It may come as somewhat of a surprise to find out that physicians don’t always think about defibrillator care when considering end of life issues, which can lead to very unpleasant experiences for dying patients. What do I mean? Well, an implantable cardioverter-defibrillator (ICD) is a device which can be inserted into patients who have heart rhythm problems. Its job is to shock the heart into proper rhythm when it goes astray. However, this may not be desired in someone who has made the decision to use hospice care in order to die as peacefully and pain-free as possible. If an ICD is not deactivated, it can go off repeatedly and deliver very unpleasant shocks to the patient. A study published in this month’s Annals of Internal Medicine suggests that most hospices don’t routinely speak to patients about defibrillator decisions, and nearly 60% of hospices had at least one patient shocked within the past year, sometimes multiple times at once. More surprisingly, only one in twenty hospices had a method to identify whether a patient had an implant or not. Defibrillators continue to be implanted at incredible rates (more than 100,000 a year). Therefore, doctors taking care of patients near end of life should be more aware and proactive in speaking to them about what their wishes are regarding deactivation of their ICD. [via AP News]
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Dr. Steven Chang, the author of DailyDose, is a staff physician with Kosmix RightHealth. Dr. Chang practices Family Medicine at the University of California Davis Medical Center, where his medical interests include both pediatric and geriatric care, public health, gay and lesbian health, and sleep medicine. Dr. Chang trained at the Stanford University affiliated O'Connor Hospital, and was a research fellow at the National Institute of Health. He holds an M.D. from McGill University and a BA in Public Health from Johns Hopkins University.