The complexities of caring for a patient with an ICD in end-stage heart failure

Despite comprehensive guidelines relating to the issue of implantable cardioverter defibrillator (ICD) deactivation in end-stage heart failure, complexities with implementation of the guidance continue to be raised in clinical practice. It is widely recognized that patients should be given the opportunity to discuss the issues surrounding deactivation of the ICD at the earliest opportunity. In practice, the process of facilitating these discussions can be challenging. This article explores relevant literature to illustrate complexities in ICD deactivation. A case study is presented to describe how a community heart failure specialist nurse succeeded in negotiating these challenges to support the timely deactivation of an ICD in a patient with end-stage heart failure.