Management of implantable cardioverter defibrillators in end-of-life care.
BACKGROUND
Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing.


OBJECTIVE
To describe the frequency, timing, and correlates of discussions about deactivating ICDs.


METHODS
Retrospective cohort study.


METHODS
Telephone survey.


METHODS
Next of kin of patients with ICDs who died of any cause. Of 136 next of kin contacted, 100 (74%) participated.


METHODS
Incidence of discussions about deactivating ICDs and timing of last shock from ICD.


RESULTS
Next of kin reported that clinicians discussed deactivating the ICD in only 27 of the 100 cases. Most discussions occurred in the last few days of life. Family members reported that 8 patients received a shock from their ICD in the minutes before death.


CONCLUSIONS
This retrospective survey relied on the reports of next of kin.


CONCLUSIONS
Next of kin reported that clinicians discussed deactivating ICDs with few patients. Individuals who choose to receive this device should have the opportunity to choose to discontinue it as death approaches.
Goldstein
Nathan E
NE
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA. nathan.goldstein@mssm.edu
Lampert
Rachel
R
Bradley
Elizabeth
E
Lynn
Joanne
J
Krumholz
Harlan M
HM
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D030881:Disclosure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013727:Terminal Care; D028761:Withholding Treatment