Abstract P72: Pattern of Deactivation of Implantable Cardioverter Defibrillator in Inpatient Hospice Units

Background: There have been an increasing number of patients receiving implantable cardioverter defibrillators (ICDs) over the last decade. Although ICDs prevent arrhythmic death, patients may still develop other terminal illnesses, or progression of underlying heart failure. ICD- delivered shocks are associated with significant pain, anxiety and reduced quality of life. Therefore for this population of patients, it may become undesirable to receive shock therapy nearing the end of life. We reviewed the practices for ICD deactivation on a series of patients admitted to a hospice center. We hypothesized that for patients with ICDs, the frequency for ICD deactivation at end of life would be low. Methods: In this retrospective study we reviewed records of patients with ICDs who were admitted to the Hildebrandt Hospice Care Center, an inpatient hospice facility, in Rochester NY from January 2005 to December 2009. Information regarding patient's demographics, indications for ICD implantation, deactivation of ICD (frequency, location) and history of shock in hospice care was recorded. Results: We identified 32 patients who were admitted to inpatient hospice with ICDs for primary prevention of sudden cardiac arrest. The mean age was 78 + 9 years and 23 out of 32 (72%) were male. Sixteen patients had metastatic cancer, 8 patients had sepsis, 4 patients had stroke, 3 patients had renal disease and one patient had liver disease. Twenty (62%) patients had their ICD deactivated in the hospital before transferring to inpatient hospice. Nine (28%) patients were transferred to the center without ICD deactivation. Among these patients, 3 (10%) received ICD shock while in hospice and subsequently died in the center (average 2 days after receiving the shock). Three (10%) patients refused to have their ICD deactivated. Out of these three patients, two died in the hospice center while one patient was discharged home and none of them had ICD shock during hospice admission. Conclusion: The discussion about ICD deactivation should be initiated in terminally ill patients who are opting for hospice care for end of life care. Deactivating the device allows patients to die without the discomfort of electric shocks.