Background: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. Aim: The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation. Methods and Results: Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making. Conclusions: Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.
|Number of pages||9|
|Journal||Journal of Cardiovascular Nursing|
|State||Published - Nov 1 2018|
Bibliographical noteFunding Information:
Professor of Nursing Science, Department of Medical and Health Sciences and Department of Cardiology, Linkoping University, Sweden. Donna Fitzsimons, PhD Head of School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland, United Kingdom; and All Ireland Institute of Hospice & Palliative Care, Dublin, Ireland. This work was supported by an HFA Nurse Fellowship training grant and an ‘‘Opportunity-led’’ award from the Public Health Agency NI (Research & Development Division). The authors have no conflicts of interest to disclose.
© 2018 The Authors. Published by Wolters Kluwer Health, Inc.
- decision making
- heart failure
- terminal care
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Advanced and Specialized Nursing