Cardiac and circulatory problems: Edited by James BeattieEthical dilemmas in device treatment for advanced heart failureKirkpatrick, James Na; Fedson, Savitri Eb; Verdino, RalphcAuthor Information aDepartment of Medicine, Cardiovascular Division and Bioethics Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA bDepartment of Medicine, Division of Cardiology, Heart Failure and Transplant, University of Chicago, Chicago, Illinois, USA cDepartment of Medicine, Cardiovascular Division, Electrophysiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA Correspondence to James N. Kirkpatrick, MD, Department of Medicine, Cardiovascular Division and Bioethics Center, University of Pennsylvania, 3400 Spruce St. HUP 9021 Gates Pavilion, Philadelphia, PA 19104, USA Tel: +1 215 662 7726; fax: +1 215 615 3652 Current Opinion in Supportive and Palliative Care: December 2007 - Volume 1 - Issue 4 - p 267-273 doi: 10.1097/SPC.0b013e3282f317a1 Buy Metrics Abstract Purpose of the review This review discusses the ethical issues raised by the increased use of devices to treat heart failure. Recent findings Recent guidelines and clinical trials describe the benefits of device therapy in advanced heart failure. Other studies and commentaries illustrate the potential for harm, both to the individual patient in the form of reduced quality of life and to society in the form of unbearable costs. Recent reports discuss the specific issues involved with deactivating different devices and document low rates of advanced care planning in relation to device management at the end of life. Summary More research, increased end-of-life education, renewed emphasis on advance directives, and a true multidisciplinary approach are needed to provide optimal care for heart failure patients in relation to device therapy. © 2007 Lippincott Williams & Wilkins, Inc.