November 8, 2010 – Physicians are significantly less comfortable discussing withdrawal of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) therapy compared with other life-sustaining therapies, according to new survey published in HeartRhythm. In the survey, almost half said they were not comfortable having the discussion with patients.
Similarly, physicians were almost twice as likely to have been involved in withdrawal of therapies such as mechanical ventilation and hemodialysis compared with cardiac devices.
The study explored the experience, legal knowledge and ethical views of 185 respondents at Beth Israel Deaconess Medical Center in Boston. It exposed a need for more education regarding the legal and ethical parameters guiding cessation of PM and ICD therapy.
Nearly half of respondents strongly agreed that patient care would be improved by national guidelines addressing the appropriate time for cardiac device deactivation in end-of-life patients.
“Our survey sheds light on important gaps in physician experience and knowledge regarding the legal and ethical underpinnings of life-sustaining therapies, most notably cardiac devices,” said lead author Daniel B. Kramer, M.D., Beth Israel Deaconess Medical Center and Harvard Medical School in Boston. “Given the broadening use of these devices in an aging American population, it is critical that physicians from different specialties work together and with their patients to understand these issues. Advanced care planning is essential, but this presupposes an appreciation of the clinical options that are ethical and legal under different circumstances.”
To address the need for more comprehensive guidelines, the Heart Rhythm Society published: The HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. The guidelines were presented at Heart Rhythm 2010, and published in the July edition of HeartRhythm.
For more information: www.heartrhythmjournal.com