To the Editor We read with great interest the article by Mandawat et al1 published in JAMA Cardiology. In their analysis of the Veteran Affairs External Peer Review Program, they report that only 7.6% of patients with severe heart failure were seen by palliative care within 1 year of hospitalization, with an increasing trend between 2007 and 2013. However, their results may not be generalizable because of the male predominance among veterans. Therefore, we sought to validate their results in a larger, nonveteran cohort that included both sexes.