The incidence and impact of implantable cardioverter defibrillator shocks in the last phase of life: An integrated review

• Published in: European Journal of Cardiovascular Nursing Vol. 17; no. 6; pp. 477 - 485
• Main Authors: Stoevelaar, Rik, Brinkman-Stoppelenburg, Arianne, Bhagwandien, Rohit E, van Bruchem-Visser, Rozemarijn L, Theuns, Dominic AMJ, van der Heide, Agnes, Rietjens, Judith AC
• Format: Book Review Journal Article
• Language: English
• Published: London, England SAGE Publications 01-08-2018; Oxford University Press
• Subjects: Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac - surgery; Defibrillators; Defibrillators, Implantable - adverse effects; Defibrillators, Implantable - statistics & numerical data; Female; Humans; Incidence; Male; Middle Aged; Review; Shock, Surgical - epidemiology; Shock, Surgical - etiology; Terminal Care - statistics & numerical data; Vice Presidents; integrated review; Implantable cardioverter defibrillator; shock; impact; end-of-life care
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1177/1474515118777421

Background:
Although the implantable cardioverter defibrillator is successful in terminating life threatening arrhythmias, it might give unwanted shocks in the last phase of life if not deactivated in a timely manner.
Aims:
This integrated review aimed to provide an overview of studies reporting on implantable cardioverter defibrillator shock incidence and impact in the last phase of life.
Methods and results:
We systematically searched five electronic databases. Studies reporting on the incidence and/or impact of implantable cardioverter defibrillator shocks in the last month of life were included. Fifteen studies were included. Two American studies published in 1996 and 1998 reported on the incidence of shocks in patients who died non-suddenly: incidences were 24% and 33%, respectively, in the last 24 hours, and 7% and 14%, respectively, in the last hour of life. Six American studies and one Danish study published between 1991–1999 reported on patients dying suddenly: incidences were 41% and 68% in the last 24 hours and 22–66% in the last hour. Four American studies and two Swedish studies published between 2004–2015 did not distinguish the cause of death: incidences were 17–32% in the last month, 3–32% in the last 24 hours, and 8% and 31% in the last hour of life. Three American studies published between 2004–2011 reported that shocks in dying patients are painful and distressing for patients, and distressing for relatives and professional caregivers.
Conclusion:
If the implantable cardioverter defibrillator is not deactivated in a timely manner, a potentially significant proportion of implantable cardioverter defibrillator patients experience painful and distressing shocks in their last phase of life.