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Life-saving devices reach the end of life with heart failure

Daniel D Matlock1, Lynne Warner Stevenson

  • 1University of Colorado School of Medicine, Aurora, CO 80045, USA. Daniel.matlock@ucdenver.edu

Progress in Cardiovascular Diseases
|December 11, 2012
PubMed

Insights

Discussions regarding deactivating life-prolonging devices like implantable cardioverter-defibrillators (ICDs) and ventricular assist devices (VADs) are crucial for advanced heart failure patients. These conversations should be standard care before and during treatment, including end-of-life planning.

Area of Science:

  • Cardiology
  • Medical Ethics
  • Palliative Care

Background:

  • Increasing use of life-prolonging devices like implantable cardioverter-defibrillators (ICDs) and ventricular assist devices (VADs) in advanced heart failure.
  • Most patients with these devices die with them in place, necessitating end-of-life care considerations.
  • Clinicians must provide comprehensive care throughout the patient's therapy, including the end-of-life phase.

Purpose of the Study:

  • To emphasize the importance of device deactivation discussions for patients with advanced heart failure.
  • To advocate for these discussions to become the standard of care at various critical points in therapy.
  • To analyze the evidence surrounding device deactivation at the end-of-life and propose improvements.

Main Methods:

  • Review of current clinical practices and ethical considerations regarding device deactivation.
  • Discussion of legal aspects of deactivating ICDs and VADs.
  • Analysis of evidence related to end-of-life device management in heart failure patients.

Main Results:

  • Device deactivation discussions are not yet standard care but are legally equivalent whether for ICDs or VADs.
  • VAD disconnection has a more immediate impact on survival compared to ICD deactivation.
  • There is a need for improved strategies and evidence to guide end-of-life device management.

Conclusions:

  • Discussions about deactivating life-prolonging devices should be integrated into routine care for advanced heart failure patients.
  • Timing of these discussions is critical: prior to implantation, during follow-ups, and as end-of-life approaches.
  • Further research and standardized guidelines are needed to optimize end-of-life care for patients with cardiac devices.

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