We agree with Dr Workman that end-of-life care is an integral management issue in many patients with end-stage heart failure and other terminal illness. As suggested by Dr Workman and Dr Rozzini et al, the goal of care in these patients may not be improvement in survival but enhancement in quality of life. However, for most community-dwelling heart failure patients who are not terminally ill, we assert that much more remains to be done (and can be done) to improve their care and outcomes. Our data showed that the mortality rates among patients 75 years or older were high, regardless of the number of concurrent comorbid conditions. While we did not focus in our study on strategies that could improve the prognosis of this sick population, other authors1 have documented that undertreatment of elderly patients with heart failure might be partly responsible for the elevated mortality rates in this subgroup. We believe that increasing practice of evidence-based heart failure care, including the appropriate use of angiotensin-converting enzyme inhibitors and β-blockers, could prolong life by preventing premature deaths in many patients with heart failure in the community today.
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