Do pacemakers prolong the dying process in a palliative setting?-a retrospective matched cohort analysis.

BACKGROUND

Clinicians caring for end-of-life patients regularly receive questions from patients and relatives about whether the pacemaker (PM) has to be deactivated. The possible life-prolonging effect of an active PM on the dying process of a palliative patient remains a scientific and clinical question in the literature and is a challenge for caregivers and patients in the end-of-life phase. This study analyzed whether there is a possible life-prolonging effect of an active PM in palliative patients.

METHODS

The time that 83 terminal palliative PM patients passed at a palliative care until death is compared with the time that 163 matched control terminal non-PM patients passed at the same palliative care unit (PCU). The non-PM patients are matched for age, gender, and underlying diseases.

RESULTS

The survival curves of PM and matched control non-PM patients were, for most of the time, exactly superimposed. Some PM patients died in the period 10-45 days after intake at the PCU a few days earlier than the control patients. This may be explained by their higher cardiovascular morbidity, more frequent previous cardiac surgery, more diabetes mellitus, and impaired kidney function.

CONCLUSIONS

There is no evidence that an active PM prolongs the dying process in terminal PCU patients; a few PM patients died even earlier than their matched control non-PM patients.