Choosing Wisely:
Don’t leave an implantable cardioverter-defibrillator activated when it is inconsistent with the patient/family goals of care.
| Rationale and Comments: | In about a quarter of patients with implantable cardioverter-defibrillators, the defibrillator fires within weeks preceding death. For patients with advanced irreversible diseases, defibrillator shocks rarely prevent death, may be painful to patients, and are distressing to caregivers/family members. Currently there are no formal practice protocols to address deactivation; fewer than 10% of hospices have official policies. Advance care planning discussions should include the option of deactivating the implantable cardioverter-defibrillator when it no longer supports the patient’s goals. |
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| References: | • Berger JT. The ethics of deactivating implanted cardioverter defibrillators. Ann Intern Med. 2005;142:631-34. • Goldstein N, et al. Brief communication: management of implantable cardioverter-defibrillators in hospice: A nationwide survey. Ann Intern Med. 2010;152(5):296-9. • Goldstein NE, et al. Management of implantable cardioverter defibrillators in end-of-life care. Ann Intern Med. 2004;141(11):835-8. • Russo, J. Deactivation of ICDs at the end of life: A systematic review of clinical practices and provider and patient attitudes. Am J Nurs. 2011;111(10):26-35. |
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