Case 8-2013: A Woman with Carcinoma in Situ of the Breast.

n engl j med 368;25 nejm.org june 20, 2013 2439 and clearly stated in our article that decisions about CPR should be individualized and informed by patients’ preferences and health status. However, discussions about patient preferences for CPR and subsequent treatments require information gathered and updated at different points in care. These discussions will obviously differ among patients who have recently survived cardiac arrest2 and those who have not had a history of cardiac arrest, and both are important conversations that physicians need to have with patients. Regarding conversations with the latter group, the 1-year and 3-year overall survival rates among patients who subsequently have a cardiac arrest are approximately 13% and 10%, respectively (on the basis of 2009 rates of in-hospital survival of 22.3%1), which far exceed in-hospital survival rates (4.6%) for patients with out-of-hospital cardiac arrest3 — a population for whom great efforts for resuscitation are undertaken. Indeed, we submit that many patients who are presented with a 3-year survival rate of 10% from the time of in-hospital cardiac arrest would not find CPR to be futile, as evidenced by their choices in other conditions, such as aggressive chemotherapy for advanced cancers.4