Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice
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Neth Heart J https://doi.org/10.1007/s12471-020-01438-6
Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice R. Stoevelaar · A. Brinkman-Stoppelenburg · R. L. van Bruchem-Visser · A. G. van Driel · R. E. Bhagwandien · D. A. M. J. Theuns · J. A. C. Rietjens · A. van der Heide
© The Author(s) 2020
Abstract The implantable cardioverter defibrillator (ICD) is effective in terminating life-threatening arrhythmias. However, in the last phase of life, ICD shocks may no longer be appropriate. Guidelines recommend timely discussion with the patient regarding deactivation of the shock function of the ICD. However, research shows that such conversations are scarce, and some patients experience avoidable and distressful shocks in the final days of life. Barriers such as physicians’ lack of time, difficulties in finding the right time to discuss ICD deactivation, patients’ reluctance to discuss the topic, and the fragmentation of care, which obscures responsibilities, prevent healthcare professionals from discussing this topic with the patient. In this point-of-view article, we argue that healthcare professionals who are involved in the care for ICD patients should be better educated on how to communicate with patients about ICD deactivation and the end of life. Optimal communication is needed to reduce the number of patients experiencing inap-
R. Stoevelaar () · A. Brinkman-Stoppelenburg · J. A. C. Rietjens · A. van der Heide Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands [email protected] R. L. van Bruchem-Visser Department of Internal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands A. G. van Driel Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands Rotterdam University of Applied Sciences, Rotterdam, The Netherlands R. E. Bhagwandien · D. A. M. J. Theuns Department of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
propriate and painful shocks in the terminal stage of their lives. Keywords Implantable cardioverter defibrillator · Decision-making · Withholding treatment · Palliative care · Advance care planning · End-of-life care
The implantable cardioverter defibrillator at the end of life The implantable cardioverter defibrillator (ICD) is highly effective in terminating potential life-threatening arrhythmias. However, for patients at the end of life, the goal of the ICD—prolonging survival—may no longer be appropriate. Guidelines recommend early and regular discussion of the appropriateness of the ICD shock function throughout the disease trajectory and subsequently deactivation of the ICD at the end of life [1, 2]. The Dutch Association of Cardiology (NVVC) released a guideline in 2013 [3] discussing the implications of the ICD at the end of life as well as the indication for and consequences of deactivating the device, but above all stresses the importance of discussing deactivation. Such discussions co
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