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90 Implantable cardiac defibrillator deactivation; contemporary outcomes from a large case series

Heart (British Cardiac Society), 2020-07, Vol.106 (Suppl 2), p.A70-A70 [Peer Reviewed Journal]

Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. ;2020 Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. ;ISSN: 1355-6037 ;EISSN: 1468-201X ;DOI: 10.1136/heartjnl-2020-BCS.90

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  • Title:
    90 Implantable cardiac defibrillator deactivation; contemporary outcomes from a large case series
  • Author: Garner, Daniel ; Blackburn, Matthew ; Llewellyn, Jennifer ; Rao, Archana ; Hughes, Sue ; Wright, David
  • Subjects: Patients
  • Is Part Of: Heart (British Cardiac Society), 2020-07, Vol.106 (Suppl 2), p.A70-A70
  • Description: IntroductionImplantable cardiac defibrillator (ICD) therapy is a lifesaving intervention for many of our patients, however with increasing age and competing comorbidity towards the end of life device therapy is often no longer advantageous. Historically advance care planning and discussions around deactivation of ICD’s have been lacking(1) and this has resulted in a large number of patients receiving inappropriate ICD shocks at the end of life.(2) We conducted a retrospective analysis of all patients under-going device deactivation to identify trends in outcomes and rates of inappropriate shock.MethodsOur electronic patient record was searched for all ICD deactivations between 2016 and 2019. These results were incorporated with hospital episode statistics to gather mortality and morbidity data.Abstract 90 Table 1Patient demographics No of patients (n= 327) Average age (range) 76.5 (27-96) Male 274 (84%) Female 53 (16%) Deceased 293 (90%) Average age of device (years) 5.1 Primary prevention 208 (64%) Secondary prevention 119 (36%) Severe LV impairment 276 (84%) CRT 168 (51%)Abstract 90 Table 2Outcomes after deactivation Shocks at the time of death 11 (3.8%) Average number of shocks 4.5 (range 1-18) Shocks in the last month of life 15 (5.1%) DNAR 149 (50.9%) Repeat hospital admission 5 Indications for deactivation; Patient felt to be end of life 200 (61%) Post death 97 (29%) Patient preference 23 (7%) Other/unknown 8 (3%) Location of de-activation; Inpatient hospital setting 149 (45%) Outpatient clinic 50 (15%) Patients home 36 (11%) Hospice 5 (2%) Mortuary/funeral home 87 (27%) Timing of device deactivation; After death 97 (29%) Day of death 24 (7%) 1-5 days 56 (17%) 6-10 days 13 (4%) 11-30 days 39 (12%) 31 days or more 98 (30%)ResultsDuring the study period 327 patients had device deactivation performed and 293 unfortunately died. The cohort was predominantly male (84%) and the ICD had been implanted for on average 5.1 years, with devices predominantly implanted for primary prevention (64%). Devices were most commonly deactivated in the inpatient hospital setting (45%), with 15% turned off in clinic and 11% in the patients home. 71% of deactivations occurred prior to death with palliative/end of life care being the most common indication. 29% had devices deactivated after death and this caused 11 (3.8%) patients to have one or multiple shocks at the time of death (range 1-18, mean 4.5). 5.1% of patients received shocks in the last month of life.ConclusionsA significant proportion of ICDs are still deactivated after death. The number of patients experiencing shocks at the end of life was lower than previously published literature but this is still a source of significant avoidable morbidity. ICD deactivation should be discussed with patients prior to implant and services need to be able to regularly review the ongoing appropriateness of device therapy.Conflict of InterestNone
  • Publisher: London: BMJ Publishing Group LTD
  • Language: English
  • Identifier: ISSN: 1355-6037
    EISSN: 1468-201X
    DOI: 10.1136/heartjnl-2020-BCS.90
  • Source: ProQuest Central
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