The authors retrospectively reviewed medical records of 150 patients who underwent deactivation of a pacemaker or implantable cardioverter-defibrillator in a four-year period at a single tertiary care center. These were older patients (median age 79) and 99% had a poor or terminal prognosis. More than half of the patients had an advance directive, yet only 1 patient explicitly mentioned device deactivation in their advanced directive. Surrogates for the patient made more than half of the requests for device deactivation (51%). Median survival after device deactivation was 2 days (IQR 0-483).

Conclusion

The intersection of implantable cardiac devices and end-of-life care is certain to become more frequent.  The current study highlights an important gap in addressing these devices as part of advance directives and end-of-life planning, leaving surrogates frequently burdened with the decision of device deactivation.

Summarized by Steven M. Bradley and Supriya Shore

• Buchhalter LC, Ottenberg AL, Webster TL, et al. Features and outcomes of patients who underwent cardiac device deactivation. JAMA Intern Med. 2014 Jan;174(1):80-5.