EHRA Expert Consensus Statement on the management of cardiovascular implantable electronic devices in patients nearing end of life or requesting withdrawal of therapy

Padeletti, Luigi; Arnar, Davíð O.; Boncinelli, Lorenzo; Brachman, Johannes; Camm, John; Daubert, Jean Claude; Hassam, Sarah; Deliëns, Luc; Glikson, Michael; Hayes, David L.; Israel, Carsten W.; Lampert, Rachel; Lobban, Trudie; Raatikainen, Pekka; Siegal, Gil; Vardas, Panos

doi:10.1093/europace/eur043

Cited by 8 publications

(9 citation statements)

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“…A structured approach is recommended (Figure 4), and several articles suggest well-documented approaches to these endeavors. 94,109,115,120–123 The most critical issue is allowing the patient and family time to understand and prepare for the sequence of events and not to influence them to make decisions that are inconsistent with their values. 2 Patients and families often benefit from guided recommendations for care and decision-making at this difficult juncture.…”

Section: End-of-life Considerationsmentioning

confidence: 99%

“…Withholding and withdrawing cardiac therapeutic supports are generally deemed ethically equivalent under conditions where a death is foreseeable because of underlying disease or where a patient with capacity and decisional authority (may be age-based legally) does not wish to receive the intervention or therapy. 107–112 The extension of discontinuation of life-sustaining therapies beyond ventilator support or critical care therapies to implantable cardiac defibrillators, 112–117 ECMO, 117–121 or ventricular assist devices (VADs) 122,123 is predicated on the same ethical justifications and legal permissions. Implantable cardiac defibrillator deactivation is suggested to decrease additional harm and distress by multiple induced shocks from a defibrillator device at the EOL.…”

Section: End-of-life Considerationsmentioning

confidence: 99%

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Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association

Blume¹,

Kirsch²,

Cousino³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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AIM: This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease. METHODS: A comprehensive literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. STRUCTURE: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.

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Section: End-of-life Considerationsmentioning

confidence: 99%

Section: End-of-life Considerationsmentioning

confidence: 99%

Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association

Blume¹,

Kirsch²,

Cousino³

et al. 2023

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

show abstract

“…One third of the participants were reluctant to discuss end-of-life issues, but according to existing expert consensus statements 25,26 a discussion about deactivation should take place already in connection with the ICD-implantation. Further, one quarter preferred to keep the shocks in connection with end-of-life.…”

mentioning

confidence: 99%

Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator

Thylén

Wenemark

Fluur³

et al. 2013

European Journal of Cardiovascular Nursing

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“…35,36 Having an ICD also incurs sensitive discussions about device deactivation among patients and families. 37 Accordingly, it is recommended that patients with an ICD/CRT-D receive counselling about living with an ICD (QI 04S01).…”

Section: Domain 4: Patient Education and Lifestyle Modificationsmentioning

confidence: 99%

European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

et al. 2022

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To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of care for the management of patients with VA and the prevention of SCD: (i) structural framework, (ii) screening and diagnosis, (iii) risk stratification, (iv) patient education and lifestyle modification, (v) pharmacological treatment, (vi) device therapy, (vii) catheter ablation, and (viii) outcomes, which included 17 main and 4 secondary QIs across these domains. Following a standardized methodology, we developed 21 QIs for the management of patients with VA and the prevention of SCD. The implementation of these QIs will improve the care and outcomes of patients with VA and contribute to the prevention of SCD.

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EHRA Expert Consensus Statement on the management of cardiovascular implantable electronic devices in patients nearing end of life or requesting withdrawal of therapy

Cited by 8 publications

References 0 publications

Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association

Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association

Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator

European Society of Cardiology quality indicators for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

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