ICDs result in adverse events at end of life

Policies for deactivation needed in hospice

Although implantable cardioverter-defibrillators (ICDs) improve survival in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation, the device can add to a patient's discomfort at the end of life.

Unless deactivated, ICDs may deliver unwanted shocks to terminally ill patients near the time of death. A study in the American Journal of Hospice and Palliative Care evaluates the adverse events that result in continued activation of the device.1 In addition to determining the frequency and nature of adverse experiences with ICDs, hospice programs were surveyed to determine preventive measures taken.

Forty-two of 50 hospices in Oregon participated in the study. A total of 36 respondents had cared for a patient with an ICD in the preceding 4 years. The average number of patients with ICDs per program increased from 2.2 in 2005 and 2006 to 3.6 in 2007 and 2008. Of the 36 programs that had cared for a patient with an ICD, 31 reported having some kind of adverse experience.

Adverse events ranged from unwanted shocks delivered (64%), patient/family distress related to the decision to deactivate the ICD (47%), and time delay in ICD deactivation (42%). Only 16 (38%) programs had policies for managing ICDs and only 19 (43%) routinely screened new patients for ICDs.

As patients near the end of their lives, receiving defibrillating shocks may no longer be consistent with their goals of care and hospices should routinely screen patients for ICDs and proactively adopt policies to manage them.

Reference

1. Fromme EK, Stewart TL, Jeppesen M, et. al. Adverse experiences with implantable defibrillators in Oregon hospices. Am J Hosp Palliat Care 2011; 28:304-309.