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To the Editor: In their Scientific Review article about treatment of advanced heart failure, Dr Nohria and colleagues¹ do not discuss relief of dyspnea by administration of low-dose narcotics.²

The literature in hospice and palliative care has numerous citations about the usefulness of narcotics for palliation of symptoms.^2-4 I have found that some patients have dramatic relief of their symptoms and commonly ask why previous physicians did not offer this simple treatment with its dramatic results. Patient and family education about disease management along with successful advance planning allows patients with advanced heart failure to be treated effectively at home.

As a final note, since advanced heart disease is a fatal illness, I also encourage physicians to initiate discussions about advance care planning to ensure that patients receive care that is consistent with their wishes.

Richard D. Brumley, MD
Southern California Permanente Medical Group
Downey

1. Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA. 2002;287:628-640. FREE FULL TEXT 2. Weissman D. Dyspnea at End-of-Life. Milwaukee: End-of-Life Physician Education Resource Center, Medical College of Wisconsin; November 2000. 3. Galanos A. Long-term care in geriatrics. Clin Fam Pract. 2001;3:683-694. 4. Friesinger G, Butler J. Heart failure in the elderly, clinics in geriatric medicine. 2000;16:663-675.

To the Editor: In their . . . [Full Text of this Article]

RELATED ARTICLE

Medical Management of Advanced Heart Failure
Anju Nohria, Eldrin Lewis, and Lynne Warner Stevenson
JAMA. 2002;287(5):628-640.
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