Navigation Links
As End of Life Nears, What to Do With Implanted Defibrillators?
Date:5/14/2010

New guidelines help patients, doctors decide on removal to avoid unnecessary shocks

FRIDAY, May 14 (HealthDay News) -- Until now no guidelines existed for one of the more difficult questions in medicine -- what to do with a heart-assisting device, such as an implanted defibrillator, in a patient's final days of life?

An implanted defibrillator delivers a potentially life-saving electric shock to restart a heart that stops beating. However, the shock can cause acute discomfort in the last days of life, when the goal is to minimize pain, and in this case continued use of the devices may conflict with a patient's wishes.

Now, expert guidelines announced Friday at the meeting of the Heart Rhythm Society in Denver suggest that, whenever possible, terminally ill patients should be free to make their own decisions as to whether they'd like the devices removed.

"This is a situation we face more and more often," noted Dr. Rachel Lampert, associate professor of cardiology at Yale University School of Medicine. "As the population in hospices grows, the issue of how to manage defibrillators becomes more important."

Lampert is co-chair of a committee scheduled to present a consensus statement on the management of pacemakers, defibrillators and other cardiovascular implantable electronic devices. The statement will also be published in the July issue of HeartRhythm.

Few medical institutions have policies about deactivating electronic heart devices. A recent study of more than 400 hospices found that just 10 percent had guidelines about disconnecting implanted defibrillators.

"At Yale, we looked at our own population and found that up to 20 percent of patients with defibrillators got shocked in the weeks before death," Lampert said.

She worked with Dr. David Hayes of the Mayo Clinic, Rochester, Minn., in assembling a committee to consider guidelines for the issue. "We put together a group of individuals with expertise in different areas," Lampert said. "It included an ethicist, a lawyer, a nurse and a psychiatrist."

The purpose of the statement "is to carry out a patient's wish to provide or withdraw therapy as the patient desires," said Dr. Richard Page, professor and chair of medicine at the University of Wisconsin and president of the Heart Rhythm Society.

Removing an implanted defibrillator near the end of life, "is not physician-assisted suicide or euthanasia," he stressed.

The statement, developed in cooperation with other organizations, including the American College of Cardiology and the American Heart Association, recommends above all that all patients with implanted electronic devices be encouraged to make advance directives.

"Ideally, you have the conversation and make the patient aware of his or her empowerment and what decision should be made before you get to this point," Page said.

Other provisions of the consensus statement:

  • All adult patients are assumed to be competent to make decisions on continuing or stopping treatment. When a patient lacks capacity, the decision can be made by a designated health care proxy.
  • Physicians or other caregivers cannot be compelled to carry out a procedure that conflicts with their ethical values. In such a case, the issue can be passed to a colleague who is willing to carry out the task.
  • The recommendations will give physicians and institutions a frame of reference, experts said. "At least now you have a consensus statement based on a number of perspectives and a literature review to provide guidance," Page said.

More information

To learn more about defibrillators, go to the U.S. National Heart, Lung, and Blood Institute.



SOURCES: Rachel Lampert, M.D., F.H.R.S., associate professor, cardiology, Yale University, New Haven, Conn.; Richard Page, M.D., professor and chair, medicine, University of Wisconsin, Madison, and President, Heart Rhythm Society; May 14, 2010, Heart Rhythm Society annual meeting, Denver; July 2010 HeartRhythm


'/>"/>
Copyright©2010 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. As Mother's Day Nears, Families Mourning Child's Death Plan for Compassionate Friends National Conference and Walk to Remember
2. Implanted Defibrillator Might Extend Life
3. In Tests, Implanted Monitor Detects Atrial Fibrillation
4. New Implanted Defibrillator May Be Simpler, Safer
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:12/8/2016)... ... 2016 , ... David J. Dykeman , Ginger Pigott , and ... speak at DeviceTalks West, Dec. 12, 2016, at the Fairmont Newport Beach in California. ... firm’s global Life Sciences & Medical Technology Group have been featured speakers at every ...
(Date:12/8/2016)... Tampa, Fla (PRWEB) , ... December 08, 2016 ... ... offering smarter modes of access for customers and employees that are both engaging ... ChangeGear 7 with Service Smart Technology, the software company revealed today its plans ...
(Date:12/8/2016)... ... 2016 , ... Catalent Pharma Solutions, the leading global provider ... products, today announced that it had joined the Pharmaceutical Supply Chain Initiative (PSCI). ... unite pharmaceutical and healthcare companies that share a vision of better, social, environmental ...
(Date:12/8/2016)... ... December 08, 2016 , ... STAT courier is pleased ... a convenient service for Texas, they are expanding their presence in Dallas. One of ... spree that will bring new jobs to the Dallas and Forth Worth market. STAT ...
(Date:12/8/2016)... ... December 08, 2016 , ... Today’s patients are encouraged to ... mind, SIGVARIS has created a new line of anti-embolism stockings to help prevent ... the benefits of graduated compression when transitioning from recovery to early rehabilitation. , ...
Breaking Medicine News(10 mins):
(Date:12/8/2016)... AMSTERDAM , December 8, 2016 Information ... TM metrics in Scopus , the world,s largest ... free access to comprehensive metrics for journals from over 5,000 publishers. ... publish, which journals to subscribe to and when to adjust a ... , , ...
(Date:12/8/2016)... 2016 According to the research report, ... is expected to be worth US$9.7 bn by the ... Between the forecast years of 2016 and 2024, the global ... The leading players operating in the global diabetes injection pens ... plc., Biocon Ltd., and Sanofi S.A. Transparency Market Research reports ...
(Date:12/8/2016)... 2016 According to a new market research report ... Therapeutic (Pain, Insulin)), End Use (Sports, Fitness, RPM), Type (Smart watch, Patch), ... global market, in terms of value, is projected to reach 12.14 Billion ... 18.0% during the forecast period. Continue Reading ... ...
Breaking Medicine Technology: