Sparing advance heart failure patients from “futile shocks”

Categories: Research.

Specialist cardiac nurse Loreena Hill has been working on a pioneering international study exploring the management of Implantable Cardioverter Defibrillators  (ICDs) at end of life..

The electronic device aims to treat life threatening heart rhythms by delivering an electrical shock, also known as defibrillation to restore a person’s healthy heart beat.

Ms Hill said when a patient nears end of life the shock delivered by an ICD may not be able to restore normal heart rhythm.

However, the shock function of the ICD can be deactivated or switched off to spare the patient and their family the trauma of a futile treatment.

Ms Hill spoke on the “Challenge of ICD Deactivation” at a recent Irish Hospice Foundation Seminar on Heart Failure and Palliative Care organised in collaboration with The Mater Misericordiae University Hospital.

Ms Hill said it is “vital” that the patients concerned and their health care professionals talk about the appropriate use of ICDs in the context of end of life planning. 

“This is vital as patients are not aware that their ICD can be deactivated to prevent distressing shocks near the end-of-life.

Ms Hill who carried out her research at University of Ulster said: “Expert guidelines recommend deactivation is discussed prior to implantation, at significant points during the patient’s illness and end-of-life. 

“Within real-life clinical practice this is not being routinely carried out. To enable patients and carers to make informed decisions at the end-of-life the discussion concerning deactivation must take place early and at a time when the patient has capacity.

“Information should be provided in a open and tailored fashion and appropriate to the patient’s needs and wishes.”            ”

Ms Hill said research found that that “all too often” the discussion about deactivation took place in the final days or hours before death depriving patients and their families of valuable advanced preparation.

She said to ensure true informed choice the patient should be fully aware of all the functions of the ICD.

“Consequently when quality of life becomes poor they have the knowledge to decide if they want their device to remain active or be deactivated,” she said.

An estimated 4,000 people living in Ireland have an ICD. 

Heart failure is a condition where the heart function is impaired and the heart fails to pump blood effectively around the body. People with heart failure can experience a wide range of symptoms including breathlessness, fatigue, pain, nausea, psychological distress and depression.

Ms Hill was among the cardiologists and palliative care specialists will share their experiences of palliative care and heart failure during the one day seminar, last month.

The overall aim of palliative care is to improve the quality of life for patients and families faced with a life-limiting illness.

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