Deactivating cardioverter defibrillators near the end of lifeBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f558 (Published 30 January 2013) Cite this as: BMJ 2013;346:f558
When US researchers surveyed 95 adults with implantable cardioverter defibrillators, 67 (71%) said they would consider deactivating the device when approaching the end of life. Responses to a series of scenarios varied between 61% wanting deactivation if they had advanced incurable disease, to 24% wanting deactivation if they were permanently unable to get out of bed.
Respondents were all over 50 years old (response rate 95/136; 70%). Their cardioverter defibrillators had been in situ for a mean of four years. Just under a third had received at least one shock. They seemed more willing to consider deactivation than participants in previous surveys, but only after a brief teaching session about the purpose, benefits, and possible harms of cardioverter defibrillators. At the start of the survey, a sizeable minority had little idea what the device was for, how it was meant to help them, or what problems it might cause.
Dying people receive inappropriate and painful shocks in about half of US hospices each year, says a linked comment (doi:10.1001/jamainternmed.2013.2130). Conversations about these issues should start early and continue at yearly reviews of heart failure treatments.
Cite this as: BMJ 2013;346:f558