RT Journal Article
SR Electronic
T1 ICDs in end-stage heart failure
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP 94
OP 97
DO 10.1136/bmjspcare-2011-000176
VO 2
IS 2
A1 Pettit, Stephen J
A1 Browne, Susan
A1 Hogg, Karen J
A1 Connelly, Derek T
A1 Gardner, Roy S
A1 May, Carl R
A1 Macleod, Una
A1 Mair, Frances S
YR 2012
UL http://spcare.bmj.com/content/2/2/94.abstract
AB Implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients with chronic heart failure but prognostic benefit is likely to attenuate with progression to end-stage heart failure. The incidence of multiple futile ICD shocks before death is uncertain. Only individual patients, supported by their healthcare professionals, can decide when ICD therapy becomes futile in end-stage heart failure. Despite consensus that ICD deactivation should be routinely discussed, this rarely occurs in clinical practice for many reasons including uncertainty about when to initiate these discussions and reluctance to confront death and dying. Patient and carer opinions about end-stage heart failure and ICD deactivation may not meet professional expectations. Future research should focus on these opinions and examine interventions that bridge the gap between best practice and the reality of current clinical practice.