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Implantable cardioverter defibrillator(ICD) deactivation discussions: Realityversus recommendations

Fitzsimons, Donna, McIlfatrick, Sonja and Taylor, Brian (2015) Implantable cardioverter defibrillator(ICD) deactivation discussions: Realityversus recommendations. european journal of Cardiovascular Nursing, 1 . [Journal article]

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DOI: DOI: 10.1177/1474515115584248


Background: The implantable cardioverter defibrillator (ICD) is a cornerstone in the treatment of life-threateningarrhythmias. As rates of device implantation continue to rise throughout Europe, European and International guidelinesrecommend professionals discuss deactivation with patients. In reality the appropriate therapeutic management of anICD at the end-of-life remains uncertain in the minds of professionals and patients.Aim: To identify current practice and examine professional decision-making for patients with an ICD from time ofimplantation to final documentation and demise.Methods: Retrospective case note review of patients with an ICD who died during a 12 month period at a regionalimplantation centre.Results: Fifty-nine patients were identified and medical notes of 44 of these patients were successfully retrieved. Themajority of patients were male, mean age at time of death 73 years with one-third diagnosed with a malignancy prior todeath. There was no documented evidence patients were informed about deactivation prior to ICD implantation. Endof-life management was discussed with 23 patients and on 17 occasions deactivation was included. Median time fromdiscussion to death was seven days. In total 62.5% of patients who experienced a shock had an active ICD at death, while93.7% who had their ICD deactivated never had a shock (p=0.003).Conclusion: Patients were not adequately informed regarding device deactivation prior to implantation, nor whentheir health deteriorated. The experience of a shock potentially affects professional decision making regarding devicedeactivation

Item Type:Journal article
Keywords:Implantable cardioverter defibrillator, professional decision-making, palliative care, end-of-life care
Faculties and Schools:Faculty of Social Sciences > School of Sociology and Applied Social Studies
Faculty of Life and Health Sciences > School of Nursing
Faculty of Life and Health Sciences
Faculty of Social Sciences
Research Institutes and Groups:Institute for Research in Social Sciences > Social Work & Social Policy
Institute of Nursing and Health Research
Institute of Nursing and Health Research > Managing Chronic Illness Research Centre
Institute for Research in Social Sciences
ID Code:31661
Deposited By: Professor Sonja McIlfatrick
Deposited On:27 May 2015 13:27
Last Modified:27 May 2015 13:27

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