BACKGROUND: Implantable cardioverter-defibrillators (ICDs) improve survival in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation. Unless deactivated, ICDs may deliver unwanted shocks to terminally ill patients near the time of death. This study sought to determine the frequency and nature of adverse experiences with ICDs in hospice programs and what preventative measures the programs had taken. METHOD: A mailed survey to all 50 Oregon Hospice Programs in August 2008. RESULTS: 42 (84%) of 50 programs participated. In all 36 (86%) of 42 programs reported having taken care of a patient with an ICD in the preceding 4 years. The average number of patients with ICDs per program increased from 2.2 (SD 2.5) in 2005 and 2006 to 3.6 (SD 3.7) in 2007 and 2008. Of the 36 programs who had cared for a patient with an ICD, 31 (86%) reported having some kind of adverse experience. These 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. DISCUSSION: As patients near the end of their lives, receiving defibrillating shocks may no longer be consistent with their goals of care. Based on the high frequencies of potentially preventable adverse outcomes documented by this study, we propose that hospices routinely screen patients for ICDs and proactively adopt policies to manage them, rather than in response to an adverse event.
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) improve survival in patients at risk for recurrent, sustained ventricular tachycardia or fibrillation. Unless deactivated, ICDs may deliver unwanted shocks to terminally ill patients near the time of death. This study sought to determine the frequency and nature of adverse experiences with ICDs in hospice programs and what preventative measures the programs had taken. METHOD: A mailed survey to all 50 Oregon Hospice Programs in August 2008. RESULTS: 42 (84%) of 50 programs participated. In all 36 (86%) of 42 programs reported having taken care of a patient with an ICD in the preceding 4 years. The average number of patients with ICDs per program increased from 2.2 (SD 2.5) in 2005 and 2006 to 3.6 (SD 3.7) in 2007 and 2008. Of the 36 programs who had cared for a patient with an ICD, 31 (86%) reported having some kind of adverse experience. These 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. DISCUSSION: As patients near the end of their lives, receiving defibrillating shocks may no longer be consistent with their goals of care. Based on the high frequencies of potentially preventable adverse outcomes documented by this study, we propose that hospices routinely screen patients for ICDs and proactively adopt policies to manage them, rather than in response to an adverse event.
Authors: Rachel Lampert; David L Hayes; George J Annas; Margaret A Farley; Nathan E Goldstein; Robert M Hamilton; G Neal Kay; Daniel B Kramer; Paul S Mueller; Luigi Padeletti; Leo Pozuelo; Mark H Schoenfeld; Panos E Vardas; Debra L Wiegand; Richard Zellner Journal: Heart Rhythm Date: 2010-05-14 Impact factor: 6.343
Authors: Stefan H Hohnloser; Karl Heinz Kuck; Paul Dorian; Robin S Roberts; John R Hampton; Robert Hatala; Eric Fain; Michael Gent; Stuart J Connolly Journal: N Engl J Med Date: 2004-12-09 Impact factor: 91.245
Authors: A J Moss; W J Hall; D S Cannom; J P Daubert; S L Higgins; H Klein; J H Levine; S Saksena; A L Waldo; D Wilber; M W Brown; M Heo Journal: N Engl J Med Date: 1996-12-26 Impact factor: 91.245
Authors: Nathan E Goldstein; Rachel Lampert; Elizabeth Bradley; Joanne Lynn; Harlan M Krumholz Journal: Ann Intern Med Date: 2004-12-07 Impact factor: 25.391
Authors: Daniel Y Choi; Michael P Wagner; Brian Yum; Deanna Pereira Jannat-Khah; Derek C Mazique; Daniel J Crossman; Jennifer I Lee Journal: BMJ Open Qual Date: 2019-12-04