title: Implantable cardioverter defibrillator (ICD) deactivation discussions: Reality versus recommendations.
abstract: BACKGROUND
  The implantable cardioverter defibrillator (ICD) is a cornerstone in the treatment of life-threatening arrhythmias. As rates of device implantation continue to rise throughout Europe, European and International guidelines recommend professionals discuss deactivation with patients. In reality the appropriate therapeutic management of an ICD at the end-of-life remains uncertain in the minds of professionals and patients.
  
  
  OBJECTIVE
  To identify current practice and examine professional decision-making for patients with an ICD from time of implantation to final documentation and demise.
  
  
  METHODS
  Retrospective case note review of patients with an ICD who died during a 12 month period at a regional implantation centre.
  
  
  RESULTS
  Fifty-nine patients were identified and medical notes of 44 of these patients were successfully retrieved. The majority of patients were male, mean age at time of death 73 years with one-third diagnosed with a malignancy prior to death. There was no documented evidence patients were informed about deactivation prior to ICD implantation. End-of-life management was discussed with 23 patients and on 17 occasions deactivation was included. Median time from discussion to death was seven days. In total 62.5% of patients who experienced a shock had an active ICD at death, while 93.7% who had their ICD deactivated never had a shock (p=0.003).
  
  
  CONCLUSIONS
  Patients were not adequately informed regarding device deactivation prior to implantation, nor when their health deteriorated. The experience of a shock potentially affects professional decision making regarding device deactivation.
authors.affiliation: Ulster University, Newtownabbey, UK Belfast Health and Social Care Trust, Royal Group of Hospitals, UK Hill-L3@email.ulster.ac.uk.
authors.forename: Loreena
authors.initials: L
authors.lastname: Hill
authors.affiliation: Ulster University, Newtownabbey, UK All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland.
authors.forename: Sonja
authors.initials: S
authors.lastname: McIlfatrick
authors.affiliation: Ulster University, Newtownabbey, UK.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Taylor
authors.affiliation: Belfast Health and Social Care Trust, Royal Group of Hospitals, UK.
authors.forename: Lana
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Belfast Health and Social Care Trust, Royal Group of Hospitals, UK.
authors.forename: Ben R
authors.initials: BR
authors.lastname: Cole
authors.affiliation: Ulster University, Newtownabbey, UK University of Kentucky, College of Nursing, Lexington, USA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: Ulster University, Newtownabbey, UK Belfast Health and Social Care Trust, Royal Group of Hospitals, UK All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland.
authors.forename: Donna
authors.initials: D
authors.lastname: Fitzsimons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D003657:Decision Making; D017147:Defibrillators, Implantable / Q000523:psychology*; D005060:Europe; D005260:Female; D017408:Guidelines as Topic; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D012189:Retrospective Studies; D013727:Terminal Care / Q000523:psychology*
keywords: Implantable cardioverter defibrillator; end-of-life care; palliative care; professional decision-making