Implantable cardioverter defibrillator deactivation: opportunities and good practice

Abstract

This literature review examines recommendations regarding good decision making for the deactivation of implantable cardioverter defibrillators in individuals who are nearing the end of life. Implantable cardioverter defibrillators are considered the first line of treatment in individuals presenting with life-threatening arrhythmias. However, there comes a time when individuals may experience unwanted shocks from the implantable cardioverter defibrillator in the last phases of life. This article reviews the complexities surrounding discussions about deactivation, including missed opportunities for these discussions during an individual's healthcare journey. Guidelines suggest that healthcare providers should have timely discussions regarding the deactivation of an implantable cardioverter defibrillator with patients and their families, empowering individuals to make an informed decision. This involves exploring the patient's values, cultural beliefs and preferences for care based on a full understanding of all options. It is recognised that good collaboration between multidisciplinary teams within secondary and primary healthcare teams plays a fundamental role in care planning. Health professionals should identify and address high levels of anxiety in patients and promote effective communication throughout the decision-making process. The nursing role should be central to this process in order to facilitate advanced care planning and enable the best healthcare outcomes for the patient. Specialist nurses play an integral part in the care of patients nearing the end of life and represent a positive force within the healthcare system in providing holistic, evidence-based care.