Defibrillator Death _VERIFIED_
Background: Implantable defibrillators (ICDs) prevent sudden cardiac death. With declining health, ICD therapy may prolong death and expose the patient to unnecessary pain and anxiety. Few studies have addressed end of life care in ICD patients. The objective of this study was to investigate end of life in ICD patients, with respect to location of death; duration between do-not-resuscitate (DNR)-orders and deactivation of ICD therapy or DNR and time of death.
Methods and results: A descriptive analysis of 65 deceased ICD patients, all whom had a written DNR-order before death, is presented. The majority (86%) was treated in hospitals, mainly (63%) university hospitals, and many (33%) in cardiology wards. Despite DNR-order, ICD shock therapy was active in 51% of all patients. In those with therapy deactivated at death, therapy deactivation was carried out two days or more after DNR-order in more than a third (38%). The time from DNR decision to death in patients with therapy active had a median of four days (IQR 1-38). During the last 24h of life, 24% of the patients experienced shock treatment.
Conclusions: The majority of ICD patients with a DNR-order were treated in university hospitals. More than half still had shock treatment active at time of death with a median of four days or more between DNR decision and death. Patients with therapy deactivated, two days or more elapsed in more than a third from DNR decision to deactivation of therapy, exposing patients to a high risk of painful shocks before death.
Methods and results: We conducted a multicenter study of the impact of the implantable cardioverter-defibrillator (ICD) for prevention of SD in 132 patients (93 males and 39 females, age 40+/-15 years) with ARVC/D. Implant indications were a history of cardiac arrest in 13 patients (10%), sustained ventricular tachycardia in 82 (62%), syncope in 21 (16%), and other in 16 (12%). During a mean follow-up of 39+/-25 months, 64 patients (48%) had appropriate ICD interventions, 21 (16%) had inappropriate interventions, and 19 (14%) had ICD-related complications. Fifty-three (83%) of the 64 patients with appropriate interventions received antiarrhythmic drug therapy at the time of first ICD discharge. Programmed ventricular stimulation was of limited value in identifying patients at risk of tachyarrhythmias during the follow-up (positive predictive value 49%, negative predictive value 54%). Four patients (3%) died, and 32 (24%) experienced ventricular fibrillation/flutter that in all likelihood would have been fatal in the absence of the device. At 36 months, the actual patient survival rate was 96% compared with the ventricular fibrillation/flutter-free survival rate of 72% (P
It has taken Carole Docherty 11 years to discuss the sensitive topic of deactivating her implantable cardioverter defibrillator (ICD) with her family. After learning about the issue from BHF arrhythmia nurse Wendy Churchouse (pictured right), Carole is appearing in a DVD aimed at healthcare professionals to encourage them to talk to patients about deactivation.
Carole, aged 65, from Carmarthen, was fitted with an ICD after being diagnosed with arrhythmogenic right ventricular cardiomyopathy, a condition that can cause sudden cardiac death. Sadly, the diagnosis came as a result of having tests conducted after her son had died from the same inherited heart condition.
What that means is that if the heart goes into a potentially lethal rhythm, the ICD delivers a shock to restore it to normal, just as an external defibrillator would. However, the difference is that an ICD keeps automatically delivering this shock unless you deactivate it, which can be very distressing for someone in their final stages of life, as well as for their loved ones and hospital staff.
Patients with implantable defibrillators (ICDs) or resynchronization devices with defibrillator (CRT-Ds) were most likely to die of heart failure or noncardiac causes, not sudden death, a single-center study found.
Of the 2,859 patients included in the analysis, the 8-year cumulative incidence for heart failure death was 8.6% among patients with an ICD for primary prevention and 9.6% among secondary prevention ICD patients, and 22.6% for those with a CRT-D (log rank P
Conversely, the 8-year cumulative incidence of sudden death was 2.1% and 3.2% in the primary and secondary prevention ICD patients, and 3.6% in those with a CRT-D (log rank P=0.026), according to the study published online in the journal HeartRhythm.
Defibrillator devices have been shown in large randomized trials to decrease mortality among primary prevention ICD patients, including those with ischemic and nonischemic heart disease at risk of sudden arrhythmic death.
They classified deaths as cardiac, noncardiac, and sudden death. They further divided the cardiac group into tachyarrhythmic, bradyarrhythmic, heart failure, nonarrhythmic nonheart failure, and in cardiac but unable to classify further.
Schalij and colleagues also found it "remarkable" that all three groups of patients had comparable rates of sudden death: 7%, 8%, and 7%, respectively. However, they said, this should be interpreted with caution because of "wide confidence intervals making accurate comparison difficult between the three groups."
Defibrillators are devices that send an electric pulse or shock to the heart to restore a normal heartbeat. They are used to prevent or correct an arrhythmia, an uneven heartbeat that is too slow or too fast. If the heart suddenly stops, defibrillators can also help it beat again. Different types of defibrillators work in different ways. Automated external defibrillators (AEDs), which are now found in many public spaces, are used to save the lives of people experiencing cardiac arrest. Even untrained bystanders can use these devices in an emergency.
Other defibrillators can prevent sudden death among people who have a high risk of a life-threatening arrhythmia. They include implantable cardioverter defibrillators (ICDs), which are surgically placed inside your body, and wearable cardioverter defibrillators (WCDs), which rest on the body. It can take time and effort to get used to living with a defibrillator, and it is important to be aware of possible complications.
Bobby Ray Stark was bedridden for seven years and relied on his wife of 35 years, Kathy Stark, for care, according to WKRN. He went to the hospital for a foot infection and bed sores last month was later transferred to TriStar Centennial, where he coded and staff tried to revive him with a defibrillator, Kathy told the outlet.
"While we cannot discuss specifics, we are reviewing the care provided to the patient and the functionality of equipment. The death of a loved one is always very difficult, and our hearts go out to this family," the hospital's statement said.
Sudden cardiac death (SCD) is the most frequent cause of cardiovascular death in industrialized nations. Patients with cardiomyopathy are at increased risk for SCD and may benefit from an implantable cardioverter-defibrillator (ICD). The risk of SCD is highest in the first months after myocardial infarction or first diagnosis of severe non-ischemic cardiomyopathy. On the other hand, left ventricular function may improve in a subset of patients to such an extent that an ICD might no longer be needed. To offer protection from a transient risk of SCD, the wearable cardioverter-defibrillator (WCD) is available. Results of the first randomized clinical trial investigating the role of the WCD after myocardial infarction were recently published. This review is intended to provide insight into data from the VEST trial, and to put these into perspective with studies and clinical experience. As a non-invasive, temporary therapy, the WCD may offer advantages over early ICD implantation. However, recent data demonstrate that patient compliance and education play a crucial role in this new concept of preventing SCD.
Cardiovascular disease is the most common cause of death in industrialized nations. For instance, in 2016, cardiovascular disease caused 37% of all deaths in Germany (338,687 of 910,902), compared to 25% caused by any cancer . Among patients with cardiovascular disease, sudden cardiac death (SCD) is the most frequent cause of death. SCD was noted on 13% of death certificates in the United States in 2016 (366,494 of 2,744,248), suggesting that 1 of 7.5 individuals in the United States die of SCD . Even in the era of acute revascularization of myocardial infarction and treatment of heart failure with beta blockers, angiotensin receptor blockers, aldosterone antagonists, and neprilysin inhibitors, SCD is still the most frequent cause of death in patients with heart failure. In the PARADIGM-HF trial, 1251 deaths (81% of all deaths) were ascribed to cardiovascular causes. Of these, 45% were categorized as SCD compared to 27% of patients who died from progressive heart failure . Of note, SCD was reduced in the group of patients treated with sacubitril/valsartan compared to the control group by 20%.
In summary, available trials did not show a benefit of ICD therapy on total mortality in patients with severe left ventricular dysfunction early after myocardial infarction or after a first diagnosis of non-ischemic cardiomyopathy. Therefore, guidelines recommend waiting times of at least 40 days after myocardial infarction and at least 90 days on optimized treatment of non-ischemic cardiomyopathy. However, SCD risk during these waiting and drug titration periods is higher than during the later course of the patient and his heart disease, and patients are exposed to a considerable risk while waiting for reassessment. The growing number of effective drugs in heart failure render medical treatment more successful but also more complex and may require even more time on optimal medical treatment until a significant improvement in LVEF has to be excluded. This can be beneficial for patients who show a delayed improvement of heart failure obviating the need for an ICD but an individual disaster for patients who die from SCD during the waiting time. Automated external defibrillators for home use had no effect on total mortality . To reduce the risk for SCD during these phases of stabilization and therapy optimization, avoiding the additional risks of an invasive procedure, a temporary therapeutic intervention such as a wearable cardioverter-defibrillator (WCD) may be useful. Based on this hypothesis, the VEST trial was initiated. 041b061a72