Management of cardiac implantable electronic devices in patients receiving palliative care
- Ann C Garlitski, MD, FACC, FHRS
Ann C Garlitski, MD, FACC, FHRS
- Assistant Professor of Medicine
- Hofstra North Shore-LIJ School of Medicine
- Hofstra University
Discontinuation of cardiac implantable electronic device (CIED) therapy, which encompasses both pacemakers and defibrillators, is a complicated issue. For many patients, these are life-sustaining therapies. In 2010, the Heart Rhythm Society (HRS) released an expert consensus statement on the management of CIEDs in patients nearing the end of life or requesting withdrawal of therapy . This statement outlines the ethical, legal, and religious principles that underlie the decision-making process to withdraw CIEDs.
The issues related to changes in CIED therapy, including specific issues related to palliative care, will be discussed here. Additional discussion of the ethical issues involved in palliative care is presented separately. (See "Ethical issues in palliative care".)
FREQUENCY OF LATE-LIFE ICD THERAPIES
Available data to guide providers in counseling patients have been obtained from studies of implantable cardioverter-defibrillator (ICD) interrogations and interviews with families.
●Interviewing family members of deceased patients in a single practice found that approximately 20 percent of patients with ICDs had the device discharge in the last month of life .
●A retrospective chart review of 98 patients with ICDs from the Multicenter Automated Defibrillator Implantation Trial II who later died found that 15 percent chose to have their ICDs deactivated. Ten patients whose ICDs remained activated received shocks during the 24 hours before death .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- FREQUENCY OF LATE-LIFE ICD THERAPIES
- INDICATIONS FOR DISCONTINUING CIED THERAPY
- Patient preference
- Perceived reduction in risk
- Device complications necessitating CIED removal
- DISCONTINUATION OF ICD THERAPY
- DISCONTINUATION OF PPM THERAPY
- Withholding versus withdrawing therapy
- Discontinuing pacemaker therapy in the nonpacemaker-dependent patient
- Discontinuing pacemaker therapy in the pacemaker-dependent patient
- ADVANCE CARE PLANNING
- Patients and advance directives
- Clinicians and advance care planning
- When patient and clinician beliefs differ
- LOGISTICS OF CIED DEACTIVATION
- SUMMARY AND RECOMMENDATIONS