TY - JOUR
T1 - Managing Implantable Cardioverter-Defibrillators at End-of-Life
T2 - Practical Challenges and Care Considerations
AU - Khera, Rohan
AU - Pandey, Ambarish
AU - Link, Mark S.
AU - Sulistio, Melanie S.
N1 - Publisher Copyright:
© 2018
PY - 2019/2
Y1 - 2019/2
N2 - Implantable cardioverter-defibrillators (ICDs) monitor for and terminate malignant arrhythmias. Given their potential as a life-saving therapy, an increasing number of people receive an ICD every year, and a growing number are currently living with ICDs. However, cardiopulmonary arrest serves as the final common pathway of natural death, and the appropriate management of an ICD near the end-of-life is crucial to ensure that a patient's death is not marked by further suffering due to ICD shocks. The tenets of palliative care at the end-of-life include addressing any medical intervention that may preclude dying with dignity; thus, management of ICDs during this phase is necessary. Internists are at the forefront of discussions about end-of-life care, and are likely to find discussions about ICD care at the end-of-life particularly challenging. The present review addresses issues pertaining to ICDs near the end of a patient's life and their potential impact on dying patients and their families. A multidisciplinary, patient-centered approach can ensure that patients receive the maximum benefit from ICDs, without any unintended pain or suffering.
AB - Implantable cardioverter-defibrillators (ICDs) monitor for and terminate malignant arrhythmias. Given their potential as a life-saving therapy, an increasing number of people receive an ICD every year, and a growing number are currently living with ICDs. However, cardiopulmonary arrest serves as the final common pathway of natural death, and the appropriate management of an ICD near the end-of-life is crucial to ensure that a patient's death is not marked by further suffering due to ICD shocks. The tenets of palliative care at the end-of-life include addressing any medical intervention that may preclude dying with dignity; thus, management of ICDs during this phase is necessary. Internists are at the forefront of discussions about end-of-life care, and are likely to find discussions about ICD care at the end-of-life particularly challenging. The present review addresses issues pertaining to ICDs near the end of a patient's life and their potential impact on dying patients and their families. A multidisciplinary, patient-centered approach can ensure that patients receive the maximum benefit from ICDs, without any unintended pain or suffering.
KW - Goals of care
KW - Informed decision-making
KW - Palliative care
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U2 - 10.1016/j.amjms.2018.11.016
DO - 10.1016/j.amjms.2018.11.016
M3 - Review article
C2 - 30665495
AN - SCOPUS:85059650794
SN - 0002-9629
VL - 357
SP - 143
EP - 150
JO - American Journal of the Medical Sciences
JF - American Journal of the Medical Sciences
IS - 2
ER -