End of battery life for CDI device!

[Love100cats]

I've just got back from hospital from my husband's checkup of his device. He has had it 7 years. Now the battery is down to the last 6%. If it's not used too much i.e. electric shocks, it should last 6 months. But though the technicians were trying to be very supportive and helpful I sensed they were choosing their words carefully. So he might have to be seen by cardiologist at that point to determine the best course of action because he would have to travel to other areas as we don't to it locally and lots of stuff I wish I could remember. So keeping in mind that my husband is almost 80, insulin dependent diabetic with afib. Has anyone else faced up to this situation? She did explain the noise and sensation the device would make if it started to fail and that on weekdays I could phone for help but at weekends we would have to travel 50 miles for help. She also said that there were financial implications in replacing the device! That I find hard. How much is he worth? Thanks to anyone who feels they can help especially all the technical jargon. my

[ling]

Hi Love100cats, I do empathise. It's a difficult decision. My dear old dad had a pacemaker and the battery had to be replaced when he was 79. He had heart failure, severe cardiovascular heart disease, AF, two TIAs, a previous stroke.

Yes, you should certainly consult a specialist. It would help in making a good decision. And sorry but is there some place u can perhaps move to in the interim, till things are sorted out? It seems a lot to deal with, especially on weekends when no help is available.

[MichaelJH Heart Star]

Hello, I find it incredibly hard to comment as I do not know your husband. There are so many factors both physically and mentally to take into consideration. The fact he has diabetes is fairly irrelevant unless he has massive complications. You desperately need to talk to a specialist as I think the technicians are going outside their job remit. Good luck with it all!

[Fortepiano]

I understand your anxiety about your husband possibly no longer having an ICD. Nevertheless at this point there are arguments against replacing it. It's not a matter of cost as much as clinical effectiveness. I apologize for being blunt, but most people of 80 and over don't die of a sudden arrhythmia of the sort ICD's prevent, but of other causes - a situation in which the ICD will give repeated but ineffectual shocks. This is not a good scenario as the ICD is actually making things worse- not saving life but instead by repeated painful shocks preventing a peaceful death.

This is why medics now try to have the ICD deactivated before such a possibility arises (if the ICD includes a pacemaker, that part will remain active).

( See the BHF page bhf.org.uk/informationsuppo...

A brief look at the academic literature shows thoughtful discussions of the subject which emphasise also that age shouldn't be necessarily a barrier to ICD implantation, but that elderly patients should be carefully selected, and patients with frailty and comorbidities like diabetes would be less likely to benefit.

I did find one article looking at replacement ICDs in elderly people where the previous ICD had not fired ( I think this is your husband's situation?). Its conclusions were that in such patients there was little benefit in replacing the ICD as they are at little risk of a life-threatening arrhythmia and instead when they die it is of causes where the ICD cannot help them.

Obviously you need to have a frank discussion with his cardiologist but from what I've read, if they say a new ICD is unlikely to be helpful in your husband's situation, I would accept this.

Maybe talk to the BHF nurses about this? It is a difficult subject but best to think about in advance.

It's not all about money, more about what will help the patient.

[Love100cats in reply to Fortepiano]

Thank you so much for your Frank and informative reply. My husband has been advised for over 12 months to have it deactivated but he won't agree and they won't do anything without his permission. He doesn't believe that he is dying even though we have had hospice nurses, g.p., HF nurses, consultants all saying the same. His end of life forms says he wants to be resucitated. Now we have got to the point where he really has to listen. I need to get through as I too have h.f. Your words have reinforced what needs to be done. I'm not sure if it will.

[MichaelJH Heart Star in reply to Love100cats]

Fortepiano's reply and your response have given me a far clearer picture of the problem. You do indeed face a difficult problem as an ICD kicking in preventing a peaceful death is the thing if nightmares. Does the hospice or GP have any counseling services that may be of help. And do ring the BHF nurses - they can offer both advice and a listening ear.

[Love100cats in reply to MichaelJH]

Thanks for your supportive words. We did have a hospice nurse coming who was extremely nice but doing her job and my husband asked her not to come as he didn't want to talk about death. He has made a protective bubble for himself and he just disappears into it when anything unpleasant needs to be talked about. I did make him tell me in front of the hospice nurse if he wanted cremation or burial and said burial and we did sort Wills out years ago but it's the big issue of how he will go. All those involved have spelt it out clearly in words a child would understand but he just switches off and turns the t.v. on. I did plan to talk to h.f. nurses today as they will have got all the info from the pacemaker technician by now. Thankyou again for taking this so seriously. I need that now. I do have a lovely son and daughter-in-law I can be open with but it's their pain too.