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Adult nursing
Over-confidence in cardiac devices can create a barrier in engaging patients in advance care planning and discussions around device deactivation
  1. K Elliott
  1. Department of Cardiology, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
  1. Correspondence to Ms K Elliott, Dorset Cardiac Centre, Dorset County Hospital NHS Foundation Trust, Dorchester DT1 2JY, UK; kay.elliott{at}

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Commentary on: Hadler RA, Goldstein NE, Bekelman DB, et al. “Why Would I Choose Death?”: A Qualitative Study of Patient Understanding of the Role and Limitations of Cardiac Devices. J Cardiovasc Nurs 2019;34:275–82. doi: 10.1097/JCN.0000000000000565.

Implications for practice and research

  • Stage II-IV heart failure patients with cardiac devices may overestimate their device’s ability to prevent further deterioration and death. This may become a barrier to engaging in advance care planning.

  • Further research is required to evaluate best methods of engaging these patients in discussions around advance care planning and device deactivation.


Guidelines for managing patients with heart failure indicate that discussions about the condition, treatment options and advance care planning should be discussed at an early stage of the disease.1 Prior to implanting a cardiac device, clinicians should be discussing when device deactivation might become appropriate.2–4 This study …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.