The potential impact of advance directives on decisions involving cardiopulmonary resuscitation

As the population ages and medical technology continues to improve, physicians, patients, and families are increasingly faced with difficult end- of-life decisions. In this issue, Drs. Palmeri and Schlag review a series of recent articles focusing on the decision-making process with regard to cardiopulmonary resuscitation and do-not-resuscitate orders. The authors then discuss the role of advance directives in helping to clarify these complex issues. This article is followed by a discussion of a recent report from the Cardiac Arrhythmia Suppression Trial (CAST), in which it is suggested that older patients are subject to a higher risk of adverse events when treated with encainide, flecainide, or moricizine for ventricular arrhythmias following myocardial infarction. Three studies dealing with the pathogenesis of arterial embolism in the elderly are then reviewed, and this is followed by an annotated review of the recent geriatric cardiovascular literature. The section concludes with a report from the Council on Geriatric Cardiology and a calendar of upcoming meetings and events.