Abstract 19303: Cognitive Dysfunction and Patients’ Attitudes Toward Generator Replacement and Deactivation of Their Implantable Cardioverter Defibrillator at the End-of-life

Abstract

Background: Despite its life saving benefits, Cardioverter Defibrillator (ICD) implantation is associated with increased risk of cognitive dysfunction. Studies examining the association between cognitive status and attitudes toward withdrawing ICD therapy [i.e., generator replacement at end-of-service and ICD deactivation at End-of-Life (EOL)] in the long term are scarce. Objective: The specific aims of this study were to: 1) describe patients’ attitudes toward withdrawal of ICD therapy at EOL; and 2) determine the association between cognitive dysfunction and recipients’ attitudes toward generator replacement and toward ICD deactivation at EOL, controlling for age, anxiety and depression. Methods: A total of 114 ICD recipients (35% female, age 67 ± 12 years) completed the Montreal Cognitive Assessment, Patient Health Questionnaire-9, and Brief Symptom Anxiety instruments. Data about participants’ attitudes toward withdrawal of therapy were collected by asking participants to answer “Yes/No” or “Not sure” for the following two statement, respectively: “I want to have the battery in my ICD replaced even if I am seriously ill suffering from another disease,” “I want to have the defibrillating shocks in my ICD even if dying of cancer or another serious disease.” The association between cognitive dysfunction and attitudes toward generator replacement and ICD deactivation were tested using logistic regression analysis. Results: The majority of participants (68%) would like to replace the generator at end-of-service even if they are seriously ill with another disease; 44% favored to keep shocks even if they are dying from cancer or other serious disease. Ten per cent and 16%, respectively, were indecisive about generator replacement and ICD deactivation at EOL. Cognitive dysfunction significantly predicted recipients’ attitude toward generator replacement (β = 4.12, p = .02), but not their attitudes toward ICD deactivation at EOL. Conclusion: Cognitive dysfunction predicted recipients’ attitude toward generator replacement at end of service. This suggests that considering patients’ cognitive function is essential to maximize ICD recipients’ ability to make treatment decisions at EOL.