Abstract 284: Comparison Of Patterns Of ICD Deactivation In Community Hospice Center Vs Hospice In An Academic Institution.

Abstract

Background: There have been an increasing number of patients receiving implantable cardioverter defibrillators (ICDs) over the last decade. Although ICDs prevent arrhythmic death, patients may still develop other terminal illnesses, or progression of underlying heart failure. ICD delivered shocks are associated with significant pain, anxiety and reduced quality of life. Therefore for this population of patients, it may become undesirable to receive shock therapy nearing the end of life. The practice of ICD deactivation may differ from community hospice center and teaching institution where in-house palliative care and cardiology service is available. We reviewed the practices for ICD deactivation on a series of patients admitted to a community hospice center and compared to a hospice center in teaching institution. We hypothesized that for patients with ICDs, the frequency for ICD deactivation at end of life would be low in community hospice center. Methods: In this retrospective study we reviewed records of patients with ICDs who were admitted to the Hildebrandt Hospice Care Center, an inpatient hospice facility and in University of Rochester medical center, Rochester NY from January 2005 to December 2009. We have included patients with ICD for primary prevention of sudden cardiac arrest. Information regarding patient's demographics, indications for ICD implantation, deactivation of ICD (frequency, location) and history of shock in hospice care was recorded. Results: We identified 32 and 35 patients who were admitted to inpatient hospice units of community and academic centers respectively, with ICDs for primary prevention of sudden cardiac arrest. Ninety one percent of ICDs were deactivated in patients in academic center, when compared to 62% of deactivated ICD in community center. Twelve (38%) patients from community center (vs three patients from academic center) were transferred to the hospice center without ICD deactivation. Among these 12 patients, 3 (10%) received ICD shock while in hospice and subsequently died in the center (average 2 days after receiving the shock). Three patients refused to have their ICD deactivated in both group. Conclusion: Rates of deactivation of ICD is higher in academic institutions, when compared to non academic centers. The discussion about ICD deactivation should be initiated in terminally ill patients who are opting for hospice care for end of life care. Deactivating the device allows patients to die without the discomfort of electric shocks.