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A 68-year-old man with ischaemic cardiomyopathy presents with acute on chronic systolic heart failure with severe mitral regurgitation. He has a history of coronary artery disease status post-coronary artery bypass surgery, stage 3 chronic kidney disease and diabetes. He is deemed high risk for surgical valve replacement and is being evaluated for transcatheter mitral valve intervention. In a goals-of-care discussion, he expresses that it is important to him to be functional and independent in his daily activities, and he wishes never to be placed on dialysis. His independence is more important to him than longevity at all costs. He is unsure how he feels about mitral valve intervention. His son, who is his healthcare power of attorney, is in favour of the intervention because he wants his father to live as long as possible, even if he is not as independent as he would like to be. They ask you how they should proceed.
Cardiovascular disease is a chronic illness with periods of acute exacerbation and intense decision-making. Our therapies are not curative, and they carry the potential to be burdensome to the patient if used unwisely. Palliative care (PC) is an approach to medical care that focuses on managing symptoms, providing emotional and spiritual support, promoting communication …
Contributors Both authors contributed to the writing and revision of this work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.
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