title: End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy.
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.
authors.affiliation: Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York.
authors.forename: Saadia
authors.initials: S
authors.lastname: Sherazi
authors.forename: Scott
authors.initials: S
authors.lastname: McNitt
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Aktas
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
authors.forename: Abrar H
authors.initials: AH
authors.lastname: Shah
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moss
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zareba
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004556:Electric Injuries / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011475:Prosthesis Failure; D018570:Risk Assessment; D015996:Survival Rate; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: end of life: ICD and deactivation