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Cardiology Research and Practice
Volume 2012 (2012), Article ID 524961, 5 pages
Review Article

Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

1Division of General Internal Medicine, Department of Medicine, Section of Palliative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
2Division of Cardiovascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
3Division of Cardiovascular Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
4Palliative Medicine, Ross Heart Hospital, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA

Received 14 October 2012; Accepted 21 November 2012

Academic Editor: Hans R. Brunner

Copyright © 2012 Keith M. Swetz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.