The prevalence and contents of advance directives in patients with pacemakers.
BACKGROUND
Little is known about the use of advance directives (ADs) in patients who have implantable cardiac pacemakers (PMs).


METHODS
We conducted a retrospective review of the medical records of residents of Olmsted County, Minnesota, who underwent implantation of a cardiac PM at Mayo Clinic (Rochester, Minnesota) during 2006 and 2007, and determined the prevalence and contents of ADs in these patients.


RESULTS
During the study period, 205 residents of Olmsted County (men, 53%) underwent PM implantation (mean age [standard deviation] at implantation, 77 [15] years). Overall, 120 patients (59%) had ADs. Of these, 63 ADs (53%) were executed more than 12 months before and 33 (28%) were executed after PM implantation. Many patients specifically mentioned life-prolonging treatments in their ADs: cardiopulmonary resuscitation, 76 (63%); mechanical ventilation, 56 (47%); and hemodialysis, 31 (26%). Pain control was mentioned in 79 ADs (66%) and comfort measures were mentioned in 42 ADs (35%). Furthermore, the AD of many patients contained a general statement about end-of-life care (e.g., no "heroic measures"). However, only one AD (1%) specifically addressed the end-of-life management of the PM.


CONCLUSIONS
More than half of the patients with PMs in our study had executed an AD, but only one patient specifically mentioned her PM in her AD. These results suggest that patients with PMs should be encouraged to execute ADs and specifically address end-of-life device management in their ADs. Doing so may prevent end-of-life ethical dilemmas related to PM management.
Mayo Medical School, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota.
Dario
D
Pasalic
Tanya H
TH
Tajouri
Abigale L
AL
Ottenberg
Paul S
PS
Mueller
D016223:Advance Directives / Q000145:classification* / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D017678:Sex Distribution; D013727:Terminal Care
advance directives; end-of-life care; ethics; pacemakers