Do implantable cardioverter defibrillators complicate end-of-life care for those with heart failure?
OBJECTIVE
We know deactivating implantable cardioverter defibrillators (ICDs) is permissible and should not complicate end-of-life care. However, patients and healthcare professionals still struggle with this concept. This review looks at the recent literature to find possible reasons behind this.


RESULTS
ICD use is on the increase and is not always in accordance with best practice guidelines. The number of clinicians having conversations about deactivation is variable, but most of them agree that it is ethical and legal. Difficulty in initiating conversations is mainly due to lack of training, viewing ICDs as being different to conventional treatments and lack of clarity about legality. Patients' knowledge around deactivation and its ethical and legal standing is low. This can be improved by giving information about end-of-life options at the time of implantation and incorporating these within care plans. Use of ICDs should be reviewed in context of disease status and patients' goals.


CONCLUSIONS
Deactivation of ICDs at end of life throws up challenges for clinicians and patients. This review points toward a need for communication training for clinicians and early initiation of discussion around the time of ICD insertion, as well improving clinicians' and patients' knowledge of the ethics and legality of deactivation.
LOROS Hospice, University Hospitals of Leicester, Leicester University, Leicester, UK. estherwaterhouse@loros.co.uk
Esther
E
Waterhouse
Fawad
F
Ahmad
D001291:Attitude of Health Personnel; D003142:Communication; D003661:Decision Support Techniques; D017147:Defibrillators, Implantable / Q000523:psychology*; D005066:Euthanasia, Passive / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy; D006801:Humans; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000379:methods* / Q000523:psychology