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[Device therapy in cardiological palliative care situations].

Jochen Dutzmann1, Carsten W Israel2

  • 1Mitteldeutsches Herzzentrum, Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland. jochen.dutzmann@uk-halle.de.

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Summary

Managing cardiac implantable electronic devices (CIEDs) in palliative care requires clear communication. Educating patients and staff on CIED deactivation ensures comfort and reduces suffering at the end of life.

Keywords:
Cardiac implantable electronic devicesImplantable cardioverter/defibrillatorPalliative careShock therapyTerminal heart failure

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Area of Science:

  • Cardiology
  • Palliative Care
  • Medical Ethics

Background:

  • Significant uncertainty exists regarding the management of patients with cardiac implantable electronic devices (CIEDs) facing end-of-life situations.
  • Patients, families, and healthcare providers experience anxiety about device function and deactivation, particularly concerning pacing and shock therapies.
  • Misinformation can lead to prolonged suffering and distress for patients and guilt for medical staff.

Purpose of the Study:

  • To clarify the role of CIEDs in palliative care.
  • To provide guidance on managing CIEDs for patients with limited prognosis.
  • To inform healthcare professionals about device deactivation procedures and communication strategies.

Main Methods:

  • Review of CIED functions (pacing, resynchronization, antitachycardia pacing, shock therapy).
  • Explanation of deactivation methods, including magnet application for ICDs.
  • Emphasis on patient education and empathic communication strategies.

Main Results:

  • Pacemakers and cardiac resynchronization therapy primarily manage symptoms like dyspnea, without prolonging life in palliative care.
  • Implantable cardioverter-defibrillators (ICDs) can be deactivated using a magnet, eliminating the need for specialized programmers.
  • Effective communication and understanding of CIED functions are crucial for appropriate end-of-life management.

Conclusions:

  • Patients should be informed that CIEDs in palliative care aim to alleviate suffering, not extend life.
  • Palliative care physicians must understand CIED functions and deactivation to prevent iatrogenic suffering.
  • Training medical staff in empathic discussions about CIED deactivation is essential for patient and family well-being.