{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T13:23:52Z","timestamp":1788441832457,"version":"build-2803163510"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"31","license":[{"start":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T00:00:00Z","timestamp":1753315200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fonds de recherche du Qu\u00e9bec en sant\u00e9"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Medical futility in the cardiovascular care of older adults presents unique challenges that necessitate a nuanced understanding of both clinical and ethical dimensions. This state-of-the-art review explores the evolving concept of futility in the context of an ageing patient population and expanding armamentarium purported to treat even the most dire of cardiovascular diseases. The first objective is to delineate a framework for clinicians to elicit the different dimensions of futility, their relative importance to the patient, and their potential for improvement with the intervention being considered. Definitions are elaborated for quantitative futility\u2014interventions with statistically negligible benefits\u2014and qualitative futility\u2014interventions misaligned with patient-specific goals and values. The second objective is to highlight the determinants of prohibitive risk, from the cardiovascular disease and procedural morbidity, to competing non-cardiovascular risks and frailty. A distinction is made between frailty and futility, and manifestations of severe frailty are reviewed based on the A-B-C-D-E mnemonic. The third and final objective is to discuss strategies and actionable approaches to care for patients once futility has been invoked. In addition to ongoing compassionate dialogue with the patient and family members, early initiation and aggressive pursuit of palliative care measures is beneficial for symptom control and quality of life. Ultimately, informed shared decision-making with a patient-centered philosophy is essential to uphold dignity and enhance the quality of life for older adults facing complex cardiovascular conditions.<\/jats:p>","DOI":"10.1093\/eurheartj\/ehaf351","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T07:44:23Z","timestamp":1746690263000},"page":"4242-4250","source":"Crossref","is-referenced-by-count":3,"title":["Decision-making for older adults with advanced heart disease: a framework for balancing benefit versus futility"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5066-2182","authenticated-orcid":false,"given":"Marc","family":"Arcens","sequence":"first","affiliation":[{"name":"Division of Cardiology, Azrieli Heart Center, Jewish General Hospital, McGill University , 3755 Cote Ste Catherine, E-222, Montreal, Quebec , , H3T 1E2","place":["Canada"]},{"name":"Division of Cardiology & Division of Geriatrics, Geneva University Hospital, Geneva ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0877-7618","authenticated-orcid":false,"given":"James N","family":"Kirkpatrick","sequence":"additional","affiliation":[{"name":"Division of Cardiology & Department of Bioethics and Humanities, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-4937","authenticated-orcid":false,"given":"Jonathan","family":"Afilalo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Azrieli Heart Center, Jewish General Hospital, McGill University , 3755 Cote Ste Catherine, E-222, Montreal, Quebec , , H3T 1E2","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,24]]},"reference":[{"key":"2026081319571110600_ehaf351-B1","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1097\/ACO.0b013e328343c5af","article-title":"Knowing when to stop: futility in the ICU","volume":"24","author":"Wilkinson","year":"2011","journal-title":"Curr Opin Anaesthesiol"},{"key":"2026081319571110600_ehaf351-B2","doi-asserted-by":"publisher","first-page":"949","DOI":"10.7326\/0003-4819-112-12-949","article-title":"Medical futility: its meaning and ethical implications","volume":"112","author":"Schneiderman","year":"1990","journal-title":"Ann Intern Med"},{"key":"2026081319571110600_ehaf351-B3","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1056\/NEJM199206043262310","article-title":"The problem with futility","volume":"326","author":"Truog","year":"1992","journal-title":"N Engl J Med"},{"key":"2026081319571110600_ehaf351-B4","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1093\/jmp\/20.2.123","article-title":"Is futility a futile concept?","volume":"20","author":"Brody","year":"1995","journal-title":"J Med Philos"},{"key":"2026081319571110600_ehaf351-B5","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1080\/20009666.2021.1877396","article-title":"How long should we run the code? 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