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Editorials

Does It Matter Why and How Patients With Heart Failure Die?

A Debate That Lives On

Paul J. Hauptman, MD

From the Division of Cardiology, Saint Louis University School of Medicine, St Louis, Mo.

Correspondence to Paul J. Hauptman, MD, Saint Louis University Hospital, 3635 Vista Ave, St Louis, MO 63110. E-mail hauptmpj@slu.edu

Key Words: Editorials • heart failure • death

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Our interest in death and illness is nothing but a way of expressing an interest in life" —Thomas Mann, The Magic Mountain.¹

Is the retort to the declarative statement that "dead is dead"² now dead? Simply answered, not at all. In the heart failure discipline, whether data are derived from clinical trials, registries, or epidemiological studies, delineating "why" and "how" patients die remains a keen interest for investigators. Cross-reference "cause of death" with "heart failure" in an online publication database, and you will find almost 60 papers in the 10 years since the "dead is dead" issue was raised. Why are we so engaged in this task? Perhaps it is because the underlying goals are sound: to understand the impact of interventions according to treatment assignment and to better understand the pathophysiology and natural history of heart failure.

Article see p 91

We have in fact learned a great deal from a long list of studies: For example, patients with nonischemic cardiomyopathy can die of ischemic complications,³ implantable defibrillators may shift death from a sudden arrhythmic cause to progressive heart failure,⁴ and sudden death is clustered in the early period after myocardial infarction.⁵ Such analyses can also raise interesting hypotheses or help to demonstrate the robustness of a treatment effect, as, for example, when an intervention reduces both sudden and nonsudden causes of cardiovascular death.⁶ Many of these concepts apply not only to death as an end point but to any number of other cardiovascular events, such as stroke . . . [Full Text of this Article]

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