Abstract 20587: Guiding the End-of-Life Discussions in Patients With ICDs and Bi-V ICDs
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 the incidence of shocks as detected by ICD 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. Data was routinely obtained from patient’s devices at the time of death and results provided to their family. 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 both in and out of the hospital. Documentation of the patient’s death was obtained from family members or review of obituaries 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) in the 24 hours preceding death. The remaining 158 patients (97%) had no documented ventricular arrhythmias that resulted in a shock in the 24 hours preceding death. In this group, 125 patients (77%) had a non-arrhythmic, cardiac death (i.e. heart failure). The remaining 33 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.
Author Disclosures: D. Dillon: None. W. Paladino: None.
- © 2016 by American Heart Association, Inc.