Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Pacing Clin Electrophysiol. 2013 Oct;36(10):1273-9. doi: 10.1111/pace.12188. Epub 2013 Jun 3.

End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy.

Author information

  • 1Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York.

Abstract

BACKGROUND:

Implantable cardioverter defibrillator (ICD)-delivered shocks can cause substantial distress, warranting consideration of ICD deactivation at end of life. This study was designed to describe the patterns of end-of-life management in patients with ICDs.

METHODS:

There was a retrospective chart review of 98 patients who died in the ICD arm of multicenter automated defibrillator implantation trial II (MADIT II). The pattern of ICD management and the frequency of ICD shocks delivered before death were reviewed.

RESULTS:

We identified three groups: Group 1 consisting of individuals who underwent ICD, deactivation, 15 (15%); Group 2 patients without ICD deactivation who were in hospice or with "do not resuscitate" (DNR) orders, 36 (37%); and Group 3 patients without ICD deactivation who were not in hospice care and did not have DNR orders, 47 (48%). Out of 15 deactivations, 11 (73%) occurred in the week before death. None of the patients in Group 1 received an ICD shock in the 24-hour period before death. However, one (3%) patient from Group 2 and nine (19%) patients from Group 3 had shocks during the 24 hours before death (P = 0.03). In the last week before death, three (20%), two (6%), and six (13%) patients received ICD shocks in the three groups, respectively (P = 0.28).

CONCLUSIONS:

In patients with terminal conditions who are at risk for imminent death, active management of the patient's ICD, including timely discussions regarding ICD deactivation, may reduce the risk of ICD shocks during the end of life.

©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

KEYWORDS:

end of life: ICD and deactivation

PMID:
23731284
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Blackwell Publishing
    Loading ...
    Write to the Help Desk