Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey.
BACKGROUND
Communication about the deactivation of implantable cardioverter-defibrillators (ICDs) in patients near the end of life is rare.


OBJECTIVE
To determine whether hospices are admitting patients with ICDs, whether such patients are receiving shocks, and how hospices manage ICDs.


METHODS
Cross-sectional survey.


METHODS
Randomly selected hospice facilities.


METHODS
900 hospices, 414 of which responded fully.


METHODS
Frequency of admission of patients with ICDs, frequency with which patients received shocks, existence of ICD deactivation policies, and frequency of deactivation.


RESULTS
97% of hospices admitted patients with ICDs, and 58% reported that in the past year, a patient had been shocked. Only 10% of hospices had a policy that addressed deactivation. On average, 42% (95% CI, 37% to 48%) of patients with ICDs had the shocking function deactivated.


CONCLUSIONS
The study relied on the knowledge of hospice administrators.


CONCLUSIONS
Hospices are admitting patients with ICDs, and patients are being shocked at the end of life. Ensuring that hospices have policies in place to address deactivation may improve the care for patients with these devices. The authors provide a sample deactivation policy.


BACKGROUND
National Institute of Aging and National Institute of Nursing Research.
Goldstein
Nathan
N
Mount Sinai School of Medicine, New York, New York 10029, USA. Nathan.Goldstein@mssm.edu
Carlson
Melissa
M
Livote
Elayne
E
Kutner
Jean S
JS
D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects; D017051:Hospice Care; D006738:Hospices / Q000941:ethics / Q000458:organization & administration; D006801:Humans; D016134:Organizational Policy; D028761:Withholding Treatment / Q000941:ethics