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Time to move beyond treating and curing to improving the end of life

  1. Simon Stewart (simon.stewart@unisa.edu.au), National Heart Foundation professor of cardiovascular nursing,
  2. John J V McMurray (j.mcmurray@bio.gla.ac.uk), professor of medical cardiology
  1. Division of Health Sciences, University of South Australia, Adelaide, South Australia 5000, Australia
  2. Department of Cardiology, Western Infirmary, Glasgow G11 6NT

    The epidemic of heart failure and its costs to health services continue to grow. 1 2 Despite important advances in evidence based treatments, age adjusted survival rates for chronic heart failure remain worse than for many forms of cancer. 3 4 The only cure for chronic heart failure—heart transplantation—is equivalent to providing a single lifeboat to the sinking Titanic.

    Most of the usually elderly patients with heart failure therefore have short lives remaining of extremely poor quality, punctuated by frequent admissions to hospital. 5 6 They often suffer dyspnoea, pain, confusion, anxiety, and depression during their last days of life. Most of them would prefer “comfort care” and do not wish for active resuscitation. Some would even prefer death.7 The growing clamour for a better experience …

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