Implantable cardioverter defibrillator deactivation and end-of-life: British Heart Rhythm Society practical consensus guideline.

IF 2 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Honey Thomas, Jane Wallace, Paul Foley, Miriam J Johnson
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引用次数: 0

Abstract

Implantable cardioverter defibrillators (ICDs) are implanted in increasing numbers of patients with the aim of treating ventricular arrhythmias in high-risk patients and reducing their risk of dying. Individuals are also living longer with these devices. As a result, a greater number of patients with an ICD will deteriorate either with worsening cardiac failure, another non-cardiac condition or general frailty and will have a limited prognosis. Frequently they will be cared for by non-cardiac teams who may be less familiar with ICDs. Therefore, to ensure the person receives high-quality end-of-life care, they should have the opportunity to consider and discuss the option to deactivate the shock function of their ICD. If the ICD shock therapy is not discontinued, there is an increased risk that as a person reaches the last days of life, the ICD may deliver painful shocks which are distressing. There is also a risk that the device may delay the person's natural death which the person would not have chosen if they had been given the opportunity to discuss discontinuation. The British Heart Rhythm Society has developed a practical document to support all healthcare professionals who are caring for patients who have an ICD. This includes descriptions of different device types, ethical and legal aspects, timing and nature of ICD discussions and practical advice regarding how the devices may be deactivated. It aims to promote awareness and timely discussion between professionals and patients and to encourage best practice.

植入式心律转复除颤器失活和生命终结:英国心律学会实用共识指南。
植入式心律转复除颤器(ICDs)被越来越多的患者植入,目的是治疗高危患者的室性心律失常,降低其死亡风险。有了这些设备,人们的寿命也更长了。因此,更多的ICD患者会恶化为心衰加重、另一种非心脏疾病或全身虚弱,预后有限。通常,他们将由可能对icd不太熟悉的非心脏小组照顾。因此,为了确保患者获得高质量的临终关怀,他们应该有机会考虑和讨论停用ICD的休克功能的选择。如果不停止ICD休克治疗,当一个人到达生命的最后几天时,ICD可能会带来痛苦的电击,这是一种增加的风险。还有一种风险是,该装置可能会推迟人的自然死亡,如果给他们机会讨论停止使用,他们是不会选择这种死亡的。英国心律协会制定了一份实用文件,以支持所有照顾患有ICD患者的医疗保健专业人员。这包括不同设备类型的描述,道德和法律方面,ICD讨论的时间和性质,以及关于如何停用设备的实用建议。它旨在提高专业人员和患者之间的认识和及时讨论,并鼓励最佳做法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Supportive & Palliative Care
BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)
CiteScore
4.60
自引率
7.40%
发文量
170
期刊介绍: Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.
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