title: ICDs in end-stage heart failure.
abstract: Implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients with chronic heart failure but prognostic benefit is likely to attenuate with progression to end-stage heart failure. The incidence of multiple futile ICD shocks before death is uncertain. Only individual patients, supported by their healthcare professionals, can decide when ICD therapy becomes futile in end-stage heart failure. Despite consensus that ICD deactivation should be routinely discussed, this rarely occurs in clinical practice for many reasons including uncertainty about when to initiate these discussions and reluctance to confront death and dying. Patient and carer opinions about end-stage heart failure and ICD deactivation may not meet professional expectations. Future research should focus on these opinions and examine interventions that bridge the gap between best practice and the reality of current clinical practice.
authors.affiliation: Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Pettit
authors.forename: Susan
authors.initials: S
authors.lastname: Browne
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Hogg
authors.forename: Derek T
authors.initials: DT
authors.lastname: Connelly
authors.forename: Roy S
authors.initials: RS
authors.lastname: Gardner
authors.forename: Carl R
authors.initials: CR
authors.lastname: May
authors.forename: Una
authors.initials: U
authors.lastname: Macleod
authors.forename: Frances S
authors.initials: FS
authors.lastname: Mair
mesh_terms: D017147:Defibrillators, Implantable / Q000941:ethics; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D010166:Palliative Care; D010361:Patients; D013727:Terminal Care; D028761:Withholding Treatment / Q000941:ethics