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Dodson JA, Fried TR, Van Ness PH, Goldstein NE, Lampert R. Patient Preferences for Deactivation of Implantable Cardioverter-Defibrillators. JAMA Intern Med. 2013;173(5):377–379. doi:10.1001/jamainternmed.2013.1883
Author Affiliations: Sections of Cardiology (Drs Dodson and Lampert) and Geriatrics (Drs Dodson, Fried, and Van Ness), Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Geriatrics and Palliative Care, Mount Sinai School of Medicine, New York, New York; James J. Peters VA Medical Center, Bronx, New York (Dr Goldstein).
While implantable cardioverter-defibrillators (ICDs) prolong life, painful shocks can occur at the end of life, and physicians rarely discuss the option of device deactivation.1,2 To prevent shocks at the end of life that do not meaningfully prolong survival, a recent Heart Rhythm Society consensus statement recommended proactive communication with patients regarding deactivation.3 However, most surveys have found that the majority of ICD patients would not consider deactivation even in deleterious future health states including terminal cancer,4 constant dyspnea,5 or frequent shocks.5,6
We examined preferences for ICD deactivation in the context of health outcomes such as functional and cognitive disabilities shown to matter most to patients.7 Our survey provided an informational description of the potential benefits and burdens of the shocking function of ICDs and subsequently presented scenarios describing broad health outcomes common in patients approaching the end of life.
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