Background Increasing numbers of patients with Implantable Cardioverter Defibrillators (ICDs) are being referred to the hospice; they may not be identified early enough to enable deactivation in an outpatient setting. There are differences in the two local hospitals’ community deactivation provision. A magnet may be needed for emergency deactivation at the end of life to prevent unnecessary shocks. One in three people with ICDs will receive multiple shocks in the last days of life; these can be painful, futile and distressing for patients and their families (Kinch Westerdahl, Sjöblom, Mattiasson, et al. Circulation. 2014; 129(4):422–9). Integrated working with local cardiology services is important for optimal patient care (Hodson, DeCourcey, Karwatoski, et al. BMJ Support Palliat Care. 2019; 9:A4).
Aims To highlight the increasing number of patients with ICDs and identify the complexities that arise. To improve early identification of these patients and ensure staff are confident to initiate timely advance care planning conversations. Ultimately, to improve pathways, enabling ICD deactivation at an appropriate time and place.
Methods Collection of data over two years on referral identification, time from deactivation request to actual deactivation and case studies illustrating patient journeys to deactivation and death. Teaching session to clinical staff to present data.
Results 22 pts referred to hospice with active ICD (16 in year 2).
6/22 documented ICD on referral.
16 deactivated since referral: 3 discharged, 13 died.
5/16 deactivated at home.
1/16 deactivated on hospice IPU.
5/16 deactivated using emergency magnet at home (despite deactivation being requested; range 7–17 days prior).
3/16 deactivated whilst inpatient in hospital.
2/16 deactivated in cardiology outpatients.
1 received multiple shocks in week prior to death.
Conclusions Consistent with other centres (Nolan, Smyth, Nash, et al. Heart. 2019;105:A3-A4), an increasing number of people with active ICDs are being referred to the hospice. They are often not identified early enough to allow timely discussions and deactivation. Staff value education and support on managing emergency magnet placement at the end of life. Resource boxes are now in place across hospice sites. The resource boxes contain local guidelines, contact numbers and emergency magnets and tape. Further liaison is planned with the two local pacing teams.