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Guidelines for heart device decisions at end of life

May 03, 2010

An implanted defibrillator can save a life by delivering an electric shock to restart the heart. But that shock can cause unnecessary discomfort during the final days of life.

This month new guidelines were announced at the meeting of the Heart Rhythm Society in Denver that suggest terminally ill patients should make their own decisions as to whether they'd like defibrillators, pacemakers or other heart-assisting devices removed.

“This is a situation we face more and more often,” notes Yale Medical Group cardiologist Rachel Lampert, MD. “As the population ages and the number of patients with defibrillators continues to grow, the issue of how to manage defibrillators as patients near the ends of their lives becomes more important.” Lampert is co-chair of a committee that recently presented a consensus statement on the management of cardiovascular implantable electronic devices.

Most medical institutions do not have policies for deactivating electronic heart devices. One study showed that only 10 percent of 400 hospices had guidelines for disconnecting implanted defibrillators.

“At Yale, we looked at our own population and found that up to 20 percent of patients with defibrillators got shocked in the weeks before death,” Lampert said.

Lampert worked with David Hayes, MD, of the Mayo Clinic, Rochester, Minn., in assembling a committee that included ethicists, lawyers, a nurse and a patient, as well as other physicians. The group developed a statement in cooperation with the American College of Cardiology, the American Heart Association and other organizations.

The statement recommends above all that caregivers communicate with patients with implanted devices about the option of deactivation as the end of their lives near.

  • Other provisions of the statement:
  • Adult patients may make decisions on continuing or stopping treatment. The decision can be made by a designated surrogate when a patient lacks capacity.If a physician or other caregivers finds device deactivation conflicts with their ethical values, the issue should be given to a colleague who is willing to carry out the task.
Submitted by Mark Santore on January 22, 2014