Background ICD patients may later develop a terminal illness. Concurrent hypoxia, sepsis, pain, heart failure and electrolyte disturbances may predispose shocks in final days of life which is distressing to both patients and their family. A previous audit within the Belfast Trust examined 44 patients with ICDs who died between 2012–2013 in which 16 (36.4%) had device deactivated pre-death. Our aim was to re-audit this for all Northern Ireland between 2013–2015.
Methods All patients who died with an ICD/CRT-D in situ between Sept 2013–Nov 2015 were included. Medical notes/and hospital electronic records were reviewed and patient and device characteristics recorded.
Results In total, 227 patients died with an implantable cardioverter defibrillator (ICD) in situ. Of these, 89 (39.2%) patients had their device deactivated prior to death to prevent inappropriate shock therapy, whilst 138 (60.8%) died with an active ICD in situ. Of the 138 that died with an active ICD: 17 (12.3%) had a diagnosis of a cancer for palliation only, a further 28 (20.3%) were being managed palliatively for non-cancerous conditions either in hospital or in the community and 7 (5.1%) patients were classified as having significant cognitive impairment. In this group ICD was mentioned in the most recent medical correspondence in 39 (28.2%). Overall, 65 (48.1%) had previously received a shock from their device, though previous history of shock did not influence likelihood of device deactivation (p = 0.665).
Conclusion Communication about ICD deactivation at end of life should be standard practice. More work is needed to ensure this occurs in an appropriate and timely manner.
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