Abstract 175: Patients with Terminal Illness Using a Wearable Cardioverter Defibrillator
Introduction Terminally ill patients face high risk of sudden cardiac death (SCD) due to a variety of cardiac causes. However, they may still have potential to recovery and may not want to make a DNR decision. An ICD is not indicated because of an unclear prognosis for 1-year survival.
Hypothesis The wearable cardioverter defibrillator (WCD) is an option to protect terminally ill patients from SCD.
Methods Medical orders that indicated a terminal illness from 01/2006 to 05/2012 were selected for the analysis. A treatable sudden cardiac arrest (SCA) event was defined as sustained ventricular tachycardia (VT) and/or ventricular fibrillation (VF) within 24 hours. Customer call reports and device recordings were reviewed for clinical outcomes. We used the social security death index to determine years of survival from the point of WCD prescription. A daily use of less than 15 minutes and patients wearing less than 1 day were excluded from the compliance analysis.
Results Patients’ characteristics are summarized in Table 1. In average, the patients wore 20.9±3.7 hours per day of use; and the average days of wear were 66.3±80.5 days. Three patients (3.6%) experienced 4 VT/VF events and were successfully converted by the WCD; however, one patient later died in the hospital. The event rate was 3.3 per 100 patient-months. Mean survival after the WCD use was 3.88 years. Twenty (24.7%) patients received an ICD, which indicated an improved prognosis at the end of WCD use.
Conclusions Patient survival was high with the majority (72.0%) surviving greater than 1 year. The WCD effectively protected terminal patients who were at risk of SCD until a clearer prognosis was determined.
- © 2012 by American Heart Association, Inc.