title: Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey.
abstract: 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.
authors.affiliation: Mount Sinai School of Medicine, New York, New York 10029, USA. Nathan.Goldstein@mssm.edu
authors.forename: Nathan
authors.initials: N
authors.lastname: Goldstein
authors.forename: Melissa
authors.initials: M
authors.lastname: Carlson
authors.forename: Elayne
authors.initials: E
authors.lastname: Livote
authors.forename: Jean S
authors.initials: JS
authors.lastname: Kutner
mesh_terms: 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