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End‐of‐Life Care in Patients with Implantable Cardioverter Defibrillators: A MADIT‐II Substudy
Author(s) -
SHERAZI SAADIA,
MCNITT SCOTT,
AKTAS MEHMET K.,
POLONSKY BRONISLAVA,
SHAH ABRAR H.,
MOSS ARTHUR J.,
DAUBERT JAMES P.,
ZAREBA WOJCIECH
Publication year - 2013
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12188
Subject(s) - medicine , implantable cardioverter defibrillator , cardiology , intensive care medicine
Background Implantable cardioverter defibrillator (ICD)‐delivered shocks can cause substantial distress, warranting consideration of ICD deactivation at end of life. This study was designed to describe the patterns of end‐of‐life management in patients with ICDs. Methods There was a retrospective chart review of 98 patients who died in the ICD arm of multicenter automated defibrillator implantation trial II (MADIT II). The pattern of ICD management and the frequency of ICD shocks delivered before death were reviewed. Results We identified three groups: Group 1 consisting of individuals who underwent ICD, deactivation, 15 (15%); Group 2 patients without ICD deactivation who were in hospice or with “do not resuscitate” (DNR) orders, 36 (37%); and Group 3 patients without ICD deactivation who were not in hospice care and did not have DNR orders, 47 (48%). Out of 15 deactivations, 11 (73%) occurred in the week before death. None of the patients in Group 1 received an ICD shock in the 24‐hour period before death. However, one (3%) patient from Group 2 and nine (19%) patients from Group 3 had shocks during the 24 hours before death (P = 0.03). In the last week before death, three (20%), two (6%), and six (13%) patients received ICD shocks in the three groups, respectively (P = 0.28). Conclusions In patients with terminal conditions who are at risk for imminent death, active management of the patient's ICD, including timely discussions regarding ICD deactivation, may reduce the risk of ICD shocks during the end of life.