Clinicians discussed deactivating the ICD in only 27% of cases, with most discussions occurring in the last few days of life, and 8% of patients receiving a shock in the minutes before death.
Cohort (n=100)
Discussions about deactivating ICDs at the end of life are infrequent and often occur very late, highlighting a need for earlier proactive communication to prevent distressing shocks near death.
BACKGROUND: Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing. OBJECTIVE: To describe the frequency, timing, and correlates of discussions about deactivating ICDs. DESIGN: Retrospective cohort study. SETTING: Telephone survey. PARTICIPANTS: Next of kin of patients with ICDs who died of any cause. Of 136 next of kin contacted, 100 (74%) participated. MEASUREMENTS: Incidence of discussions about deactivating ICDs and timing of last shock from ICD. RESULTS: Next of kin reported that clinicians discussed deactivating the ICD in only 27 of the 100 cases. Most discussions occurred in the last few days of life. Family members reported that 8 patients received a shock from their ICD in the minutes before death. LIMITATIONS: This retrospective survey relied on the reports of next of kin. CONCLUSIONS: Next of kin reported that clinicians discussed deactivating ICDs with few patients. Individuals who choose to receive this device should have the opportunity to choose to discontinue it as death approaches.
Goldstein et al. (Tue,) conducted a cohort in End-of-life care in patients with implantable cardioverter defibrillators (n=100). Discussions about deactivating ICDs was evaluated on Incidence of discussions about deactivating ICDs and timing of last shock from ICD. Clinicians discussed deactivating the ICD in only 27% of cases, with most discussions occurring in the last few days of life, and 8% of patients receiving a shock in the minutes before death.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: