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Discussant Gordon Guyatt, MD

JAMA. 1999;281:2321-2328.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

DR DELBANCO: Mr C is a 75-year-old retired fisherman who came to the United States from the West Indies more than 10 years ago. He and his wife live in Boston, Mass, with their daughter, who has been an important source of support for him. He has Medicare and supplemental commercial insurance.

In 1988, Mr C developed exertional dyspnea and was diagnosed as having congestive heart failure and chronic obstructive pulmonary disease (COPD), with a forced expiratory volume in 1 second of less than 0.5 L. Chest radiographs showed a large cardiac silhouette, with hyperlucent lung fields and flat diaphragms. Electrocardiogram results showed poor R-wave progression and were consistent with left ventricular hypertrophy and left atrial enlargement. Echocardiogram results showed severe left ventricular dilatation, diffuse hypokinesis, ejection fraction of less than 0.20, and mild right heart dilatation, with 3+ mitral regurgitation and 2+ tricuspid regurgitation. He . . . [Full Text of this Article]

MS C, THE PATIENT'S DAUGHTER: HER UNDERSTANDING AND PERCEPTIONS

DR M, THE PRIMARY PHYSICIAN: HER UNDERSTANDING AND PERCEPTIONS

AT THE CROSSROADS: QUESTIONS TO DR GUYATT

Epidemiology, Diagnosis, and Prognosis

Management: Where to Look for the Best Evidence

Judging the Magnitude of Treatment Effects

Vasodilators

Diuretics

Digoxin

-Blockers

Antiarrhythmic Agents

Anticoagulation

Nonpharmacological Therapy

Individualizing the Care of the Heart Failure Patient

Conclusion

QUESTIONS AND DISCUSSION

Author Affiliation: Dr Guyatt is Professor, Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario.

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