Management of Implantable Cardioverter Defibrillators in End- of-Life Care
Creator
Goldstein, Nathan E.
Lampert, Rachel
Bradley, Elizabeth
Lynn, Joanne
Krumholz, Harlan M.
Bibliographic Citation
Annals of Internal Medicine 2004 December 7; 141(11): 835-838
Abstract
BACKGROUND: Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing. OBJECTIVE: To describe the frequency, timing, and correlates of discussions about deactivating ICDs. DESIGN: Retrospective cohort study. SETTING: Telephone survey. PARTICIPANTS: Next of kin of patients with ICDs who died of any cause. Of 136 next of kin contacted, 100 (74%) participated. MEASUREMENTS: Incidence of discussions about deactivating ICDs and timing of last shock from ICD. RESULTS: Next of kin reported that clinicians discussed deactivating the ICD in only 27 of the 100 cases. Most discussions occurred in the last few days of life. Family members reported that 8 patients received a shock from their ICD in the minutes before death. LIMITATIONS: This retrospective survey relied on the reports of next of kin. CONCLUSIONS: Next of kin reported that clinicians discussed deactivating ICDs with few patients. Individuals who choose to receive this device should have the opportunity to choose to discontinue it as death approaches.
Date
2004-12-07Collections
Metadata
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Next-of-Kin Responses and Do-Not-Resuscitate Implications for Implantable Cardioverter Defibrillators
Morrison, Laura J.; Sinclair, Christian T.; Goldstein, Nathan E.; Lampert, Rachel; Krumholz, Harlan M. (2005-04-19)