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ICDs in end-stage heart failure

Stephen J Pettit1, Susan Browne, Karen J Hogg

  • 1Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, UK.

BMJ Supportive & Palliative Care
|March 22, 2014
PubMed

Insights

Implantable cardioverter defibrillators (ICDs) may offer less benefit in advanced heart failure. Discussing ICD deactivation is crucial but often overlooked, highlighting a gap between best practice and patient care.

Area of Science:

  • Cardiology
  • Medical Ethics
  • Palliative Care

Background:

  • Implantable cardioverter defibrillators (ICDs) improve survival in select chronic heart failure patients.
  • Prognostic benefits of ICDs may diminish in end-stage heart failure.
  • The frequency of futile ICD shocks before death is not well-established.

Purpose of the Study:

  • To explore the uncertainty surrounding the futility of ICD therapy in end-stage heart failure.
  • To investigate patient and carer perspectives on ICD deactivation.
  • To identify barriers to discussing ICD deactivation in clinical practice.

Main Methods:

  • Literature review on ICD use in advanced heart failure.
  • Analysis of clinical guidelines and expert consensus.
  • Qualitative research exploring patient and healthcare professional views (implied).

Main Results:

  • The prognostic benefit of ICDs likely decreases as heart failure progresses.
  • Decisions regarding ICD futility are best made by individual patients with professional support.
  • Routine discussion of ICD deactivation is recommended but infrequently practiced.

Conclusions:

  • Patient and carer opinions on ICD deactivation may differ from healthcare professionals' expectations.
  • Further research is needed on patient/carer views and interventions to improve deactivation discussions.
  • Bridging the gap between recommended practice and actual clinical implementation is essential.

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