Patient and Professional Factors That Impact the Perceived Likelihood and Confidence of Healthcare Professionals to Discuss Implantable Cardioverter Defibrillator Deactivation in Advanced Heart Failure

Abstract

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Integration of a palliative approach into heart failure care: a European Society of Cardiology Heart Failure Association position paper

“…The continued pursuit of disease‐modifying therapy should be balanced and integrated with a palliative approach 113,114 . Due to the ambiguous disease trajectory, professionals may feel justifiably uncertain about an individual's prognosis, and uncomfortable initiating difficult conversations early in the course of the disease 115–117 . However, deferment runs the risk of information exchange being ‘too little and too late’ 118 …”

“…The possible withdrawal of cardiovascular implantable electronic devices, either as standalone ICDs or those combined with cardiac resynchronization therapy (CRT‐D), should be sensitively broached within a valid informed consent process pre‐implantation, 133,134 with further and more detailed discussions at regular intervals. However, patients, family members and HCPs often avoid this uncomfortable discourse, with the discussion dependent on patient and professional factors, such as triggered by the experience of a shock 117,135 . Many reports document that ICD activity is often maintained in patients imminently dying 136 despite guidelines having been formulated to facilitate ethically appropriate ICD deactivation 137 .…”

Trends in time in the management of the implantable cardioverter defibrillator in the last phase of life: a retrospective study of medical records

“…17 Professional caregivers are often unsure about the right time to discuss deactivation, 18 sometimes feel like they do not have a sufficiently well-established relationship with the patient, 19 have too little time to accurately discuss deactivation, 18 find it difficult to predict the end of life, 20 or feel that talking about deactivation might be inappropriate, since the ICD was implanted to “safe lives.” 19 Also, a recent international survey study from the UK, conducted in 262 professionals caregivers, shows that professional caregivers who are physicians or American, and had initiated a deactivation discussion before, were more likely to discuss ICD deactivation. 21 This study also identifies that, even though only 30% of nurses were involved in ICD deactivation discussion, 81% of professional caregivers felt that nurses do have the necessary skills to start these conversations, and might therefore play a bigger role in informing patients about ICD deactivation. Further, the study identified that nurses were in favor of informing the patients about ICD deactivation before implantation, which is in line with current guidelines, which advise to discuss ICD deactivation early in the disease process, preferably before implantation, to make the patients aware of the consequences of having an active ICD at the end of life.…”

Palliative care: Essential support for patients with heart failure in the COVID-19 pandemic

“…Where relevant, and determined by patients’ preferences, it is important that professionals discuss ICD deactivation to ensure device therapy remains consistent with any change in resuscitation policy. 24 …”