title: Palliative Care Consultation and Associated End-of-Life Care After Pacemaker or Implantable Cardioverter-Defibrillator Deactivation.
abstract: The presence of cardiac pacemakers and defibrillators complicates making end-of-life (EOL) medical decisions. Palliative care/medicine consultation (PCMC) may benefit patients and primary providers, but data are lacking. We retrospectively reviewed 150 charts of patients who underwent device deactivation at our tertiary care center (between November 1, 2008, and September 1, 2012), assessing for PCMC and outcomes. Overall, 42% of patients received a PCMC, and 68% of those PCMCs specifically addressed device deactivation. Median survival following deactivation was 2 days, with 42% of deaths occurring within 1 day of deactivation. There was no difference in survival between the groups. The EOL care for patients with implanted cardiac devices is complex, but PCMC may assist with symptom management and clarification of goals of care for such patients.
authors.affiliation: Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Dario
authors.initials: D
authors.lastname: Pasalic
authors.affiliation: Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA gazelka.halena@mayo.edu.
authors.forename: Halena M
authors.initials: HM
authors.lastname: Gazelka
authors.affiliation: Mayo Clinic Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.|Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Johns Hopkins Medical Institutes, Baltimore, MD, USA.
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Topazian
authors.affiliation: Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Lillian C
authors.initials: LC
authors.lastname: Buchhalter
authors.affiliation: Program in Professionalism and Ethics, Mayo Clinic, Rochester, MN, USA.|SSH Health, Mission, Legal and Government Affairs, St Louis, MO, USA.
authors.forename: Abigale L
authors.initials: AL
authors.lastname: Ottenberg
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Webster
authors.affiliation: Mayo Clinic Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.|Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Birmingham VA Medical Center, Birmingham, AL, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Swetz
authors.affiliation: Mayo Clinic Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.|Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.|Program in Professionalism and Ethics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology; D062606:Tertiary Care Centers
keywords: cardiac pacemaker; cardiovascular implantable electronic device; end of life; implantable cardioverter-defibrillator; medical ethics; palliative care