Your very real world story (especially for a 72 year old guy like me) is greatly appreciated and a wake-up call. Even as "specialists", we can get lulled into the "same ol', same ol' " rut. Like the saying goes..."you see what you know" and in this case the attending cardiologist just saw another old man with chronic CHF!! CHF specialists can be hard to come by wherever you are, so I don't fault the attending cardiologist who may be overrun with the usual "vascular problems" and failing protoplasm associated with advanced age. As suggested, prolonging a poor quality of life for another 6 months while putting a patient through a "living autopsy" in a futile effort to prolong life, is undesirable. Nevertheless, thinking "outside the box" using critical thinking and intellectual honesty is our main defense against "same ol', same ol' thinking be it for CHF or vasculitis. To quote Jonathan Swift-"Vision is the ability to see what others do not."