{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T19:05:03Z","timestamp":1767899103116,"version":"3.49.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,9,22]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Implantable cardioverter\u2010defibrillators (\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              s) are commonly implanted in older patients, including those with multiple comorbidities. There are few prospective studies assessing the clinical course and end\u2010of\u2010life circumstances for these patients.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We prospectively followed 51 patients with\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              s for up to 18\u00a0months to longitudinally assess in terms of (1) advance care planning, (2) health status, (3) healthcare utilization, and (4) end\u2010of\u2010life circumstances through quarterly phone interviews and electronic medical record review. The mean age was 71.1\u00b18.3, 74.5% were men, and 19.6% were non\u2010white. Congestive heart failure was predominant (82.4%), as was chronic kidney disease (92%). At baseline, a total of 12% of subjects met criteria for major depression, and 78.4% met criteria for mild cognitive impairment. From this initial study cohort, 76% survived to 18\u00a0months and completed all follow\u2010up interviews, 18% died, and 19% withdrew or were lost to follow\u2010up. Though living will completion and healthcare proxy assignment were common (cumulative outcome at 18\u00a0months 88% and 98%, respectively), discussions of prognosis were uncommon (baseline, 9.8%; by 18\u00a0months, 22.7%), as were conversations regarding\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              deactivation (baseline, 15.7%; by 18\u00a0months, 25.5%). Five decedents with available data received shocks in the days immediately prior to death, including 3 of whom ultimately had their\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              s deactivated prior to death.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We demonstrated the feasibility of prospective enrollment and follow\u2010up of older, vulnerable\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              patients. Early findings suggest a high burden of cognitive and psychological impairment, poor communication with providers, and frequent shocks at the end of life. These findings will inform the design of a larger cohort study designed to further explore the experiences of living and dying with an\n              <jats:styled-content style=\"fixed-case\">ICD<\/jats:styled-content>\n              in this important patient population.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.117.006881","type":"journal-article","created":{"date-parts":[[2017,9,23]],"date-time":"2017-09-23T00:12:00Z","timestamp":1506125520000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["The\n            <i>D<\/i>\n            ecisions,\n            <i>I<\/i>\n            nterventions, and\n            <i>G<\/i>\n            oals in Impla\n            <i>N<\/i>\n            table Cardioverter\u2010Def\n            <i>I<\/i>\n            brillator\n            <i>T<\/i>\n            herap\n            <i>Y<\/i>\n            (DIGNITY) Pilot Study"],"prefix":"10.1161","volume":"6","author":[{"given":"Daniel B.","family":"Kramer","sequence":"first","affiliation":[{"name":"Hebrew SeniorLife Institute for Aging Research, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"},{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Habtemariam","sequence":"additional","affiliation":[{"name":"Hebrew SeniorLife Institute for Aging Research, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaw","family":"Adjei\u2010Poku","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA"},{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Samuel","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA"},{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Engorn","sequence":"additional","affiliation":[{"name":"Hebrew SeniorLife Institute for Aging Research, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew R.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA"},{"name":"Lahey Hospital and Medical Center, Burlington, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Hebrew SeniorLife Institute for Aging Research, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001660"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.115.002053"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2009.04.010"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.07.028"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020677"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.02.014"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2015.0248"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e31824f2173"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02304.x"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2007.113"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02137.x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1963.03060120024016"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/9.3_Part_1.179"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2012.06.001"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2007.06.005"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.960013"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.06.026"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.830"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2011.88"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1159\/000255464"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000406411.49438.91"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-141-11-200412070-00006"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2017.01.014"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2017.03.008"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2016.12.008"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/JCN.0000000000000343"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.117.006881","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:46:03Z","timestamp":1715597163000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.117.006881"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,22]]},"references-count":26,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2017,9,22]]}},"alternative-id":["10.1161\/JAHA.117.006881"],"URL":"https:\/\/doi.org\/10.1161\/jaha.117.006881","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,22]]},"assertion":[{"value":"2017-06-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-07-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e006881"}}