The prevalence of implantable defibrillator devices is increasing in the UK. These devices may prevent sudden cardiac death from arrhythmias, however, they do not alter disease trajectory in chronic conditions. Patients approaching end of life are predisposed to arrhythmias. This may lead to patients with implantable defibrillators receiving a shock in their final days of life which could be distressing and inappropriate when comfort is the priority. Despite this, elective deactivation of defibrillator devices is infrequently discussed and is often left until the last days of life.
An online survey of healthcare professionals was performed to assess attitudes toward device deactivation and knowledge of local procedures for deactivation. A total of 30 responses were collected. Responders were doctors and specialist nurses with variable clinical experience from a variety of specialties.
Only 50% of individuals were able to correctly identify all implantable devices that contained a defibrillator component. Thirteen individuals felt they knew the protocol for arranging a planned deactivation of devices, however, only six individuals were able to correctly describe the process.
77% of individuals felt that deactivation should be discussed as soon as possible in a patient identified as being in their last year of life and 73% felt that anyone involved in the patient’s care should be able to have this discussion. In spite of this, when asked to rank their confidence having the conversation, the mean score was 54/100.
The most selected appropriate timescale between defibrillator deactivation and death from a chronic disease was months and 87% of individual felt that deactivation should occur in the outpatient setting or community rather than during an acute admission.
In summary, healthcare professionals felt that deactivation should be discussed and planned at the earliest opportunity, however, many did not feel confident having this discussion and were unable to identify all devices containing defibrillators or describe the local procedure for deactivation.
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