Only 18% of hospital documents advised ICD deactivation discussions at time of insertion, highlighting insufficient guidance for end-of-life care management.
There is a significant paucity of local health service guidance documents in Australian hospitals to support clinicians navigating ICD deactivation at the end of life.
AimMore older adults are living with an implantable cardioverter defibrillator (ICD).Deactivation rates for those approaching end-of-life are low, risking undue distress and an undignified death.This scoping review aimed to determine the availability and content of hospital guidance documents regarding ICD deactivation towards end-of-life. MethodGuidelines' databases from two Australian states (Victoria and South Australia) were systematically searched between September 2022 to February 2023, to identify all documents that specified guidance for ICD deactivation at end-of-life.Relevant documents were analysed using a pre-specified data extraction tool. ResultsFollowing screening of 59,662 documents from 94 health services providing acute, aged or palliative care, 11 were included.Most were from public (10, 91%), metropolitan (eight, 73%) health services.Guidance on timing of ICD deactivation discussions was limited; only two (18%) documents advised discussion at time of insertion, one (9%) at generator change and six (55%) during advance care planning discussions.Recommended criteria for ICD deactivation varied: people with a terminal illness (two, 18%), with an active do not resuscitate order (five, 45%), receiving end-of-life care (11, 100%), or at the person's request (seven, 64%).Nine (82%) recommended consent dialogue that deactivation does not cause/hasten death (eight, 73%) or deactivate pacing (eight, 73%), aims to promote a peaceful death (eight, 73%) and that reactivation is possible (eight, 73%). ConclusionsThere is a paucity of local health service guidance to support clinicians navigating ICD deactivation at end-of-life.
Grose et al. (2026) studied this question. Only 18% of hospital documents advised ICD deactivation discussions at time of insertion, highlighting insufficient guidance for end-of-life care management.