Conclusion
Patients with CHF are willing to address their end-of-life preferences, often value longevity even at older age, but individual preferences are impossible to predict and may change over time, reinforcing the value of listening to patients to provide relevant insight and individualize care. Openness and communication about prognosis, trajectories, and realistic treatment possibilities engender hope and allow patients to plan for their future. This applies to various decisions that confront CHF patients, but may be particularly important with respect to ICD implantation, turning off the device, and treatment with purely symptomatic medical therapy that may even reduce survival.