Management of Implantable Cardioverter Defibrillators in End-of-Life Care

Published in: Annals of Internal Medicine, v. 141, no. 11, Dec. 7, 2004, p. 835-838, W-155

Posted on RAND.org on January 01, 2004

by Nathan E. Goldstein, Rachel Lampert, Elizabeth Bradley, Joanne Lynn, Harlan M. Krumholz

Read More

Access further information on this document at www.annals.org

This article was published outside of RAND. The full text of the article can be found at the link above.

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: 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.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.