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End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy.

Publication ,  Journal Article
Sherazi, S; McNitt, S; Aktas, MK; Polonsky, B; Shah, AH; Moss, AJ; Daubert, JP; Zareba, W
Published in: Pacing Clin Electrophysiol
October 2013

BACKGROUND: Implantable cardioverter defibrillator (ICD)-delivered shocks can cause substantial distress, warranting consideration of ICD deactivation at end of life. This study was designed to describe the patterns of end-of-life management in patients with ICDs. METHODS: There was a retrospective chart review of 98 patients who died in the ICD arm of multicenter automated defibrillator implantation trial II (MADIT II). The pattern of ICD management and the frequency of ICD shocks delivered before death were reviewed. RESULTS: We identified three groups: Group 1 consisting of individuals who underwent ICD, deactivation, 15 (15%); Group 2 patients without ICD deactivation who were in hospice or with "do not resuscitate" (DNR) orders, 36 (37%); and Group 3 patients without ICD deactivation who were not in hospice care and did not have DNR orders, 47 (48%). Out of 15 deactivations, 11 (73%) occurred in the week before death. None of the patients in Group 1 received an ICD shock in the 24-hour period before death. However, one (3%) patient from Group 2 and nine (19%) patients from Group 3 had shocks during the 24 hours before death (P = 0.03). In the last week before death, three (20%), two (6%), and six (13%) patients received ICD shocks in the three groups, respectively (P = 0.28). CONCLUSIONS: In patients with terminal conditions who are at risk for imminent death, active management of the patient's ICD, including timely discussions regarding ICD deactivation, may reduce the risk of ICD shocks during the end of life.

Duke Scholars

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

October 2013

Volume

36

Issue

10

Start / End Page

1273 / 1279

Location

United States

Related Subject Headings

  • United States
  • Terminal Care
  • Survival Rate
  • Risk Assessment
  • Prosthesis Failure
  • Prevalence
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
 

Citation

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Sherazi, S., McNitt, S., Aktas, M. K., Polonsky, B., Shah, A. H., Moss, A. J., … Zareba, W. (2013). End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy. Pacing Clin Electrophysiol, 36(10), 1273–1279. https://doi.org/10.1111/pace.12188
Sherazi, Saadia, Scott McNitt, Mehmet K. Aktas, Bronislava Polonsky, Abrar H. Shah, Arthur J. Moss, James P. Daubert, and Wojciech Zareba. “End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy.Pacing Clin Electrophysiol 36, no. 10 (October 2013): 1273–79. https://doi.org/10.1111/pace.12188.
Sherazi S, McNitt S, Aktas MK, Polonsky B, Shah AH, Moss AJ, et al. End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy. Pacing Clin Electrophysiol. 2013 Oct;36(10):1273–9.
Sherazi, Saadia, et al. “End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy.Pacing Clin Electrophysiol, vol. 36, no. 10, Oct. 2013, pp. 1273–79. Pubmed, doi:10.1111/pace.12188.
Sherazi S, McNitt S, Aktas MK, Polonsky B, Shah AH, Moss AJ, Daubert JP, Zareba W. End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy. Pacing Clin Electrophysiol. 2013 Oct;36(10):1273–1279.

Published In

Pacing Clin Electrophysiol

DOI

EISSN

1540-8159

Publication Date

October 2013

Volume

36

Issue

10

Start / End Page

1273 / 1279

Location

United States

Related Subject Headings

  • United States
  • Terminal Care
  • Survival Rate
  • Risk Assessment
  • Prosthesis Failure
  • Prevalence
  • Middle Aged
  • Male
  • Humans
  • Heart Failure