Management of Implantable Cardioverter Defibrillators in End-of-Life Care

Goldstein, Nathan E.; Lampert, Rachel; Bradley, Elizabeth H.; Lynn, Joanne; Krumholz, Harlan M.

doi:10.7326/0003-4819-141-11-200412070-00006

Cited by 287 publications

(222 citation statements)

References 14 publications

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“…Guidelines issued by the European Heart Rhythm Association suggest that end‐of‐life issues should be incorporated in pre‐implant discussions and revisited at intervals along the heart failure disease trajectory 32. Many studies have demonstrated that discussion of device deactivation, if it takes place at all, may occur very close to the point of death 33. Advance care planning might obviate some of these problems but has been little espoused by heart failure patients.…”

Section: Implanted Electronic and Mechanical Assist Devicesmentioning

confidence: 99%

Palliative care in heart failure: facts and numbers

Riley

Beattie

2016

ESC Heart Failure

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Millions of people worldwide have heart failure. Despite enormous advances in care that have improved outcome, heart failure remains associated with a poor prognosis. Worldwide, there is poor short‐term and long‐term survival. The 1 year survival following a heart failure admission is in the range of 20–40% with between‐country variation. For those living with heart failure, the symptom burden is high. Studies report that 55 to 95% of patients experience shortness of breath and 63 to 93% experience tiredness. These symptoms are associated with a high level of distress (43–89%). Fewer patients experience symptoms such as constipation (25–30%) or dry mouth (35–74%). However, when they do, such symptoms are associated with high levels of distress (constipation: 15–39%; dry mouth: 14–33%). Psychological symptoms also predominate with possibly as many as 50% experiencing depression. Palliative care services in heart failure are not widely available. Even in countries with well‐developed services, only around 4% of patients are referred for specialist palliative care. Many patients and their families would benefit from receiving specialist palliative care support.

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Section: Implanted Electronic and Mechanical Assist Devicesmentioning

confidence: 99%

Palliative care in heart failure: facts and numbers

Riley

Beattie

2016

ESC Heart Failure

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“…96 Clinicians infrequently discuss ICD deactivation with patients, and most devices remain active until death. 97 Qualitative studies have shown that patients may not fully understand how their ICDs work and develop complex psychological relationships with their devices that may contribute to a reluctance to deactivate the ICDs. 98 For end-stage heart failure patients, deactivation of ICDs when death is near is advisable to avoid repeated shocks in a dying patient.…”

Section: Icds and Cardiac Resynchronization Therapymentioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

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H eart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure). 1 Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. In recognition of this, palliative/hospice care referral was recommended for endstage heart failure (Level of Evidence 1A) in the most recent American College of Cardiology/American Heart Association heart failure guidelines. 2 To identify evidence-based studies of palliative care in heart failure, we searched the Medline database for literature with the medical subject headings "heart failure" and "palliative care," "supportive care," or "symptom management" and found 394 results. We identified 92 systematic reviews, 44 of which were English-language systematic reviews published within the past 5 years.

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“…This leads to not only patient distress, but also distress of their families and supporting health care team (Goldstein et al 2004). Discontinuation of ICD therapy is an option for eliminating this distress.…”

Section: Icds and Crt Devicesmentioning

confidence: 99%