Recommended Citation
Zalzaleh J, Sharma K, Riutta S, Wankowski D, Badi N. Pacemaker Deactivation: Perspectives Among Clinicians and Providers. Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Abstract
Background/Significance:
Pacemaker deactivation at the end of life (EOL) presents complex ethical and clinical challenges for healthcare providers, particularly cardiologists and palliative care physicians. Existing guidelines affirm the ethical and legal permissibility of deactivating cardiac devices upon patient request. A 2023 study highlighted that patients prefer to be informed about the possibility of pacemaker withdrawal as early as the pre-implantation phase, emphasizing the need for clear communication between patients and providers. Inspired by a patient case requesting deactivation of their pacemaker, our survey-based project aims to better understand the barriers, facilitators, and ethical considerations involved in pacemaker deactivation.
Purpose:
This survey seeks to provide insights into perspectives of providers and decision-making processes surrounding EOL pacemaker deactivation. The findings aim to improve interprofessional communication and inform clinical guidelines, supporting patient-centered care and ethical decision-making.
Methods:
An anonymous REDCap survey was emailed to palliative care (HPM), cardiology (CV), and electrophysiology (EP) providers within Advocate Health. The survey assessed participants' knowledge, attitudes, and experiences with pacemaker deactivation.
Results:
72 survey responses were received. Respondents represented all three target specialties (31% CV, 17% EP, 53% HPM) and a range of years of practice (35% 1-5 yrs, 29% 6-10 yrs, 15% 11-15 yrs, and 21% >15 yrs). More CV (22%) and EP (33%) providers reported they were uncomfortable discussing pacemaker deactivation compared to HPM providers (13%). Many CV (31%) and HPM (47%) providers, but few EP (8%) providers, feel the most appropriate time to discuss pacemaker deactivation is pre-implantation. Most providers believe pacemaker deactivation is appropriate in certain EOL situations (91% CV, 66% EP, 92% HPM).
Conclusion:
This project has begun to shed light on clinicians' perspectives on pacemaker deactivation, highlighting the need for clearer guidelines and enhanced communication strategies between specialties and patients. This survey has led to numerous participants reaching out with comments and their own experiences, sparking further conversations on this topic. Insights gained may inform educational initiatives and policy development to support compassionate, ethical end-of-life care within Advocate Health.
Presentation Notes
Presented at Scientific Day; May 21, 2025; Park Ridge, IL.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
Pacemaker Deactivation: Perspectives Among Clinicians and Providers
Background/Significance:
Pacemaker deactivation at the end of life (EOL) presents complex ethical and clinical challenges for healthcare providers, particularly cardiologists and palliative care physicians. Existing guidelines affirm the ethical and legal permissibility of deactivating cardiac devices upon patient request. A 2023 study highlighted that patients prefer to be informed about the possibility of pacemaker withdrawal as early as the pre-implantation phase, emphasizing the need for clear communication between patients and providers. Inspired by a patient case requesting deactivation of their pacemaker, our survey-based project aims to better understand the barriers, facilitators, and ethical considerations involved in pacemaker deactivation.
Purpose:
This survey seeks to provide insights into perspectives of providers and decision-making processes surrounding EOL pacemaker deactivation. The findings aim to improve interprofessional communication and inform clinical guidelines, supporting patient-centered care and ethical decision-making.
Methods:
An anonymous REDCap survey was emailed to palliative care (HPM), cardiology (CV), and electrophysiology (EP) providers within Advocate Health. The survey assessed participants' knowledge, attitudes, and experiences with pacemaker deactivation.
Results:
72 survey responses were received. Respondents represented all three target specialties (31% CV, 17% EP, 53% HPM) and a range of years of practice (35% 1-5 yrs, 29% 6-10 yrs, 15% 11-15 yrs, and 21% >15 yrs). More CV (22%) and EP (33%) providers reported they were uncomfortable discussing pacemaker deactivation compared to HPM providers (13%). Many CV (31%) and HPM (47%) providers, but few EP (8%) providers, feel the most appropriate time to discuss pacemaker deactivation is pre-implantation. Most providers believe pacemaker deactivation is appropriate in certain EOL situations (91% CV, 66% EP, 92% HPM).
Conclusion:
This project has begun to shed light on clinicians' perspectives on pacemaker deactivation, highlighting the need for clearer guidelines and enhanced communication strategies between specialties and patients. This survey has led to numerous participants reaching out with comments and their own experiences, sparking further conversations on this topic. Insights gained may inform educational initiatives and policy development to support compassionate, ethical end-of-life care within Advocate Health.
Affiliations
Aurora St. Luke's Medical Center, Aurora Zilber Family Hospice, Aurora UW Medical Group, Aurora Sinai Medical Center, Aurora West Allis Medical Center