Background Recommendations from NICE technology appraisals would suggest that the number of patients meeting the criteria for implantable cardioverter defibrillator (ICD) implantation is far greater than the current implantation rate in the UK. With an increasing number of centres implanting ICDs we can expect to see an increasing number of patients with ICDs in the palliative care setting over the next decade. Although for some patients their life-limiting illness will be of a cardiac nature, others will require palliative care for an unrelated pathology for example, advanced cancer. The impetus for this project came after noting an increasing number of patients at our regional cancer centre with ICD devices. A telephone survey of 8 specialist palliative care units (SPCUs) across South Wales was undertaken, where medical directors were asked if either guidelines or a policy for managing patients with ICDs were available to them. The survey identified a complete lack of guidelines for managing patients with ICDs at the end of life. Hence the need for concise and practical guidelines for the management of ICDs in palliative care inpatient settings was identified.

Aims and Methods To develop a guideline that would simplify the science of ICDs to non-cardiologists, provide information to help a palliative physician discuss available options with patients and their families and deliver practical advice on ICD deactivation both in an emergency setting and after death. Cardiologists from the two device implanting centres in South Wales were consulted and provided input throughout the guideline development process. The medical illustration department were approached to provide images to demonstrate emergency deactivation.

Conclusion Following development and national ratification of the guideline it has been introduced together with an education tool to the medical directors of SPCUs across Wales for implementation.