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Original Investigation |

Features and Outcomes of Patients Who Underwent Cardiac Device Deactivation

Lillian C. Buchhalter1; Abigale L. Ottenberg, MA2; Tracy L. Webster, RN3; Keith M. Swetz, MD, MA2,4; David L. Hayes, MD3; Paul S. Mueller, MD, MPH2,4
[+] Author Affiliations
1Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota
2Program in Professionalism and Ethics, Mayo Clinic, Rochester, Minnesota
3Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
4Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
JAMA Intern Med. 2014;174(1):80-85. doi:10.1001/jamainternmed.2013.11564.
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Importance  Little is known about patients who undergo cardiovascular implantable electronic device deactivation.

Objective  To describe features and outcomes of patients who underwent cardiovascular implantable electronic device deactivation.

Design, Setting, and Participants  Retrospective review of medical records of 150 patients at a tertiary academic medical center (Mayo Clinic, Rochester, Minnesota).

Exposure  Cardiovascular implantable electronic device deactivation.

Main Outcomes and Measures  Demographic and clinical data and information regarding advance directives, ethics consultations, palliative medicine consultations, and cardiovascular implantable electronic device deactivations.

Results  Of the 150 patients (median age, 79 years; 67% were male), 149 (99%) had poor or terminal prognoses. Overall, 118 patients (79%) underwent deactivation of tachycardia therapies only, and 32 (21%) underwent deactivation of bradycardia therapies with or without tachycardia therapies (6 patients [4%] were pacemaker-dependent). Half of the deactivation requests (51%) were made by surrogates. A majority of deactivations (55%) were carried out by nurses. Although 85 patients (57%) had advance directives, only 1 mentioned the device in the directive. Ethics consultations occurred in 3 patients (2%) and palliative medicine consultations in 64 (43%). The proportions of patients who died within 1 month of device deactivation were similar for those who underwent deactivation of tachycardia therapies only and those who underwent deactivation of bradycardia therapies with or without tachycardia therapies (85% vs 94%; P = .37).

Conclusions and Relevance  Most requests for cardiovascular implantable electronic device deactivation were for implantable cardioverter-defibrillator–delivered tachycardia therapies only. Many of these requests were made by surrogates. Advance directives executed by patients with these devices rarely addressed device management. Regardless of device therapy, most patients died shortly after device deactivation. Hence, a device deactivation decision may reflect the seriousness of a given patient’s underlying illness. Patients with devices should engage in advance care planning to ensure that future care is consistent with their preferences.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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