Heartbeat: When should patients consider implantable cardiac defibrillator deactivation?

The use of implantable cardiac defibrillators (ICDs) has dramatically improved outcomes for patients with many types of heart disease. Yet, the patient with an ICD faces a difficult decision near the end of life—should the ICD be deactivated and, if so, when? Evidence to support a specific approach to this clinical dilemma is not amenable to standard research approaches because the outcomes are qualitative, not quantitative. Thus, carefully designed and implemented qualitative research studies are needed to inform clinical practice. In this issue of Heart , Stoevelaar and colleagues1 performed a focus group study using a constant comparative method for analysis of transcriptions from group sessions with 41 participants. Patients reported that few physicians discussed deactivation of ICDs. Patients also expressed a desire for more information about deactivation and advance care planning, depending on disease stage and patient preferences. The online version of this article also features a helpful video abstract. In the accompanying editorial, Steiner2, Bernacki and Kirkpatrick suggest a tiered approach to discussing the patient’s experience with their ICD, their understanding of the options for advance care planning and the possibility of ICD deactivation (figure 1). They conclude: ‘The heterogeneity of patients’ views on ICD therapy at the end of life presented in this manuscript supports the need for more open communication and ongoing education on this topic for both patients and providers. Patients look to their clinicians for guidance with end-of-life decision-making, and it is the …