Deactivation of implantable cardioverter defibrillators towards the end of life: a survey of perceptions and practice among New Zealand clinicians

Background: Implantable cardioverter defibrillators (ICDs) have the potential to reduce the quality of life in patients with life-limiting illnesses. Despite this, the literature suggests deactivation of ICDs occurs infrequently, and there is a lack of guidance on this issue. Aims: This nationwide survey aimed to investigate perceptions and practices regarding deactivation of ICDs among New Zealand clinicians caring for patients with life-limiting illnesses, and to identify barriers to conversations about ICD deactivation. Methods: Cardiologists, general physicians and geriatricians across New Zealand were sent a survey that explored their views and practices regarding deactivation of defibrillators in terminally ill patients. Results: One hundred and forty-five out of 457 clinicians (32%) replied. Most (98%) of clinicians felt deactivation may be appropriate in this group. Key barriers to discussions were felt to include uncertainty over prognosis (77%), likelihood of causing anxiety in their patients (70%), lack of clarity of roles and inexperience in the field. Cardiologists were more likely than general physicians and geriatricians to start deactivation discussions in patients with terminal disease. Doctors with more years in practice felt more comfortable raising the topic of deactivation. Conclusion: While most doctors were comfortable with the concept of device deactivation, issues such as uncertainty of prognosis, fear of causing anxiety, lack of role clarity and inexperience can be barriers to initiating conversations. Further guidance, education, support and shared care could benefit doctors caring for ICD recipients who have life-limiting illnesses.