2010 HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in Patients Nearing End of Life or Requesting Withdrawal of Therapy

May 17, 2010—The 2010 HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in Patients Nearing End of Life or Requesting Withdrawal of Therapy was developed in collaboration with and endorsed by the American College of Cardiology (ACC), the American Geriatrics Society (AGS), the American Academy of Hospice and Palliative Medicine (AAHPM), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), and the Hospice and Palliative Nurses Association (HPNA). It focuses on patients nearing the end of life and addresses patients who have made a decision for CIED deactivation at other times, as well as the rights and responsibilities of clinicians (and others, such as industry-employed allied professionals) who may not wish to perform deactivation.

The goals of this document are 1) to make clinicians aware of the legal, ethical, and religious principles that underlie withdrawal of life-sustaining therapies, including device deactivation, in patients who have made this decision; 2) to highlight the importance of proactive communication by the clinician in order to minimize suffering as the end of life nears for patients with CIEDs; and 3) to provide a management scheme to guide the clinician in assisting a patient with a request to withdraw CIED therapy.