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.

We used Explorys,² a large clinical registry of US patients seen in inpatient and outpatient settings at 26 major health care institutions representing the work of 360 hospitals serving approximately 50 million individuals across all 50 states. The deidentified and standardized data are drawn from electronic medical records, including billing, procedures, laboratories, and clinical diagnoses documentation.