Harvard Health Letter

Deactivating the ICDs of hospice patients

Turning off these devices can spare patients pain and suffering.

The front-page article of the March 2011 Health Letter was about implantable cardioverter-defibrillators (ICDs), devices that jolt the heart back into a normal rhythm if it starts to beat too fast or in an irregular fashion. ICDs, which are about the size of a small cell phone, are surgically implanted under the skin, just below the collarbone. The article touched on several issues, including some research suggesting that too many people are getting ICDs, partly because doctors aren't waiting long enough after heart failure is diagnosed to see if other kinds of treatments might be effective.

One issue that wasn't covered is people choosing to deactivate — in plainer English, turn off — their ICDs after they start receiving hospice care, which has become an issue because of the growing number of hospice patients with ICDs. After cancer, heart failure is the second most common diagnosis of hospice patients.

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