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Supportive Care in Heart Failure$
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James Beattie and Sarah Goodlin

Print publication date: 2008

Print ISBN-13: 9780198570288

Published to Oxford Scholarship Online: November 2011

DOI: 10.1093/acprof:oso/9780198570288.001.0001

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Decision-making in Advanced Heart Failure

Decision-making in Advanced Heart Failure

(p.431) Chapter 23 Decision-making in Advanced Heart Failure
Supportive Care in Heart Failure

Clyde W. Yancy

Oxford University Press

This chapter provides a discussion on decision-making in issues surrounding advanced heart failure (HF). It concentrates on patients with American College of Cardiology/American Heart Association (ACC/AHA) Stage D HF. It introduces the natural history of advanced HF. It addresses the evidence that guides management of ACC/AHA Stage D HF. The uses of inotropes, device therapy with a defibrillator and/or cardiac resynchronization pacemaker, and left-ventricular assist device (LVAD) are presented. Next, it reports the importance of transplantation and handling difficult treatment discussions. Medicine is an art and the best practitioners are humble students of science, clinical practice, and life experiences. The real test of a physician is not how tall one stands at the time of triumph but how gracious one bows at the time of death.

Keywords:   advanced heart failure, decision-making, American College of Cardiology, American Heart Association, inotropes, device therapy, defibrillator, cardiac resynchronization pacemaker, transplantation

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