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Brief Communication: Management of Implantable Cardioverter-Defibrillators in Hospice: A Nationwide Survey

BACKGROUND
Communication about the deactivation of implantable cardioverter-defibrillators (ICDs) in patients near the end of life is rare.


OBJECTIVE
To determine whether hospices are admitting patients with ICDs, whether such patients are receiving shocks, and how hospices manage ICDs.


DESIGN
Cross-sectional survey.


SETTING
Randomly selected hospice facilities.


PARTICIPANTS
900 hospices, 414 of which responded fully.


MEASUREMENTS
Frequency of admission of patients with ICDs, frequency with which patients received shocks, existence of ICD deactivation policies, and frequency of deactivation.


RESULTS
97% of hospices admitted patients with ICDs, and 58% reported that in the past year, a patient had been shocked. Only 10% of hospices had a policy that addressed deactivation. On average, 42% (95% CI, 37% to 48%) of patients with ICDs had the shocking function deactivated.


LIMITATION
The study relied on the knowledge of hospice administrators.


CONCLUSION
Hospices are admitting patients with ICDs, and patients are being shocked at the end of life. Ensuring that hospices have policies in place to address deactivation may improve the care for patients with these devices. The authors provide a sample deactivation policy.


PRIMARY FUNDING SOURCE
National Institute of Aging and National Institute of Nursing Research.