Patients’ perception of implantable cardioverter defibrillator deactivation at the end of life

Abstract

Patients regard the implantable cardioverter defibrillator as a complex and solely beneficial device, with little insight regarding its potential impact on a peaceful death. This review confirms the need for professionals to discuss with patients and families implantable cardioverter defibrillator functionality and deactivation at appropriate opportunities.

Palliative Care Consultation and Associated End-of-Life Care After Pacemaker or Implantable Cardioverter-Defibrillator Deactivation

“…Recent work suggests that patients themselves face uncertainty with the ethical and legal implications of CIED deactivation and ultimately feel more comfortable leaving the decision in a physician's hands, thereby stressing the importance of communication between providers and patients. 31 Although the present study is one of the first to characterize the patient-specific factors and outcomes for patients who undergo CIED deactivation with or without a PCMC, we recognize its limitations. Our results are constrained to a homogeneous population that is largely white, Christian, and from Minnesota, which limits generalizability.…”

“…2,18 Preparing for future events through use of patient education or advance directives may be helpful and should be a priority for clinicians because patients with CIEDs are often underprepared for EOL, and they face challenges with how their devices should be managed. 5,30,31 Most patients do not mention CIEDs in their advance directive documents, and communication between patients and clinicians is often lacking until the last moments of life. 5,[31][32][33] In this study, we retrospectively explored the survival and associated factors of patients who underwent CIED deactivation and who received or did not receive a concurrent PCMC.…”

“…5,30,31 Most patients do not mention CIEDs in their advance directive documents, and communication between patients and clinicians is often lacking until the last moments of life. 5,[31][32][33] In this study, we retrospectively explored the survival and associated factors of patients who underwent CIED deactivation and who received or did not receive a concurrent PCMC. Given the increasing complexity of clinical care at EOL, including uncertainty about prognosis and a desire to engage patients and surrogates in a model of shared decisions, palliative care/medicine providers have been looked to in many EOL life situations.…”

Communication about the Heart Failure Trajectory in Patients, their Families and Health Care Professionals

“…Patients have expressed that some of the information they receive from the health care professionals is not adequate. They want to be better informed about their prognosis and want to feel that the professionals listen to them (45). Honest and competent delivery of information maximizes the patients' comprehension of their prognosis (46).…”

“…It has been shown that many patients have several ICD shocks during the last days of their life, and that discussions about deactivation rarely take place (43,44). Patients might regard the ICD as a solely beneficial device, having little insight about its possible impact on a peaceful death (45).…”