Highlights the lack of clear criteria for ICD deactivation near the end of life and calls for more focused research on patient-centered outcomes and quality of life.
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Absence of deactivation criteria leaves end-of-life ICD decisions unguided; leaves open research on patient-centered outcomes and quality of life.
The number of annual implantable cardioverter defibrillator (ICD) implants has substantially increased over the last 5 years and is expected to grow rapidly. Implantable cardioverter defibrillators have a proven mortality benefit by terminating the life-threatening arrhythmias, even near end of life. In patients with moderate/severe symptomatic heart failure, enough clinical literature representing mortality benefits has been published, but limited numbers of studies have reviewed the dwindling risk-benefit profile near end of life, studying quality of life (QoL)/psychosocial impact. Criteria outlining either continued use or deactivation policy/procedures near end of life have not been clearly defined and/or largely implemented, which in turn requires more focused research using multifactorial approach to determine improved patient-centered outcomes.
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Singh et al. (2012) studied this question.
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