The incidence and impact of implantable cardioverter defibrillator shocks in the last phase of life: An integrated review.
Rik Stoevelaar, Arianne Brinkman-Stoppelenburg, Rohit E Bhagwandien and 4 others
PMID 29772911WHAT IT FOUND
Patients with an active ICD can receive shocks in the last month, last 24 hours, or final hour of life.
Shocks were reported as distressing for patients, families, and hospice staff.
Key findings
01In studies of patients dying non-suddenly, 24% and 33% experienced one or more shocks in the last 24 hours, and 14% and 7% experienced one or more shocks in the final hour.
02In studies of patients dying suddenly, shocks in the final hour ranged from 22% to 66%.
03Surveyed clinicians and relatives reported shocks were distressing: 76% of physicians thought shocks distressing to patients, 74% of hospice administrators reported patient distress, and 92% of family members found witnessing shocks distressing.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The search was limited to English and excluded case reports, so some relevant evidence may be missing. Publication bias may have favoured studies with notable shock findings. Many incidence studies were small; only three included more than 100 participants. Seven incidence studies were 20 years or longer old, and current ICD programming may lower shocks. Most studies were conducted in the USA, which may limit generalisability to European patients. Impact evidence was limited to a few survey and retrospective reports, not patient-centred outcome studies or a tested deactivation intervention. Shock incidence varied widely, partly because death type, implantation era, and programming differed.
Declared interests
The authors declared no conflict of interest. Funding was from the Netherlands Organization for Health Research and Development.
The easy way to misread this
Do not read these percentages as current rates or proof that deactivation prevents distress. Most incidence studies are old, many small, and the review did not test deactivation or outcomes.