PT  - JOURNAL ARTICLE
AU  - Sarah E. Myers
AU  - Gregory L. Eastwood
TI  - Implantable Cardiac Defibrillator Deactivation During End-of-Life Care in the COVID-19 Pandemic
AID  - 10.3122/jabfm.2021.03.200536
DP  - 2021 May 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 474--476
VI  - 34
IP  - 3
4099  - http://www.jabfm.org/content/34/3/474.short
4100  - http://www.jabfm.org/content/34/3/474.full
SO  - J Am Board Fam Med2021 May 01; 34
AB  - 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 noncardiac diseases and may be cared for by primary care physicians. Despite published recommendations 10 years ago regarding the 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 Coronavirus disease 2019 (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 offer the following recommendations: (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; and (3) clinicians should compensate for the impediments to communication with patients and families associated with the COVID-19 pandemic, which includes 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.