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Rebuttal From Dr RichRebuttal

Jonathan D. Rich, MD
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From the Department of Medicine, Section of Cardiology, the University of Chicago Pritzker School of Medicine.

Correspondence to: Jonathan D. Rich, MD, Department of Medicine, Section on Cardiology, the University of Chicago Pritzker School of Medicine, 5841 S Maryland Ave, MC 6080, Chicago, IL 60637; e-mail: jrich@nmff.org


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1540-1541. doi:10.1378/chest.13-0298
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While some may accept that “perfect is the enemy of good,”1 when it comes to the care of patients with potentially fatal diseases such as pulmonary arterial hypertension (PAH), to strive for anything less than perfect, or to “strive for good enough,”1 is a prescription for failure. First, let us begin with the emotional side of a PAH diagnosis. With a mortality rate comparable to that of many advanced malignancies, the anguish and mental strife associated with being falsely diagnosed with PAH is gut wrenching for both the patient and the family and is occurring at an alarming rate. Consider the published hospital discharge data from the Centers for Medicare & Medicaid Services, which placed the number of hospitalized patients with pulmonary hypertension (PH) from all causes at 240,000 in 2002; this figure rose dramatically to 560,000 in 2005 largely because of the ease and availability of Doppler echocardiography (DE).2

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