Patients' Perspective on Deactivation of the Implantable Cardioverter-Defibrillator Near the End of Life

2013 ◽  
Vol 111 (10) ◽  
pp. 1443-1447 ◽  
Author(s):  
Susanne S. Pedersen ◽  
Rismy Chaitsing ◽  
Tamas Szili-Torok ◽  
Luc Jordaens ◽  
Dominic A.M.J. Theuns
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Cardioverter Defibrillator ◽  
Patients Perspective

Abstract 11135: Missed Opportunities! End-Of-Life Discussions and Implantable Cardioverter Defibrillator Recipients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jennifer Miller ◽  
Ingela Thylen ◽  
Martha J Biddle ◽  
Alison L Bailey ◽  
Muna H Hammash ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Community Hospital ◽  
Surgical Intervention ◽  
Missed Opportunities ◽  
Cardioverter Defibrillator ◽  
Duration Of Therapy ◽  
Level Of Knowledge ◽  
Eol Care ◽  
Patients Perspective

Introduction: Guidelines for device based therapy of cardiac rhythm abnormalities were updated by the ACC/AHA/HRS in 2008 to include discussions beginning at the time of implantation with implantable cardioverter defibrillator (ICD) recipients regarding end-of-life (EOL) choices and withdrawal of defibrillation therapy. The level of adherence to this guideline from the patients’ perspective is unknown. Methods: The purpose of this study was to determine (1) ICD patients’ perspectives about discussions held with their providers focused on EOL choices regarding the withdrawal of defibrillation therapy and (2) ICD recipients’ level of knowledge regarding ICD function at EOL. ICD recipients from outpatient cardiology clinics associated with an academic health center, a community hospital, or a suburban hospital located in Central Kentucky completed the EOL-ICD questionnaire. The EOL-ICD measures three domains: experiences of EOL issues, attitudes about EOL discussions and actions, and knowledge of the ICD in relation to EOL issues. This instrument is valid and reliable in the ICD population. Results: Of the 115 ICD recipients (mean age = 63 yrs., 22% non-white, 24% non-partnered, with a mean educational level = 13.6 yrs., a mean duration of therapy = 5yrs., and 34% reporting one or more ICD shocks) 71% reported that they have never had discussions with their health care provider regarding what withdrawal of defibrillation therapy implies. A total of 44% believed that turning off the ICD shocks was the same as active euthanasia and that to disable defibrillation therapy required surgical intervention; 43% believed that once defibrillation was disabled it could not be enabled again; and 24% of recipients believed that the heart would stop beating due to the withdrawal of defibrillation therapy. Conclusion: Adherence to the guidelines regarding EOL discussions with ICD recipients was minimal from the patients' perspective. Despite national and international guideline recommendations to discuss EOL issues with ICD recipients beginning at implant, most patients report not having these discussions and many hold alarming misperceptions that could interfere with optimal EOL care.

scholarly journals 176-55: Implantable Cardioverter Defibrillator Patients Remain at Risk of Painful Shocks at the End of Life

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i131-i131
Author(s):  
Dilek Yilmaz ◽  
Aafke Van Der Heijden ◽  
Joep Thijssen ◽  
Martin Schalij ◽  
Lieselot van Erven
Keyword(s):  
At Risk ◽  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Cardioverter Defibrillator

Normativity under change

2015 ◽  
Vol 23 (3) ◽  
pp. 328-338 ◽  
Author(s):  
Jette Rolf Svanholm ◽  
Jens Cosedis Nielsen ◽  
Peter Thomas Mortensen ◽  
Charlotte Fuglesang Christensen ◽  
Regner Birkelund
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Political Ideology ◽  
Older Persons ◽  
Empirical Studies ◽  
Modern Society ◽  
Cardioverter Defibrillator ◽  
Life Issues ◽  
End Of Life Issues ◽  
Critical Interpretation

Background: In modern society, death has become ‘forbidden’ fed by the medical technology to conquer death. The technological paradigm is challenged by a social-liberal political ideology in postmodern Western societies. The question raised in this study was as follows: Which arguments, attitudes, values and paradoxes between modern and postmodern tendencies concerning treatment and care of older persons with an implantable cardioverter defibrillator appear in the literature? Aims: The aim of this study was to describe and interpret how the field of tension concerning older persons with an implantable cardioverter defibrillator – especially end-of-life issues – has been expressed in the literature throughout the last decade. Methods: Paul Ricoeur’s reflexive interpretive approach was used to extract the meaningful content of the literature involving qualitative, quantitative and normative literature. Analysis and interpretation involved naive reading, structural analysis and critical interpretation. Ethical considerations: The investigation complied with the principles outlined in the Declaration of Helsinki. Findings and discussions: The unifying theme was ‘Normativity under change’. The sub-themes were ‘Death has become legitimate’, ‘The technological imperative is challenged’ and ‘Patients and healthcare professionals need to talk about end-of-life issues’. There seems to be a considerable distance between the normative approach of how practice ought to be and findings in empirical studies. Conclusion: Modern as well as postmodern attitudes and perceptions illustrate contradictory tendencies regarding deactivation of the implantable cardioverter defibrillator and replacement of the implantable cardioverter defibrillator in older persons nearing the end of life. The tendencies challenge each other in a struggle to gain position. On the other hand, they can also complement each other because professionalism and health professional expertise cannot stand alone when the patient’s life is at stake but must be unfolded in an alliance with the patient who needs to be understood and accepted in his vulnerability.

Cardiac Pacemakers at End of Life #111; Implantable Cardioverter Defibrillator (ICD) at End of Life #112

2005 ◽  
Vol 8 (5) ◽  
pp. 1055-1057 ◽  
Author(s):  
M.D. Harrington ◽  
D.L. Luebke ◽  
W.R. Lewis ◽  
M.P. Aulisio ◽  
N.J. Johnson
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Cardiac Pacemakers ◽  
Cardioverter Defibrillator

Implantable cardioverter-defibrillator deactivation at the end of life: A physician survey

2009 ◽  
Vol 157 (4) ◽  
pp. 702-708.e1 ◽  
Author(s):  
Amy S. Kelley ◽  
M. Carrington Reid ◽  
David H. Miller ◽  
Joseph J. Fins ◽  
Mark S. Lachs
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Physician Survey ◽  
Cardioverter Defibrillator

Patients’ perception of implantable cardioverter defibrillator deactivation at the end of life

2014 ◽  
Vol 29 (4) ◽  
pp. 310-323 ◽  
Author(s):  
Loreena Hill ◽  
Sonja McIlfatrick ◽  
Brian Taylor ◽  
Lana Dixon ◽  
Mark Harbinson ◽  
...  
Keyword(s):  
American Literature ◽  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
Empirical Studies ◽  
Cardioverter Defibrillator ◽  
Dutch Study ◽  
Ethical And Legal Considerations ◽  
Individualised Care ◽  
Patient’S Perception ◽  
Positive Outlook

Background: Individualised care at the end of life requires professional understanding of the patient’s perception of implantable cardioverter defibrillator deactivation. Aim: The aim was to evaluate the evidence on patients’ perception of implantable cardioverter defibrillator deactivation at end of life. Design: Systematic narrative review of empirical studies was published during 2008–2014. Data Sources: Data were collected from six databases, citations from relevant articles and expert recommendations. Results: In all, 18 studies included with collective population of n = 5810. Concept mapping highlighted three themes: (1) Diverse preferences regarding discussion and deactivation. Deactivation was rarely discussed pre-implantation, with some studies demonstrating patients’ reluctance to discuss implantable cardioverter defibrillator deactivation at any stage. Two studies found the majority of patients valued such discussions. Diversity was reflected in patients’ willingness to deactivate, ranging from 12% (n = 9) in Irish cohort to 79% (n = 195) in Dutch study. (2) Ethical and legal considerations were predominant in Canadian and American literature as patients wanted to contribute but felt the decision should be a doctor’s responsibility. Advance directives were uncommon in Europe, and where they existed the implantable cardioverter defibrillator was not mentioned. (3) ‘Living in the now’ was evident as despite deteriorating symptoms many patients maintained a positive outlook and anticipated surviving more than 10 years. Several studies asserted living longer was more important than quality of life. Conclusion: Patients regard the implantable cardioverter defibrillator as a complex and solely beneficial device, with little insight regarding its potential impact on a peaceful death. This review confirms the need for professionals to discuss with patients and families implantable cardioverter defibrillator functionality and deactivation at appropriate opportunities.

Physicians' Preferences and Attitudes About End-of-Life Care in Patients With an Implantable Cardioverter-Defibrillator

2008 ◽  
Vol 83 (10) ◽  
pp. 1139-1141 ◽  
Author(s):  
Saadia Sherazi ◽  
James P. Daubert ◽  
Robert C. Block ◽  
Vinodh Jeevanantham ◽  
Khalid Abdel-Gadir ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Cardioverter Defibrillator
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