Abstract 12490: In a World Full of Talk, No One Wants to Discuss Death: An International Analysis of End-of-Life Discussions With Implantable Cardioverter Defibrillator Recipients

Abstract

Introduction: End-of-life (EOL) decision making in implantable cardioverter defibrillator (ICD) recipients is a difficult process that requires input from patients, families, and providers. International guidelines advise providers to discuss EOL scenarios with patients prior to ICD implantation, and throughout the life of the patient. Healthcare systems and culture differ across countries and may determine whether these conversations occur. The purpose of this study was to determine if country of origin affected whether an ICD recipient had engaged in a conversation with their provider or next-of-kin about EOL decisions related to the ICD. Methods: Participants (N = 682) from six countries—United States (US), Australia, Northern Ireland, Republic of Ireland, Sweden, and South Korea—completed demographic information, and an EOL questionnaire. Binomial logistic regression was used to examine if country of origin predicted whether patients had discussed EOL with an ICD with their providers or next of kin controlling for demographic (age and gender) and clinical (having a cardiac resynchronization therapy device, history of myocardial infarction and having received a shock from the ICD) variables. Results: Overall, 21% of participants had an EOL discussion with their provider, and 15% had an EOL discussion with their next-of-kin. Country of origin was a significant predictor of having had an EOL discussion with a provider (p=0.003) and next-of-kin (p=0.005). Significant differences were found between the US and Korea for discussions with providers (OR=0.265, p<0.001) and next-of-kin (OR=0.301, p=0.003), and the US and Sweden for discussions with providers (OR=0.614, p=0.040) and next-of-kin (OR=0.537, p=0.021), with the US being the reference group. Having received a shock in the past was a significant predictor of having an EOL with providers (OR=2.275, p<0.001) and next-of-kin (OR=1.692, p=0.019). Conclusions: End-of-life decision making is a complicated process, and a person’s cultural beliefs, along with healthcare system may play a role. These factors should be considered when creating interventions and policy to improve EOL discussions for patients with an ICD in order to improve quality of EOL care.