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