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Hospices not deactivating defibrillators in patients
Date:3/1/2010

Researchers from Mount Sinai School of Medicine have found that patients admitted to hospice care who have an implantable cardioverter defibrillator (ICD) are rarely having their ICDs deactivated and are receiving electrical shocks from these devices near the end of life. This first-of-its-kind study of hospice patients with ICDs is published in the March 2, 2010 issue of the Annals of Internal Medicine.

Mount Sinai researchers surveyed 900 hospices, 414 of which responded. Ninety-seven percent of the responding hospices admitted patients with ICDs. On average, nearly 60 percent of patients did not have the shocking function of the ICD deactivated. Only 20 percent of hospices had a question on their intake forms to identify patients with ICDs, and just 10 percent reported having a policy in place to discuss deactivation with patients and their families.

An ICD is a device programmed to detect cardiac arrhythmias and shock the heart back into normal rhythm. ICDs are effective in preventing sudden cardiac death in patients with recurrent arrhythmias, but for patients in hospice care they may cause unnecessary pain, and significant stress and anxiety for their family members who feel helpless in watching their loved one suffer.

"Hospices are the foremost experts at dealing with the complex communication issues surrounding end-of-life discussions with patients and their families," said Nathan Goldstein, MD, assistant professor, Hertzberg Palliative Care Institute, Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine. "The fact that so few organizations have a policy about deactivation shows how complicated these conversations are. Having a policy in place can improve communication and provide better quality of care for patients and their families."

ICD shocks may cause physical and psychological distress for patients and their caregivers. Patients report that receiving shocks from an
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Contact: Mount Sinai Press Office
newsnow@mountsinai.org
212-241-9200
The Mount Sinai Hospital / Mount Sinai School of Medicine
Source:Eurekalert

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