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Majority of Patients Will Consider ICD Deactivation

Last Updated: January 30, 2013.

The majority of patients with implantable cardioverter-defibrillators (ICDs) would want ICD deactivation in at least one scenario describing deteriorating health outcomes common in patients approaching the end of life, according to a study published online Jan. 28 in JAMA Internal Medicine.

WEDNESDAY, Jan. 30 (HealthDay News) -- The majority of patients with implantable cardioverter-defibrillators (ICDs) would want ICD deactivation in at least one scenario describing deteriorating health outcomes common in patients approaching the end of life, according to a study published online Jan. 28 in JAMA Internal Medicine.

John A. Dodson, M.D., from Yale University in New Haven, Conn., and colleagues conducted a 20-minute telephone survey of ICD patients 50 years or older, including two open-ended questions related to ICDs and questions to examine preferences for ICD deactivation in five scenarios common among patients approaching the end of life. The five scenarios were: permanently unable to get out of bed; permanent memory problems; burden to family members; prolonged mechanical ventilation; and advanced incurable disease.

The researchers found that, of the 95 people participating in the survey, ICD placement occurred a mean duration of 4.0 years prior and 29 percent of participants had received a previous ICD shock. Sixty participants could not name a potential harm, while 31 participants reported unknown or no benefits of their ICD. Seventy-one percent of participants wanted ICD deactivation in at least one scenario. There was variation in response to scenarios, ranging from 61 percent wanting deactivation if facing advanced incurable disease to 24 percent wanting deactivation if permanently unable to get out of bed. Wanting deactivation was associated with race and disability but not age.

"We believe that our findings emphasize the importance of incorporating multiple patient-centered outcomes into advance care planning for ICD patients," the authors write.

One author disclosed financial ties to Medtronic and Boston Scientific.

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