Nathan E Goldstein1, Harriet Mather2, Karen McKendrick2, Laura P Gelfman3, Mathew D Hutchinson4, Rachel Lampert5, Hannah I Lipman6, Daniel D Matlock7, Jacob J Strand8, Keith M Swetz9, Jill Kalman10, Jean S Kutner11, Sean Pinney12, R Sean Morrison3. 1. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York. Electronic address: Nathan.Goldstein@mssm.edu. 2. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; James J. Peters Veterans Affairs Medical Center, Bronx, New York. 4. Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine Tucson, Tucson, Arizona. 5. Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, Connecticut. 6. Hackensack University Medical Center, Hackensack, New Jersey; Hackensack Meridian School of Medicine at Seton Hall, Nutley, New Jersey. 7. Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado. 8. Division of General Internal Medicine, Department of Medicine, Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota. 9. Birmingham Veterans Affairs Medical Center, Department of Medicine and UAB Center for Palliative and Supportive Care, University of Alabama Birmingham, Birmingham, Alabama. 10. Lenox Hill Hospital, Northwell Health, New York, New York. 11. Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. 12. Division of Cardiology, Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND: Although implantable cardioverter-defibrillators (ICDs) reduce sudden death, these patients die of heart failure (HF) or other diseases. To prevent shocks at the end of life, clinicians should discuss deactivating the defibrillation function. OBJECTIVES: The purpose of this study was to determine if a clinician-centered teaching intervention and automatic reminders increased ICD deactivation discussions and increased device deactivation. METHODS: In this 6-center, single-blinded, cluster-randomized, controlled trial, primary outcomes were proportion of patients: 1) having ICD deactivation discussions; and 2) having the shocking function deactivated. Secondary outcomes included goals of care conversations and advance directive completion. RESULTS: A total of 525 subjects were included with advanced HF who had an ICD: 301 intervention and 224 control. At baseline, 52% (n = 272) were not candidates for advanced therapies (i.e., cardiac transplant or mechanical circulatory support). There were no differences in discussions (41 [14%] vs. 26 [12%]) or deactivation (33 [11%] vs. 26 [12%]). In pre-specified subgroup analyses of patients who were not candidates for advanced therapies, the intervention increased deactivation discussions (32 [25%] vs. 16 [11%]; odds ratio: 2.90; p = 0.003). Overall, 99 patients died; there were no differences in conversations or deactivations among decedents. SECONDARY OUTCOMES: Among all participants, there was an increase in goals of care conversations (47% intervention vs. 38% control; odds ratio: 1.53; p = 0.04). There were no differences in completion of advance directives. CONCLUSIONS: The intervention increased conversations about ICD deactivation and goals of care. HF clinicians were able to apply new communication techniques based on patients' severity of illness. (An Intervention to Improve Implantable Cardioverter-Defibrillator Deactivation Conversations [WISDOM]; NCT01459744). Published by Elsevier Inc.
RCT Entities:
BACKGROUND: Although implantable cardioverter-defibrillators (ICDs) reduce sudden death, these patients die of heart failure (HF) or other diseases. To prevent shocks at the end of life, clinicians should discuss deactivating the defibrillation function. OBJECTIVES: The purpose of this study was to determine if a clinician-centered teaching intervention and automatic reminders increased ICD deactivation discussions and increased device deactivation. METHODS: In this 6-center, single-blinded, cluster-randomized, controlled trial, primary outcomes were proportion of patients: 1) having ICD deactivation discussions; and 2) having the shocking function deactivated. Secondary outcomes included goals of care conversations and advance directive completion. RESULTS: A total of 525 subjects were included with advanced HF who had an ICD: 301 intervention and 224 control. At baseline, 52% (n = 272) were not candidates for advanced therapies (i.e., cardiac transplant or mechanical circulatory support). There were no differences in discussions (41 [14%] vs. 26 [12%]) or deactivation (33 [11%] vs. 26 [12%]). In pre-specified subgroup analyses of patients who were not candidates for advanced therapies, the intervention increased deactivation discussions (32 [25%] vs. 16 [11%]; odds ratio: 2.90; p = 0.003). Overall, 99 patientsdied; there were no differences in conversations or deactivations among decedents. SECONDARY OUTCOMES: Among all participants, there was an increase in goals of care conversations (47% intervention vs. 38% control; odds ratio: 1.53; p = 0.04). There were no differences in completion of advance directives. CONCLUSIONS: The intervention increased conversations about ICD deactivation and goals of care. HF clinicians were able to apply new communication techniques based on patients' severity of illness. (An Intervention to Improve Implantable Cardioverter-Defibrillator Deactivation Conversations [WISDOM]; NCT01459744). Published by Elsevier Inc.
Entities:
Keywords:
communication; heart failure; implantable defibrillator; palliative care
Authors: Nathan E Goldstein; Jill Kalman; Jean S Kutner; Erik K Fromme; Mathew D Hutchinson; Hannah I Lipman; Daniel D Matlock; Keith M Swetz; Rachel Lampert; Omarys Herasme; R Sean Morrison Journal: J Pain Symptom Manage Date: 2014-04-21 Impact factor: 3.612
Authors: Risa P Hayes; David W Baker; Jean-Christophe Luthi; Rebecca L Baggett; William McClellan; Dawn Fitzgerald; Frederick R Abrams; Dale Bratzler; David J Ballard Journal: Am J Med Qual Date: 2002 Nov-Dec Impact factor: 1.852
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: Laura P Gelfman; Marie Bakitas; Lynne Warner Stevenson; James N Kirkpatrick; Nathan E Goldstein Journal: J Palliat Med Date: 2017-05-12 Impact factor: 2.947
Authors: Amalia Karahalios; Laura Baglietto; John B Carlin; Dallas R English; Julie A Simpson Journal: BMC Med Res Methodol Date: 2012-07-11 Impact factor: 4.615
Authors: Ian B Kwok; Harriet Mather; Karen McKendrick; Laura Gelfman; Mathew D Hutchinson; Rachel J Lampert; Hannah I Lipman; Daniel D Matlock; Keith M Swetz; Jill Kalman; Sean Pinney; R Sean Morrison; Nathan E Goldstein Journal: J Palliat Med Date: 2020-06-29 Impact factor: 2.947
Authors: Rebecca E Ryan; Michael Connolly; Natalie K Bradford; Simon Henderson; Anthony Herbert; Lina Schonfeld; Jeanine Young; Josephine I Bothroyd; Amanda Henderson Journal: Cochrane Database Syst Rev Date: 2022-07-08
Authors: Linda C Chyr; Lyndsay DeGroot; Julie M Waldfogel; Susan M Hannum; Danetta H Sloan; Valerie T Cotter; Allen Zhang; JaAlah-Ai Heughan; Renee F Wilson; Karen A Robinson; Sydney M Dy Journal: Ann Fam Med Date: 2022 Jan-Feb Impact factor: 5.707
Authors: Laura P Gelfman; Rebecca L Sudore; Harriet Mather; Karen McKendrick; Mathew D Hutchinson; Rachel J Lampert; Hannah I Lipman; Daniel D Matlock; Keith M Swetz; Sean P Pinney; R Sean Morrison; Nathan E Goldstein Journal: Circ Heart Fail Date: 2020-09-02 Impact factor: 8.790
Authors: Laura P Gelfman; Harriet Mather; Karen McKendrick; Angela Y Wong; Mathew D Hutchinson; Rachel J Lampert; Hannah I Lipman; Daniel D Matlock; Keith M Swetz; Sean P Pinney; R Sean Morrison; Nathan E Goldstein Journal: J Card Fail Date: 2021-06 Impact factor: 6.592
Authors: Rebecca N Hutchinson; Caitlin Gutheil; Benjamin S Wessler; Hayley Prevatt; Douglas B Sawyer; Paul K J Han Journal: J Am Heart Assoc Date: 2020-08-31 Impact factor: 5.501