Groenveld H F, Coster J E, van Veldhuisen D J, Rienstra M, Blaauw Y, Maass A H
Department of Cardiology, Heart Centre, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Neth Heart J. 2021 May;29(5):243-252. doi: 10.1007/s12471-021-01555-w. Epub 2021 Mar 12.
Implantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients' options in this critical phase of their illness.
植入式心脏复律除颤器被大规模植入心力衰竭（HF）患者体内以预防心源性猝死。在不同情况下，不再需要或不适合进行除颤器治疗，这种情况在老年患者中越来越常见。通常，设备治疗会持续到设备电池耗尽。届时，需要做出更换设备或降级为仅具备起搏功能设备的决定。这一决定取决于许多因素，包括患者的活力及其偏好，但也可能受到指南中建议变化的影响。在过去几年中，人们越来越意识到围绕这些决定进行讨论很重要且有用。高级护理计划和共同决策变得很重要，并越来越被认可。在这篇简短的综述中，我们描述了六例患有HF的老年患者，在他们的病例中我们讨论了这些问题，并且我们旨在为这种情况下的临床决策提供一些科学和伦理依据。当前指南提倡在植入设备时讨论临终选择，医生应该意识到他们的选择会在患者疾病的这个关键阶段影响患者的选择。
