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JACC April 5, 2016

Volume 67, Issue 13

Arrhythmias and Clinical EP

IMPLANTABLE DEFIBRILATOR MANAGEMENT NEAR THE END OF LIFE: DO PATIENTS KNOW
ENOUGHT TO DECIDE?
Poster Contributions
Poster Area, South Hall A1
Monday, April 04, 2016, 9:45 a.m.-10:30 a.m.

Session Title: Clinical Care of Patients With Implanted Devices

Abstract Category: 18. Arrhythmias and Clinical EP: Devices
Presentation Number: 1266-324

Authors: Silvia del Castillo, Miguel Angel Arias, Roger Villuendas, Marta Pachon, Alberto Puchol, Damia Pereferrer, Alejandro Curcio,
Hospital Universitario de Fuenlabrada, Madrid, Spain
Background: Management of ICD therapies in terminal patients or patients with a bad quality of life is complex. About 33% of the patients
with an ICD implanted can receive painful and stressing shocks in the last day of life if those therapies are not deactivated. Patient
autonomy is a bioethics imperative. In order to respect it, patients should be informed of the possibility and have a complete understanding
of the consequences of deactivation.
Methods: We carried out a survey among 243 consecutive adult patients (21% female) in the outpatient clinic of 3 University Hospitals.
Questions were organized in 3 fields: Motivation of the implant, Basic ICD function and shocks and, end-of-life management. Age, sex and
educational background were also registered.
Results: Patients had a high level of knowledge of the reason of the implant and a basic knowledge of their functioning (91% described
correctly the reason for implant, 86% could name the device, 66% knew that an ICD does not cure their illness and 74% that they can
have a cardiac death after the implant). Their knowledge about shocks was very variable: 64% knew shocks are painful, 78% knew that an
ICD can be programmed but 68% think that shocks are inevitable in the presence of a ventricular tachycardia. Patients were remarkably
unaware of their right to decide in end-of-life questions regarding their ICD (just 38% think they can decide to deactivate after consulting
with their doctors), and were confused about what ICD deactivation means (21% think that deactivation leads to immediate heart arrest).
Just 37% knew that ICD deactivation is ethically appropriate and recommended by the scientific societies. Surprisingly a higher level of
education did not imply a better knowledge of the patients’ rights or an understanding of the bioethical questions regarding their device
management.
Conclusions: Knowledge of ICD functions and possibility of reprogramming, especially concerning end-of-life decisions among ICD
patients must be improved in order to respect their right to autonomous decisions.