1 Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands.
2 Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
Eur J Cardiovasc Nurs. 2019 Aug;18(6):449-457. doi: 10.1177/1474515119844660. Epub 2019 Apr 17.
The implantable cardioverter defibrillator (ICD) might give unwanted shocks in the last month of life. Guidelines recommend deactivation of the ICD prior to death.
The aims of this study were to examine trends in time (2007-2016) in how and when decisions are made about ICD deactivation, and to examine patient- and disease-related factors which may have influenced these decisions. In addition, care and ICD shock frequency in the last month of life of ICD patients are described.
Medical records of a sample of deceased patients who had their ICD implanted in 1999-2015 in a Dutch university ( = 308) or general ( = 72) hospital were examined.
Median age at death was 71 years, and 88% were male. ICD deactivation discussions increased from 6% for patients who had died between 2007 and 2009 to 35% for patients who had died between 2013 and 2016. ICD deactivation rates increased in these periods from 16% to 42%. Presence of do-not-resuscitate (DNR) orders increased from 9% to 46%. Palliative care consultations increased from 0% to 9%. When the ICD remained active, shocks were reported for 7% of patients in the last month of life. Predictors of ICD deactivation were the occurrence of ICD deactivation discussions after implantation (OR 69.30, CI 26.45-181.59), DNR order (OR 6.83, CI 4.19-11.12), do-not-intubate order (OR 6.41, CI 3.75-10.96), and palliative care consultations (OR 8.67, CI 2.76-27.21).
ICD deactivation discussions and deactivation rates have increased since 2007. Nevertheless, ICDs remain active in the majority of patients at the end of life, some of whom experience shocks.
植入式心脏复律除颤器（ICD）可能在生命的最后一个月发出不必要的电击。指南建议在死亡前停用 ICD。
本研究旨在探讨 2007 年至 2016 年间，关于 ICD 停用决策的时间和方式的趋势，并探讨可能影响这些决策的患者和疾病相关因素。此外，还描述了 ICD 患者生命最后一个月的护理和 ICD 电击频率。
检查了 1999 年至 2015 年期间在荷兰一所大学（=308）或普通（=72）医院植入 ICD 的一组已故患者的病历。
死亡时的中位年龄为 71 岁，88%为男性。2007 年至 2009 年期间死亡的患者中，ICD 停用讨论比例为 6%，而 2013 年至 2016 年期间死亡的患者中，ICD 停用讨论比例为 35%。在此期间，ICD 停用率从 16%增加到 42%。不复苏（DNR）医嘱的比例从 9%增加到 46%。姑息治疗咨询从 0%增加到 9%。当 ICD 仍然活跃时，7%的患者在生命的最后一个月报告有电击。ICD 停用的预测因素包括植入后 ICD 停用讨论的发生（OR 69.30，95%CI 26.45-181.59）、DNR 医嘱（OR 6.83，95%CI 4.19-11.12）、不插管医嘱（OR 6.41，95%CI 3.75-10.96）和姑息治疗咨询（OR 8.67，95%CI 2.76-27.21）。
自 2007 年以来，ICD 停用讨论和停用率有所增加。然而，在生命的最后阶段，大多数患者的 ICD 仍然活跃，其中一些人经历了电击。
