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Implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients with chronic heart failure but prognostic benefit is likely to attenuate with ogression 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. [ABSTRACT FROM AUTHOR]

The author reflects on the prognostication of palliative treatment for advanced heart failure (HF). He tells that the HF is responsible for morbidity and mortality despite the presence of persistent advances related to the therapeutic strategies which are applicable for the HF. The author further tells that mortality identification in advanced HF reflects towards the obstacle inhibiting discussion concerning the death and appropriate initiation of palliative treatment.