Palliative Care for Defibrillator Patients

A study has found that doctors rarely discuss implanted defibrillators with their sickest patients, so many of them undergo repeated defibrillator shocks during their last days, hours, or minutes of life as they are dying.

At that late stage of life, defibrillation shocks cause discomfort, anxiety, and a prolonged death. In the study, researchers found that discussions about deactivating defibrillators took place in only 27 of 100 cases of terminally ill patients. Among these 27 patients, 21 patients or family members decided to deactivate the defibrillator. Even among patients with do-not-recuscitate (DNR) orders, discussions about continued use of the defibrillator occurred in fewer than 45% of cases.

Next of kin reported that more than one-quarter of the 100 patients received a shock from the defibrillator in the last month of life, and 30% of that group received a shock in the last minutes of life. The study findings were reported in the December 7, 2004, issue of the Annals of Internal Medicine.

"Among patients with heart failure and months or years to live, defibrillators save thousands of lives,” said lead investigator Nathan Goldstein, M.D., assistant professor, department of geriatrics and adult development, Mount Sinai School of Medicine (New York, NY, USA). "However, this study makes clear that physicians should talk about the pros and cons of continuing the device when patients are approaching the last days or weeks of life.”




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