Department of Cardiology and Institute for Palliative Care, Faculty of Medicine, Lund University, Sweden.
Professor in Palliative Medicine, Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.
Int J Cardiol. 2023 Sep 1;386:91-94. doi: 10.1016/j.ijcard.2023.05.046. Epub 2023 May 30.
The Implantable Cardioverter-Defibrillator (ICD) is a well-established life-saving therapy for heart failure patients, but due to the risk for unnecessary shocks, deactivation of ICD:s is recommended at the end of life. We aimed to identify i) how many people with HF and an ICD who died in Sweden in 2018 received Specialized Palliative Care (SPC), ii) of those dying outside of hospital, the proportion with deactivated ICDs prior to death for the group as a whole and by SPC access.
We analyzed data from i) the Swedish ICD and Pacemaker Registry to find all who died with an ICD in Sweden in 2018, ii) the Swedish Register of Palliative Care and, iii) the Swedish Causes of Death Certificate Register to find those who died outside of hospital. Clinical records were obtained to assess if ICDs were deactivated before death. Descriptive statistics, t-tests and chi-squared tests were applied. 46/406 (11%) of those who died with an ICD in Sweden in 2018 had SPC access, of whom 50% also had cancer. 86/164 (52%) ICDs were deactivated prior to death in people dying outside of hospital; higher in those accessing SPC (36/46, (78%) SPC access versus 151/360, (42%) no SPC access; p < 0.05).
Half of those with HF and an ICD dying outside of hospital had ICD deactivation prior to death. Those accessing SPC were more likely to have their ICD deactivated but few received SPC, without a comorbid cancer diagnosis.
植入式心脏复律除颤器（ICD）是心力衰竭患者一种成熟的救命疗法，但由于存在不必要电击的风险，建议在生命末期停用 ICD。我们旨在确定：i）2018 年在瑞典死于心力衰竭和 ICD 的患者中有多少人接受了专门的姑息治疗（SPC）；ii）在医院外死亡的患者中，在 ICD 停用的比例，包括整体组和 SPC 组。
我们分析了 i）瑞典 ICD 和起搏器登记处的数据，以找到 2018 年在瑞典死于 ICD 的所有人；ii）瑞典姑息治疗登记处和 iii）瑞典死因登记处的数据，以找到在医院外死亡的患者。获得临床记录以评估 ICD 是否在死亡前被停用。应用描述性统计、t 检验和卡方检验。2018 年在瑞典死于 ICD 的患者中，有 46/406（11%）人接受了 SPC 治疗，其中 50%患有癌症。在医院外死亡的患者中，有 86/164（52%）的 ICD 在死亡前被停用；在接受 SPC 治疗的患者中，停用率更高（36/46，（78%）SPC 治疗与 151/360，（42%）无 SPC 治疗；p<0.05）。
一半的心力衰竭和 ICD 患者在医院外死亡前已停用 ICD。接受 SPC 治疗的患者更有可能停用 ICD，但很少有人接受 SPC 治疗，且没有合并癌症诊断。
