Physicians' knowledge of implantable defibrillator treatment: are we good enough?

Westerdahl, Annika Kinch; Frykman, Viveka

doi:10.1093/europace/euw228

Cited by 9 publications

(12 citation statements)

References 21 publications

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“…11 A recent study in Sweden demonstrated that only 41% of physicians surveyed had sufficient basic knowledge about ICD therapy, and this lack of knowledge was more prominent in Internal Medicine and Geriatrics, but also extended to Cardiology. 17 These studies are consistent with findings of the current study by Bernier et al, 13 highlighting that the need to improve education is not unique to the United States, but appears to be a global issue.…”

supporting

confidence: 91%

Gaps in physician knowledge are associated with under‐referral for evidence‐based implantable cardioverter defibrillator therapy: How can we improve care?

Russo

2017

Cardiovasc electrophysiol

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supporting

confidence: 91%

Gaps in physician knowledge are associated with under‐referral for evidence‐based implantable cardioverter defibrillator therapy: How can we improve care?

Russo

2017

Cardiovasc electrophysiol

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“…A recent Swedish study by Westerdahl et al showed that one out of four patients received at least one shock during the last day of their life. It is noteworthy that this study also showed that ICD devices were active in half of patients with a do-not-resuscitate order [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the lack of knowledge is not just on the patient side. Many physicians, medically responsible for elderly patients with an ICD, have limited knowledge of ICD treatment and may therefore not be able to provide the best possible care from implantation to the end-of-life in the elderly ICD-recipients [ 19 ]. Thus, we see a need for more education on ICD care and communication about deactivation to physicians both in geriatrics, internal medicine and primary care as well as a more close collaboration with cardiologists and device nurses responsible for ICD follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…There are several obstacles to effective communication and patient education regarding this issue. Firstly, many professionals still feel uncomfortable discussing end-of-life with their patients [ 17 ] and lack the competence and skills to communicate about end-of life issues [ 18 , 19 ]. Secondly, professionals may feel uncertain about if and/or when patients prefer to discuss generator replacement and deactivation, which could result in a delayed end-of-life discussion [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

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Octo- and nonagenarians’ outlook on life and death when living with an implantable cardioverter defibrillator: a cross-sectional study

2018

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BackgroundElderly individuals are increasingly represented among patients with implantable cardioverter defibrillators (ICD), but data describing life with an ICD are scarse among octo- and nonagenarians. Moreover, few studies have reported those elderly patients’ perspective on timly discussions concerning what shock deactivation involves, preferences on battery replacement, and their attitudes about turning off the ICD nearing end-of-life. Consequently, the aim of the study was to describe outlooks on life and death in octo- and nonagenarian ICD-recipients.MethodsParticipants were identified via the Swedish Pacemaker- and ICD-registry, with 229 octo- and nonagenarians (82.0 ± 2.2 years, 12% female) completing the survey on one occasion. The survey involved questions on health and psychological measures, as well as on experiences, attitudes and knowledge of end-of-life issues in relation to the ICD.ResultsThe majority (53%) reported their existing health as being good/very good and rated their health status as 67 ± 18 on the EuroQol Visual Analog Scale. A total of 34% had experienced shock(s), 11% suffered from symptoms of depression, 15% had anxiety, and 26% reported concerns related to their ICD. About one third (34%) had discussed their illness trajectory with their physician, with those octo- and nonagenarians being more decisive about a future deactivation (67% vs. 43%, p < .01). A minority (13%) had discussed what turning off shocks would involve with their physician, and just 7% had told their family their wishes about a possible deactivation in the future. The majority desired battery replacement even if they had reached a very advanced age when one was needed (69%), or were seriously ill with a life-threatening disease (55%). When asked about deactivation in an anticipated terminal illness, about one third (34%) stated that they wanted to keep the shocks in the ICD during these circumstances. About one-fourth of the octo- and nonagenarians had insufficient knowledge regarding the ethical aspects, function of the ICD, and practical consequences of withdrawing the ICD treatment in the end-of-life.ConclusionsIncreasing numbers of elderly persons receive an ICD and geriatric care must involve assessments of life expectancy as well as the patient’s knowledge and attitudes in relation to generator changes and deactivation.

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“…In a published multicentre cross-sectional study in Sweden, more than two-thirds of the physicians had experience of admitting ICD patients but rated their knowledge of ICD management to be low. 5 …”

Section: Problemmentioning

confidence: 99%

Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care

2018

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Implantable cardioverter defibrillators (ICDs) save lives in selected patients at risk of sudden cardiac death. However, in patents suffering with terminal illness, ICD therapy could pose a risk of unnecessary futile shocks which could lead to undignified discomfort in their final days of life. National guidelines advise that patients approaching the end of their natural life should be offered a compassionate choice of having their defibrillator deactivated. Following an actual clinical incident involving a patient receiving avoidable ICD shocks in his final hours, we identified shortcomings in communication and gaps in knowledge about ICD management in end-of-life care. We developed a quality improvement programme targeting training and educational support to general physicians and nurses at our large District General Hospital. A series of interventions were delivered including Grand Round presentation, departmental seminars and publicity posters. In parallel, we introduced a local protocol for implementing ICD deactivation which was published on our intranet for Trust-wide accessibility. Following interventions, we examined the clinical notes of each end-of-life care patient who died with an ICD in situ over a 6-month observation period and recorded the proportion who received consent-guided ICD deactivation versus died with an active ICD in situ because no deactivation discussion had been offered. Before our interventions in 2015, 0 out of 10 eligible patients (0%) received consent-guided ICD deactivation. Six months into our campaign to encourage healthcare workers to undertake advance care planning discussion in 2016, 7 out of 13 eligible patients (54%) received consent-guided ICD deactivation and no patients received shocks in their final month of life. This programme was successful in raising awareness of this emerging issue, improving physician knowledge and delivering patient choice as well as contributing to safe and compassionate end-of-life care.

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Physicians' knowledge of implantable defibrillator treatment: are we good enough?

Cited by 9 publications

References 21 publications

Gaps in physician knowledge are associated with under‐referral for evidence‐based implantable cardioverter defibrillator therapy: How can we improve care?

Gaps in physician knowledge are associated with under‐referral for evidence‐based implantable cardioverter defibrillator therapy: How can we improve care?

Octo- and nonagenarians’ outlook on life and death when living with an implantable cardioverter defibrillator: a cross-sectional study

Improving rates of implantable cardioverter defibrillator deactivation in end-of-life care

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