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 togethe
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