Deactivation of implantable defibrillators at the end of life - A register-based study of ICD-deactivation at home and the impact of palliative care

Highlights

• This is a nationwide, register based study of all who died with heart failure and an ICD in Sweden in 2018.

• A study of ICD-deactivation in patients dying outside of hospital and the impact of Specialized Palliative Care (SPC).

• Half of those with HF and an ICD dying outside of hospital had ICD deactivation prior to death.

• Those in SPC were more likely to have their ICD deactivated but few received SPC, without a comorbid cancer diagnosis.

Abstract

Background

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.

Methods and results

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).

Conclusions

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.