Do pacemakers prolong the dying process in a palliative setting?-a retrospective matched cohort analysis.

Abstract

Background: Clinicians caring for end-of-life patients regularly receive questions from patients and relatives about whether the pacemaker (PM) has to be deactivated. The possible life-prolonging effect of an active PM on the dying process of a palliative patient remains a scientific and clinical question in the literature and is a challenge for caregivers and patients in the end-of-life phase. This study analyzed whether there is a possible life-prolonging effect of an active PM in palliative patients.

Methods: The time that 83 terminal palliative PM patients passed at a palliative care until death is compared with the time that 163 matched control terminal non-PM patients passed at the same palliative care unit (PCU). The non-PM patients are matched for age, gender, and underlying diseases.

Results: The survival curves of PM and matched control non-PM patients were, for most of the time, exactly superimposed. Some PM patients died in the period 10-45 days after intake at the PCU a few days earlier than the control patients. This may be explained by their higher cardiovascular morbidity, more frequent previous cardiac surgery, more diabetes mellitus, and impaired kidney function.

Conclusions: There is no evidence that an active PM prolongs the dying process in terminal PCU patients; a few PM patients died even earlier than their matched control non-PM patients.