title: Guidelines on the management of implantable cardioverter defibrillators at the end of life.
abstract: This article is a joint document of the Spanish Society of Geriatrics and Gerontology, the Spanish Society of Palliative Care and the Section of Geriatric Cardiology of the Spanish Society of Cardiology. Its aim is to address the huge gap that exists in Spain with regard to the management of implantable cardioverter defibrillators (ICDs) in the final stages of life. It is increasingly common to find patients carrying these devices that are in the terminal stage of an advanced disease. This occurs in patients with advanced heart disease and subsequent heart failure refractory to treatment but also in a patient with an ICD who develops cancer disease, organ failure or other neurodegenerative diseases with poor short-term prognosis. The vast majority of these patients are over 65, so the paper focuses particularly on the elderly who are in this situation, but the decision-making process is similar in younger patients with ICDs who are in the final phase of their life.
authors.affiliation: Unidad de Arritmias y Electrofisiología, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: T
authors.initials: T
authors.lastname: Datino
authors.affiliation: Unidad de Cuidados Paliativos, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Rexach
authors.affiliation: Servicio de Geriatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
authors.forename: M T
authors.initials: MT
authors.lastname: Vidán
authors.affiliation: Unidad de Cuidados Paliativos, Hospital Universitario La Paz, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Unidad del Dolor y Cuidados Paliativos, Clínica Ruber, Madrid, España.
authors.forename: Á
authors.initials: Á
authors.lastname: Gándara
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Ruiz-García
authors.affiliation: Servicio de Geriatría y Cuidados Paliativos, Consorci Sanitari Integral L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: B
authors.initials: B
authors.lastname: Fontecha
authors.affiliation: Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Europea de Madrid, Madrid, España. Electronic address: mmselles@secardiologia.es.
authors.forename: M
authors.initials: M
authors.lastname: Martínez-Sellés
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D017147:Defibrillators, Implantable; D019468:Disease Management; D006801:Humans; D010166:Palliative Care; D013727:Terminal Care
keywords: Cuidados paliativos; Decision-making; Desfibrilador automático implantable; Implantable cardioverter defibrillator; Palliative care; Retirada de tratamiento; Toma de decisiones; Treatment retrieval