ICD deactivation at end of life in Northern Ireland 2013–2015

Rebecca Louise Noad*, Loreena Hill, Lana Dixon

*Corresponding author for this work

Research output: Contribution to conferencePosterpeer-review


Background ICD patients may later develop a terminal illness. Concurrent hypoxia, sepsis, pain, heart failure and electrolyte disturbances may predispose shocks in final days of life which is distressing to both patients and their family. A previous audit within the Belfast Trust examined 44 patients with ICDs who died between 2012–2013 in which 16 (36.4%) had device deactivated pre-death. Our aim was to re-audit this for all Northern Ireland between 2013–2015.
Methods All patients who died with an ICD/CRT-D in situ between Sept 2013–Nov 2015 were included. Medical notes/and hospital electronic records were reviewed and patient and device characteristics recorded.
Results In total, 227 patients died with an implantable cardioverter defibrillator (ICD) in situ. Of these, 89 (39.2%) patients had their device deactivated prior to death to prevent inappropriate shock therapy, whilst 138 (60.8%) died with an active ICD in situ. Of the 138 that died with an active ICD: 17 (12.3%) had a diagnosis of a cancer for palliation only, a further 28 (20.3%) were being managed palliatively for non-cancerous conditions either in hospital or in the community and 7 (5.1%) patients were classified as having significant cognitive impairment. In this group ICD was mentioned in the most recent medical correspondence in 39 (28.2%). Overall, 65 (48.1%) had previously received a shock from their device, though previous history of shock did not influence likelihood of device deactivation (p = 0.665).
Conclusion Communication about ICD deactivation at end of life should be standard practice. More work is needed to ensure this occurs in an appropriate and timely manner.
Original languageEnglish
Publication statusPublished - 28 Dec 2016


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