Featured Research
This page features research conducted by RAND Health research staff that has been published in a scholarly journal.Management of Implantable Cardioverter Defibrillators in End-of-Life Care
Goldstein NE, Lampert R, Bradley E, Lynn J, Krumholz HM. Annals of Internal Medicine, Vol. 141, No. 11, Dec 7 2004, pp. 835-838, W-155.
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Background
Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing.
Objective
To describe the frequency, timing, and correlates of discussions about deactivating ICDs.
Design
Retrospective cohort study.
Setting
Telephone survey.
Participants
Next of kin of patients with ICDs who died of any cause. Of 136 next of kin contacted, 100 (74%) participated.
Measurements
Incidence of discussions about deactivating ICDs and timing of last shock from ICD.
Results
Multivariate analysis showed that patients in the West (referent group) had a higher OR of undergoing surgery than radiation compared with the Northeast, South or Midwest (OR 0.77, 95% CI 0.67 to 0.87, OR 0.86, 95% CI 0.76 to 0.98 and OR 0.75, 95% CI 0.64 to 0.87, respectively. Black men, men with lower grade and higher stage tumors, and unmarried men were less likely to undergo curative treatment and less likely to undergo surgery than radiation. Next of kin reported that clinicians discussed deactivating the ICD in only 27 of the 100 cases. Most discussions occurred in the last few days of life. Family members reported that 8 patients received a shock from their ICD in the minutes before death.
Limitations
This retrospective survey relied on the reports of next of kin.
Conclusions
Next of kin reported that clinicians discussed deactivating ICDs with few patients. Individuals who choose to receive this device should have the opportunity to choose to discontinue it as death approaches.
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