Study suggests doctors overlook effects of implanted heart defibrillators in dying patients

The Associated Press reports that heart defibrillators implanted in a patient's chest may disrupt a quiet death, but doctors and relatives of people dying of non-heart related diseases often don't consider that issue. "It's not unusual for health professionals to avoid the topic, says Dr. Nathan Goldstein of New York's Mount Sinai Medical Center. His research, published this month in Annals of Internal Medicine, suggests most hospices — expert in end-of-life care — aren't making defibrillator decisions part of their routine." The devices can cause "painful, repeated shocks" in some patients if they are not turned-off. "Nearly 60 percent of hospices he examined had at least one patient shocked within the past year, sometimes multiple times at once. Yet just one in 20 hospices had a method even to identify who harbored the implant when they entered the program. But with more than 100,000 implantable cardioverter-defibrillators, or ICDs, inserted every year, more and more families ... will face the question" (Neergaard, 3/15).

Britain's Nursing Times reports: "Nurses will have to follow a standard list of clinical checks for all [National Health Service] hospital emergency patients, under plans being developed by the Department of Health. The DH is working with the Royal College of Nursing and other professional groups to produce the checklist, which will require clinicians to record whether checks such as venous thromboembolism risk assessment, vital signs and pain management had been carried out for every patient. The plan is part of the NHS quality, innovation, productivity and prevention (QIPP) programme, which is intended to prepare the NHS for spending cuts while protecting and improving care. ... The checklist may also be used to improve end of life care by requiring clinicians to answer what is known as 'the surprise question' for each admitted patient. This refers to whether the clinician would be surprised if the patient died within a year of admission and, if not, plan for palliative and end of life care" (West, 3/16).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.