Deactivation of Implantable Cardioverter–Defibrillators in Terminal Illness and End-of-Life Care

      I read with interest the recent article by Kirkpatrick et al
      • Kirkpatrick J.N.
      • Gottlieb M.
      • Sehgal P.
      • Patel R.
      • Verdino R.J.
      Deactivation of implantable cardioverter defibrillators in terminal illness and end of life care.
      regarding deactivation of implantable cardioverter–defibrillators (ICDs) in end-of-life care. The authors surveyed 278 patients regarding their attitude to ICDs at the end of life. They specifically asked about advance directives and patient opinion on whether subjects defined ICD deactivation as physician-assisted suicide. Half of patients had some form of advance directive, but only 3 had included a plan for their ICD at the end of life. 44% of patients in 2009 and 12% of patients in 2010 considered ICD deactivation to be physician-assisted suicide. This was a worrying statistic because physician-assisted suicide is illegal in most parts of the world and most states in the United States. Patients interviewed in 2010 were more likely to want their ICD deactivated at the end of life than those interviewed in 2009 (49% vs 0%).
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        • Kirkpatrick J.N.
        • Gottlieb M.
        • Sehgal P.
        • Patel R.
        • Verdino R.J.
        Deactivation of implantable cardioverter defibrillators in terminal illness and end of life care.
        Am J Cardiol. 2012; 109: 91-94
        • Raphael C.E.
        • Koa-Wing M.
        • Stain N.
        • Wright I.
        • Francis D.P.
        • Kanagaratnam P.
        Implantable cardioverter-defibrillator recipient attitudes towards device deactivation: how much do patients want to know?.
        Pacing Clin Electrophysiol. 2011; 34: 1628-1633
        • Lampert R.
        • Hayes D.L.
        • Annas G.J.
        • Farley M.A.
        • Goldstein N.E.
        • Hamilton R.M.
        • Kay G.N.
        • Kramer D.B.
        • Mueller P.S.
        • Padeletti L.
        • Pozuelo L.
        • Schoenfeld M.H.
        • Vardas P.E.
        • Wiegand D.L.
        • Zellner R.
        HRS expert consensus statement on the management of cardiovascular implantable electronic devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy this document was developed in collaboration with the American College of Cardiology (ACC), American Geriatrics Society (AGS), American Academy of Hospice and Palliative Medicine (AAHPM), American Heart Association (AHA), and the European Heart Rhythm Association (EHRA).
        Heart Rhythms. 2010; 7: 1008-1026

      Linked Article

      • Deactivation of Implantable Cardioverter Defibrillators in Terminal Illness and End of Life Care
        American Journal of CardiologyVol. 109Issue 1
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          Cardiology professional societies have recommended that patients with cardiovascular implantable electronic devices complete advance directives (ADs). However, physicians rarely discuss end of life handling of implantable cardioverter defibrillators (ICDs), and standard AD forms do not address the presence of ICDs. We conducted a telephone survey of 278 patients with an ICD from a large, academic hospital. The average period since implantation was 5.15 years. More than 1/3 (38%) had been shocked, with a mean of 4.69 shocks.
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