The implantable cardioverter-defibrillators at the end of life: a double-edged sword of a life-saving technology.

IF 9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Giacomo Mugnai, Davide Genovese, Luca Tomasi, Alessia Gambaro, Flavio Ribichini
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引用次数: 0

Abstract

Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. Although a robust ethical framework founded on patient autonomy supports deactivation in certain circumstances, its principles are poorly implemented. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.

生命末期植入式心律转复除颤器:一种救命技术的双刃剑。
植入式心律转复除颤器(ICDs)对于预防心源性猝死至关重要,但其功能对姑息治疗提出了重大挑战,因为姑息治疗的目标从延长生命转向了舒适。相当大比例的病人在最后的日子里受到痛苦的、无效的电击,造成严重的痛苦。本综述综合了这些冲击影响的证据,并强调了临床实践与以患者为中心的护理之间的差距。及时停用ICD的主要障碍包括临床医生的不适、患者的误解以及分散的护理和缺乏机构协议等系统性缺陷。尽管建立在病人自主基础上的健全的伦理框架支持在某些情况下的失活,但其原则执行得很差。本综述主张向积极主动的跨学科护理模式转变,呼吁进行有组织的沟通、常规的预先护理计划和姑息性心脏病学模式的整合,以确保这种挽救生命的技术不会损害有尊严的死亡。
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
Trends in Cardiovascular Medicine
Trends in Cardiovascular Medicine 医学-心血管系统
CiteScore
18.70
自引率
2.20%
发文量
143
审稿时长
21 days
期刊介绍: Trends in Cardiovascular Medicine delivers comprehensive, state-of-the-art reviews of scientific advancements in cardiovascular medicine, penned and scrutinized by internationally renowned experts. The articles provide authoritative insights into various topics, encompassing basic mechanisms, diagnosis, treatment, and prognosis of heart and blood vessel disorders, catering to clinicians and basic scientists alike. The journal covers a wide spectrum of cardiology, offering profound insights into aspects ranging from arrhythmias to vasculopathies.
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