Sarah E. Myers, MS; Gregory L. Eastwood, MD
Corresponding Author: Gregory L. Eastwood, MD; SUNY Upstate Medical University. Email: eastwood@upstate.edu
Section: Special Communication
Publication: June 3, 2021
People with implantable cardiac defibrillators (ICDs) who are nearing the end of life are at risk for arrhythmias, which activate the ICD and may cause unnecessary shocks and suffering. Because ICDs have enabled more patients to live longer, they often succumb to non-cardiac diseases and may be cared for by primary care physicians. Despite published recommendations ten years ago regarding management of ICDs during the end of life, over half of patients with ICDs who are dying still have not been offered the choice of deactivation. The COVID-19 pandemic has complicated this issue and the need to discuss it because of practices that separate patients from loved ones and that modify the usual interactions of patients with doctors and nurses. We recommend: (1) The management of ICDs at the end of life needs to be understood by all physicians who care for patients with ICDs. (2) Discussions about deactivating the ICD should occur while patients have decision-making capacity and are clinically stable, beginning at the time of ICD implantation, then periodically at follow up appointments, and certainly when a change in the patient’s clinical status warrants a reconsideration of the goals of care. (3) Clinicians should compensate for the impediments to communication with patients and families associated with the COVID pandemic, which include patient isolation and restrictive visitor policies, by using devices that permit visual communication to reexamine goals of care, including defibrillator deactivation, in patients with ICDs who are expected to die.