Deactivation of implantable defibrillators at end of life — Can we do better?

Westerdahl, Annika Kinch; Magnsjö, Jackline; Frykman, Viveka

doi:10.1016/j.ijcard.2019.03.005

Cited by 5 publications

(6 citation statements)

References 45 publications

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“…Subsequent reports suggested that the consensus statements may have had an insufficient effect on the frequency of device deactivation in end-of-life care. 2,9 Over half of the patients with ICDs who are nearing the end of their lives still have not been offered the choice of deactivation. In addition, because patients with ICDs are living longer, 1 many succumb to other diseases, and most patients with ICDs die on non-cardiology services.…”

Section: Consensus Statementsmentioning

confidence: 99%

“…In addition, because patients with ICDs are living longer, 1 many succumb to other diseases, and most patients with ICDs die on non-cardiology services. 2 Perhaps physicians continue to have concerns or are simply uninformed about ICD deactivation since the guidelines were published in cardiology journals.…”

Section: Consensus Statementsmentioning

confidence: 99%

“…1 For these reasons, many more patients with ICDs succumb to noncardiac diseases and are likely to be cared for by noncardiologists. 2 COVID-infected patients with ICDs have a high risk of dying and end-of-life considerations may arise quickly in such patients. Because of this, the possibility of deactivating the ICD during end-of-life care should be discussed well before the patient is dying, ideally during the months and years that they are under the care of a primary care physician.…”

Section: Introductionmentioning

confidence: 99%

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Implantable Cardiac Defibrillator Deactivation During End-of-Life Care in the COVID-19 Pandemic

Myers

Eastwood

2021

J Am Board Fam Med

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People with implantable cardiac defibrillators (ICDs) who are nearing the end of life are at risk for arrhythmias, which activate the ICD and may cause unnecessary shocks and suffering. Because ICDs have enabled more patients to live longer, they often succumb to noncardiac diseases and may be cared for by primary care physicians. Despite published recommendations 10 years ago regarding the management of ICDs during the end of life, over half of patients with ICDs who are dying still have not been offered the choice of deactivation. The Coronavirus disease 2019 (COVID-19) pandemic has complicated this issue and the need to discuss it because of practices that separate patients from loved ones and that modify the usual interactions of patients with doctors and nurses. We offer the following recommendations: (1) the management of ICDs at the end-of-life needs to be understood by all physicians who care for patients with ICDs;(2) discussions about deactivating the ICD should occur while patients have decision-making capacity and are clinically stable, beginning at the time of ICD implantation, then periodically at follow-up appointments, and certainly when a change in the patient's clinical status warrants a reconsideration of the goals of care; and (3) clinicians should compensate for the impediments to communication with patients and families associated with the COVID-19 pandemic, which includes patient isolation and restrictive visitor policies, by using devices that permit visual communication to reexamine goals of care, including defibrillator deactivation, in patients with ICDs who are expected to die.

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Section: Consensus Statementsmentioning

confidence: 99%

Section: Consensus Statementsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implantable Cardiac Defibrillator Deactivation During End-of-Life Care in the COVID-19 Pandemic

Myers

Eastwood

2021

J Am Board Fam Med

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“…16,18,21,23,28 They reported lower reprogramming prevalence (pooled proportion prevalence of 20%, 95% CI: 16%-25%) than articles evaluating the outcome after 2010 (pooled proportion prevalence of 40%, 95% CI: 32%-49%). 24,28,29 Two studies included patients treated both before and after 2010 and presented the results separately. Kinch Westerdahl et al 29 conducted a study in 2019 that included 341 patients from more than 60 hospitals in Sweden and reported the prevalence of implantable cardioverter defibrillator reprogramming at the end of life among patients who died between 2003 and 2010 (34%) and the prevalence of reprogramming among patients who died in 2014 (52%).…”

Section: Main Outcomesmentioning

confidence: 99%

“…24,28,29 Two studies included patients treated both before and after 2010 and presented the results separately. Kinch Westerdahl et al 29 conducted a study in 2019 that included 341 patients from more than 60 hospitals in Sweden and reported the prevalence of implantable cardioverter defibrillator reprogramming at the end of life among patients who died between 2003 and 2010 (34%) and the prevalence of reprogramming among patients who died in 2014 (52%). Stoevelaar et al conducted a study that included 380 deceased patients from Dutch hospitals; the prevalence of reprogramming among patients who died between 2007 and 2009 was 16% and the prevalence among those who died between 2010 and 2016 was 34%.…”

Section: Main Outcomesmentioning

confidence: 99%

Unmet device reprogramming needs at the end of life among patients with implantable cardioverter defibrillator: A systematic review and meta-analysis

et al. 2020

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Background: Use of implantable cardioverter defibrillators is increasingly common. As patients approach the end of life, it is appropriate to deactivate the shock function. Aim: To assess the prevalence of implantable cardioverter defibrillator reprogramming to deactivate the shock function at the end of life and the prevalence of advance directives among this population. Design: Following a previously established protocol available in PROSPERO, we performed a narrative synthesis of our findings and used the logit transformation method to perform our quantitative synthesis. Data sources: We searched seven bibliographic databases (Embase, Cochrane Central register of controlled Trials, Medline-Ovid, Web-of-Science, Scopus, PsychInfo, and CINAHL) and additional sources until April 2019. Results: Of the references we identified, 14 were included. We found a pooled prevalence of implantable cardioverter defibrillator reprogramming at the end of life of 28% (95% confidence interval, 22%–36%) with higher reprogramming rates after the recommendations for managing the device at the end of life were published. Among patients with advance directives, the pooled prevalence of advance directives that explicitly mentioned the device was 1% (95% confidence interval, 1%–3%). Conclusions: The prevalence of implantable cardioverter defibrillator reprogramming and advance directives that explicitly mentioned the device was very low. Study data suggested reprogramming decisions were made very late, after the patient experienced multiple shocks. Patient suffering could be ameliorated if physicians and other healthcare professionals adhere to clinical guidelines for the good management of the device at the end of life and include deactivating the shock function in the discussion that leads to the advance directive.

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The difficult discussion on the deactivation of implantable cardioverter devices at the end of life: a systematic review

Murray,

McNamara,

Chatzi

2024

ESC Heart Failure

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Implantable cardioverter defibrillators (ICDs) reliably prevent death due to life‐threatening arrhythmias; this may become less relevant in people with more severe heart failure who are reaching the end of life (EOL). This review aimed to explore the ICD deactivation process and identify ethical issues, especially around the initiation of relevant discussions among professionals and patients. Available literature was reviewed using four electronic databases to identify issues that may deter healthcare professionals from having important deactivation discussions and to address considerations for ICD management prior to the EOL. The search resulted in the retainment of 12 studies. Three themes emerged from the data: barriers and facilitators, ethical considerations in clinical practice, and nurse's role. Lack of knowledge, which has been associated with cultural differences, has been found among the barriers, and interdisciplinary education and open communication appeared as facilitators. As clinicians' ethical considerations and fears emerged from the literature, nurses' special role has not been sufficiently supported. Complex care requires facilitation by multidisciplinary teams and education around the device's function regarding EOL issues. Establishing expert consensus statements on advance care planning might help define the distinct roles of each healthcare practitioner involved. Further research is needed in addressing the identified gaps.

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Deactivation of implantable defibrillators at end of life — Can we do better?

Cited by 5 publications

References 45 publications

Implantable Cardiac Defibrillator Deactivation During End-of-Life Care in the COVID-19 Pandemic

Implantable Cardiac Defibrillator Deactivation During End-of-Life Care in the COVID-19 Pandemic

Unmet device reprogramming needs at the end of life among patients with implantable cardioverter defibrillator: A systematic review and meta-analysis

The difficult discussion on the deactivation of implantable cardioverter devices at the end of life: a systematic review

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