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Published on: February 13, 2021

Ethical dilemmas in device treatment for advanced heart failure

James N Kirkpatrick1, Savitri E Fedson, Ralph Verdino

  • 1Department of Medicine, Cardiovascular Division and Bioethics Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.

Current Opinion in Supportive and Palliative Care
|August 8, 2008
PubMed

Insights

Device therapy for heart failure offers benefits but raises ethical concerns regarding patient quality of life and societal costs. Improved end-of-life care planning and multidisciplinary approaches are crucial for optimal patient management.

Area of Science:

  • Cardiology
  • Medical Ethics
  • Health Economics

Background:

  • Device therapy is increasingly used for advanced heart failure.
  • Ethical considerations surrounding device implantation and management are paramount.

Purpose of the Study:

  • To review the ethical issues associated with the growing use of device therapy for heart failure.
  • To examine the balance between benefits, harms, and costs of cardiac device interventions.

Main Methods:

  • Literature review of recent guidelines, clinical trials, and commentaries.
  • Analysis of studies addressing device deactivation and end-of-life care planning.

Main Results:

  • Device therapy demonstrates benefits in advanced heart failure but carries risks of reduced quality of life and high societal costs.
  • Low rates of advance care planning are reported for device management at the end of life.
  • Specific ethical challenges arise concerning device deactivation.

Conclusions:

  • Further research is essential to address the ethical complexities of cardiac device therapy.
  • Enhanced end-of-life education and a stronger emphasis on advance directives are needed.
  • A multidisciplinary approach is critical for optimizing care for heart failure patients undergoing device therapy.
Abstract

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