Abstract 19798: Guiding the End-of-Life Discussion in Patients With Implantable Cardiac Defibrillators and Bi-Ventricular Implantable Cardiac Defibrillators
Introduction: Patients with terminal diseases and their families fear multiple defibrillator shocks at the end-of-life. Despite conversations discussing deactivation of device tachy therapies, even patients and families who adopt “do-not-resuscitate” often decline the option to turn off tachy therapies. This decision often results in anxiety for both patient and family as the end-of-life approaches.
Objectives: To evaluate the mode of death and incidence of shocks detected by ICDs and Bi-V ICDs in the 24 hours preceding death.
Methods: A cohort of consecutive patients with an ICD (n=69) or Bi-V ICD (n=94) who died from 2010-2015 was analyzed. Documentation of the patient’s death was obtained from family members or obituaries. Data was routinely obtained from devices at the time of death and results provided to families. This provided assurance to the families of appropriate device function at the time of death as well as the existence or non-existence of ICD shocks. The database included patients who died in or out of the hospital. Recorded patient data was reviewed for cause of death and defibrillator shocks in the 24 hours preceding death.
Results: Data from 163 patients was reviewed. Five patients (3%) had a documented ventricular arrhythmia and received a shock(s) at the time of death. The remaining 158 patients (97%) had no documented ventricular arrhythmias that resulted in a shock in the 24 hours preceding death. One hundred and twenty-five patients (77%) had a non-arrhythmic, cardiac death (i.e. heart failure). Thirty- three patients (20%) died from a non-cardiac cause (i.e. malignancy, renal failure, CVA).
Conclusion: Despite having end-of-life conversations with terminally ill patients regarding deactivation of device tachy therapies, few choose this option. Data from 163 deceased device patients revealed that device shocks occurred in only 3% of the patients in the 24 hours preceding death. Sharing this information in conversations with patients and their families may be helpful in allaying anxiety in making end-of-life decisions.
- Implantable cardiovertor defibrillator
- End of life
- Palliative care
- Patient education/teaching psychosocial aspects
Author Disclosures: W.P. Paladino: None. D. Dillon: None.
- © 2016 by American Heart Association, Inc.