Literature Review

Deactivation of cardiac devices at the end of life: clinical and ethical challenges Current Heart Failure Reports; by Marie-Gabrielle Courtès, Fiona Ecarnot, Mathilde Giffard; 8/13/26 Device deactivation in patients with heart failure is an increasingly relevant clinical and ethical challenge as the use of cardiovascular implantable electronic devices expands. ... Deactivating implantable cardioverter defibrillators can prevent painful and unnecessary shocks at the end of life, which may otherwise prolong dying without improving quality of life. Multidisciplinary involvement, including palliative care consultation, is essential to support patient-centered decision-making and symptom management. This review synthesizes the latest evidence and consensus on device deactivation in heart failure, emphasizing the need for communication, initiated early in the disease course, as well as individualized care, and integration of patient preferences throughout the disease trajectory.Editor's Note: What Policies and Procedures does your organization have in place? What interdisciplinary education do you ensure for all IDG members regarding this challenge for patients, families, and legal representatives? This clinical and ethical challenges presents potentially horrific trauma for the patient and those present when the person is actively dying and dies. Clincial and legal knowledge, preparations, and communications, and documentation are crucial.

"It felt like throwing in the towel": Family caregiver perspectives on end-of-life decision making in chronic obstructive pulmonary diseaseJournal of Palliative Medicine; by Natalia Smirnova, Tivona Batieste, Sarah H Cross, Samir Jamdar, Catherine S Peterson, Camille P Vaughan, Dio Kavalieratos; 7/26Chronic obstructive pulmonary disease (COPD) has an unpredictable trajectory and high symptom burden, complicating end-of-life (EOL) decisions around place of death and hospice use. We conducted semi-structured interviews with bereaved caregivers of people with COPD who received pulmonary care at a U.S. academic center and died within 12 months. Fifty-six percent of decedents received hospice; 33% died at home. Caregivers described five themes: missed prognostic cues and poor communication; hospice as both loss and relief; home as ideal but hospital as default; financial influences on decisions; and mismatch between hospice and COPD needs. Caregivers identified a readiness gap driven by prognostic uncertainty, communication challenges, and financial constraints.

[Italy] Fever in a palliative care setting: Clinical insights and implications from a prospective observational cohort studyPalliative Medicine; by Stefania Cheli, Elena Angeli, Oscar Corli, Sofia Dinegro, Agostino Zambelli, Tania Carta, Romina Shazivari, Michaela Smolikova, Paolo Franceschi, Francesco Molà, Yara Silva Cruzeiro, Emilio Clementi, Andrea Gori; 5/26Fever is a frequent but complex symptom in adults with a limited prognosis, arising from multifactorial causes beyond infection. The study was conducted in an inpatient hospice palliative care unit within the Luigi Sacco Hospital in Milan, Italy (January and December 2024). Fever occurred in 40% of patients, with a median onset of 5.5 days after admission. In 39.7% of cases, fever was attributed to infections, mainly catheter-associated urinary tract infection. Its strong association with medical devices highlights the need for proportional, personalised interventions that primarily consider prognosis, symptom relief, and quality of life.

Emotional and ethical impacts on healthcare professionals performing cardiopulmonary resuscitationAmerican Journal of Hospice & Palliative Medicine; by Patrick J. Macmillan, Susan Hughes, Dumindra Gurusinghe, Allison Go, Chase Lancaster, Iris Price; 6/26Many studies exist outlining poor outcomes related to cardiopulmonary resuscitation (CPR) administered to patients who are elderly and/or have comorbid medical conditions with sudden cardiac arrest. Studies show only 10% of patients with out-of-hospital cardiac arrest and initial asystole survive until they reach the hospital. Less than 5% survive until hospital discharge with good neurologic function. This study presents data that suggests that there is an association between moral distress and performing CPR on individuals who are elderly with multiple comorbid medical conditions. More than sixty percent of our respondents were challenged emotionally during these types of code situations, and a similar number of healthcare workers felt the code could be considered unethical.

Cardiologists treating increasingly complex patients as America ages Medscape; by Sarah Amandolare; 7/14/26 ... Heart failure (HF) affects 15%-20% of adults over 80, according to the American Heart Association/American College of Cardiology/Heart Failure Society of America Guideline for the Management of Heart Failure. HF with preserved ejection fraction (HFpEF), which becomes more likely after age 80, is related to other common conditions of aging, including hypertension, chronic kidney disease, diabetes, and obesity. “Almost by definition, most people that have HFpEF have multiple comorbidities,” Hummel said. “You have to account for a lot of them when you’re thinking about how to help the patient best.” This population also has higher chances of developing dementia and frailty, which affect 35% of adults age 90 and older and 31% of octogenarians, respectively. Older adults hospitalized for HF also have a high likelihood of polypharmacy; 68% take 10 or more medicines.

Palliative care for older adults with hip fracture: An explanatory sequential mixed-methods studyJournal of Pain & Symptom Management; by Daniel I Hoffman, Sydney Moore, Amanda J Reich, Christina Sheu, Mengyuan Ruan, Masami Tabata-Kelly, Kate Sciacca, Tamryn F Gray, Daniel Dohan, Charlotta Lindvall, Zara Cooper; 6/26After hip fracture, older adults experience burdensome treatments and high mortality; they may therefore benefit from palliative care (PC). Among 1,433 hip fracture admissions, GOCC [goals of care conversations], hospice discussions, and specialty PC were documented in view on their role in GOCC. Conclusion: Limited standardization, role uncertainty, and cultural factors limited PC documentation and delivery, highlighting opportunities to strengthen PC integration in surgical care.

The hidden cost of cancer's end: how financial strain shapes final months of care Fred Hutch Cancer Center, University of Washingon, Seattle, WA; by D. Moosavi; 6/25/26 ... Previous Fred Hutch research has shown that people with cancer are more than twice as likely to file for bankruptcy, and nearly twice as likely to experience what researchers call an “adverse financial event,” compared with people who don’t have cancer. But most of that earlier work focused on financial hardship as an outcome caused by cancer. This study flips the question: once someone is already dealing with financial strain, what happens to the care they receive as their illness progresses? 

7 ways palliative care can help people with ATTR-CMEveryday Health; by Abby McCoy, RN; 7/3/26 Transthyretin cardiac amyloidosis (ATTR-CM), a rare type of heart failure, can cause symptoms that affect more than just your heart, and many of them can lower your quality of life. But palliative care, or care meant to provide symptom relief, comfort, and support, can help you live better with this condition. ... Here’s how your palliative care team can help you manage life with ATTR-CM and feel your best.