Dying patients with an implantable heart defibrillator don’t know the device can be turned off so that it doesn’t give them painful shocks during their last days of life, researchers report.
Implantable cardioverter defibrillators (ICDs) are surgically implanted in people with certain heart conditions. They deliver a shock to restore normal heart rhythm when they detect a potentially deadly abnormal rhythm.
Doctors are encouraged to inform patients with an implantable cardioverter defibrillator about the benefits of deactivating the device when they are near death. But research shows that up to 31 percent of people with an ICD receive shocks in their final days.
Two new studies provide further proof that many doctors aren’t following the Heart Rhythm Society and European Society of Cardiology recommendations.
A Spanish study of 243 patients with implantable cardioverter defibrillators found that only 38 percent knew they could choose to deactivate their ICD after consulting with their doctor. And only 37 percent knew that ICD deactivation is ethical and recommended by major medical groups.
And a study in the Netherlands of 328 patients with ICDs found that 73 percent knew their device could be turned off, but just 12 percent had talked with their doctor about it.
The studies are to be presented April 2 at an American College of Cardiology meeting in Chicago.
“When you reach the stage of palliative care, sometimes the ICD doesn’t have a role in caregiving anymore,” said Dr. Dilek Yilmaz, a fellow in cardiology at Leiden University Medical Center and lead author of the Dutch study.
“If a person is dying of a terminal cancer, for example, the ICD is not going to prolong their life, but it is fairly likely to cause pain in their last hours and prevent them from having a peaceful death,” Yilmaz explained in a college news release.
These shocks are often much more frequent on the patient’s last day than any other day of their life, said Dr. Silvia del Castillo, a cardiologist at Fuenlabrada University Hospital in Madrid and lead author of the Spanish study.
“I think it’s cruel in many cases to leave the ICD on until the very end, and when doctors don’t provide enough information about deactivation or delay that conversation until the final hours, it undercuts the patient’s right to make their own decisions,” del Castillo said in the news release.
About 100,000 ICDs are implanted each month in the United States, the researchers said. The devices can be deactivated in a cardiologist’s office without additional surgery.
Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.
The Heart Rhythm Society has more about ICDs.
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