Trends in time in the management of the implantable cardioverter defibrillator in the last phase of life: a retrospective study of medical records.
Eur J Cardiovasc Nurs
; 18(6): 449-457, 2019 08.
Article
em En
| MEDLINE
| ID: mdl-30995145
ABSTRACT
BACKGROUND:
The implantable cardioverter defibrillator (ICD) might give unwanted shocks in the last month of life. Guidelines recommend deactivation of the ICD prior to death.AIMS:
The aims of this study were to examine trends in time (2007-2016) in how and when decisions are made about ICD deactivation, and to examine patient- and disease-related factors which may have influenced these decisions. In addition, care and ICD shock frequency in the last month of life of ICD patients are described.METHODS:
Medical records of a sample of deceased patients who had their ICD implanted in 1999-2015 in a Dutch university (n = 308) or general (n = 72) hospital were examined.RESULTS:
Median age at death was 71 years, and 88% were male. ICD deactivation discussions increased from 6% for patients who had died between 2007 and 2009 to 35% for patients who had died between 2013 and 2016. ICD deactivation rates increased in these periods from 16% to 42%. Presence of do-not-resuscitate (DNR) orders increased from 9% to 46%. Palliative care consultations increased from 0% to 9%. When the ICD remained active, shocks were reported for 7% of patients in the last month of life. Predictors of ICD deactivation were the occurrence of ICD deactivation discussions after implantation (OR 69.30, CI 26.45-181.59), DNR order (OR 6.83, CI 4.19-11.12), do-not-intubate order (OR 6.41, CI 3.75-10.96), and palliative care consultations (OR 8.67, CI 2.76-27.21).CONCLUSION:
ICD deactivation discussions and deactivation rates have increased since 2007. Nevertheless, ICDs remain active in the majority of patients at the end of life, some of whom experience shocks.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Assistência Terminal
/
Desfibriladores Implantáveis
/
Suspensão de Tratamento
/
Tomada de Decisões
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Qualitative_research
Limite:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Eur J Cardiovasc Nurs
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
ENFERMAGEM
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Holanda