Trends in time in the management of the implantable cardioverter defibrillator in the last phase of life: a retrospective study of medical records.
Rik Stoevelaar, Arianne Brinkman-Stoppelenburg, Anne Geert van Driel and 6 others
PMID 30995145WHAT IT FOUND
Shocks in the last month or day did not clearly change from 2007 to 2016, but ICD deactivation discussions rose from 6% to 35% and deactivations from 16% to 42%. 71% died with an active device.
Key findings
01Discussions about ICD deactivation were documented in 21% of records overall and rose from 6% in 2007-2009 to 35% in 2013-2016.
02ICD deactivation before death was documented in 30% of records overall and rose from 16% in 2007-2009 to 42% in 2013-2016.
03Most patients died with an active ICD (71%), and shocks in the last month (7%) or last day (2%) did not show a clear change across periods.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective medical record review, so discussions or decisions made outside the hospital may not have been captured. The records could be incomplete, which may have led to underreporting of deactivation discussions. The study did not know the exact content of deactivation discussions. It included only two Dutch hospitals and a sampled subset of university hospital deaths, so it may not apply elsewhere. Most patients were men (88%), and cause of death was unknown for 90 patients (24%). The study reports associations, not proof that discussions or DNR orders caused deactivation.
Declared interests
The authors declared no conflicts of interest. The study was funded by The Netherlands Organization for Health Research and Development.
The easy way to misread this
Do not read the increase in deactivation discussions and deactivations as proof that shocks at the end of life have been reduced. 71% died with an active ICD, and shocks in the last month or day did not show a clear change across periods.