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Cardiologists' perspective on termination of pacemaker therapy-an anonymous survey among cardiologists in Germany
Irene Portig1, Elena Hofacker1, Philipp Sommer2
1Research Group Medical Ethics, Faculty of Medicine, Philipps University of Marburg, Baldingerstraße, 35043, Marburg, Germany.
Insights
Cardiologists are willing to withdraw pacemakers but hesitate when patients depend on them, fearing ethical and legal issues. Official guidelines are needed for pacemaker withdrawal decisions.
Area of Science:
- Cardiology
- Medical Ethics
Background:
- European consensus addresses implantable cardioverter defibrillator deactivation but lacks guidance on pacemaker withdrawal.
- Patient requests for pacemaker therapy withdrawal are increasing, posing ethical and medical challenges for healthcare professionals.
- This study addresses the gap in understanding physician attitudes towards pacemaker deactivation.
Purpose of the Study:
- To investigate the opinions, concerns, and attitudes of cardiologists regarding patient requests for pacemaker withdrawal.
- To identify factors influencing cardiologists' decisions on pacemaker deactivation.
Main Methods:
- An anonymous questionnaire was distributed to 288 German cardiology departments.
- 247 completed questionnaires were returned, representing a 48% response rate.
Main Results:
- The majority of responding cardiologists were experienced and regularly performed pacemaker check-ups.
- Most cardiologists were willing to deactivate pacemakers upon patient request and had done so.
- Willingness to withdraw pacemakers decreased in cases of pacemaker dependency due to concerns about patient symptoms, responsibility, and legal implications.
Conclusions:
- Uncertainties persist among cardiologists regarding pacemaker withdrawal, particularly in dependent patients.
- Official European cardiologic society statements are recommended to clarify ethical, legal, and practical aspects of pacemaker withdrawal.
Background:
The patient's right to refuse pacemaker therapy is mentioned in the relevant European consensus statement but additional information is only available on deactivation of implantable cardioverter deactivator and not on other cardiac implantable electronic devices such as pacemakers. Therefore, we were interested in opinions, concerns and attitudes of cardiologists, who are the primary contact persons for such requests, since the number of patients asking for withdrawal of pacemaker therapy is likely to increase leaving cardiologists and healthcare professionals with a difficult medical but also ethical problem.
Methods:
An anonymous questionnaire was sent to all German cardiology departments (N = 288).
Results:
48% of cardiology departments responded by sending back 247 completed questionnaires. Most participating cardiologists were experienced when considering the duration of their professional activity. Almost all of the respondents regularly perform check-ups of pacemakers. The majority of cardiologists answering our questionnaire were prepared to deactivate a pacemaker upon patients' request, and have done so. In pacemaker dependency, however, the willingness to withdraw decreases, even if death is imminent, for fear of causing distressing symptoms, sense of being responsible for patients possible immediate death, or fear of legal consequences.
Conclusions:
The survey could clearly show that uncertainties remain among cardiologists dealing with a patient's wish for withdrawal, especially in cases of pacemaker dependency. We suggest that official statements of cardiologic societies in Europe are issued to clarify ethical, legal and practical aspects of pacemaker withdrawal.
Trial Registration:
Registered in the German Clinical Trials Register (DRKS00026168) on 30.08.2021.
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