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Implanted Heart Devices Should Be Recyled After Death, Researchers Say

Morticians and patients willing to donate defibrillators and pacemakers for further use, survey finds.

SUNDAY, Nov. 12, 2006 (HealthDay News) -- Apparently you can take it with you -- but maybe you shouldn't.

The issue of an afterlife for implantable pacemakers and defibrillators was raised Sunday in a novel report on what happens to the devices once their owners die.

Most get buried with their owners, but they could be put to better use, researchers said at the annual meeting of the American Heart Association (AHA) in Chicago.

Morticians and patients alike would be willing to donate the pacemakers or defibrillators or return them to the manufacturer to analyze malfunction rates as long as legal guidelines are in place, the researchers found.

Implantable cardiac devices, whose use has surged in recent years, can be buried with a person but must be removed if there is a cremation because they will explode, the researchers pointed out at a Sunday news conference.

For their study, they interviewed 100 morticians and 150 heart patients.

"We asked questions primarily about what they [the patients] would want done with the pacemaker or defibrillator after death, and if they would be willing to sign a 'device living will,'" said study author Dr. James Kirkpatrick, of the University of Chicago.

Eighty-two percent of the patients said they would be willing to have the device analyzed noninvasively, 79 percent said they would be willing to have it removed upon their death and returned to the manufacturer, and 72 percent were willing to sign a "device living will."

Of those willing to sign a living will, 91 percent said they were willing to donate their device to a medically underserved nation.

In querying the morticians, the researchers reported that 44 percent of them said they threw the devices away as medical waste after death, 18 percent donated them for human use in developing nations, 10 percent returned them to the next of kin, 8 percent stored them in the mortuary, 4 percent returned them to the manufacturer, 4 percent returned them to the hospital where the patient died, 3 percent donated them to veterinary schools for implantation into animals (mostly dogs), and 24 percent didn't know or had no answer on what had been done.

On the other hand, 87 percent of morticians said it would be feasible to remove a device and return it to the manufacturer.

"Pacemakers and defibrillators are not analyzed or returned to the manufacturer after a patient dies, signifying that there are probably significant barriers to following guidelines of cardiology societies," Kirkpatrick said. The Heart Rhythm Society recently issued guidelines advocating the return of devices to manufacturers.

"Device living wills appear to be an attractive option, if given the same legal weight as standard wills," Kirkpatrick continued.

"There also needs to be a comfort level in talking to the patient about dying," added Dr. Lynne Warner Stevenson, of Brigham and Women's Hospital in Boston. "It's been said that in the U.S., death is considered optional."

Stevenson was senior author of another study being presented at the meeting which found that patients greatly overestimated the ability of implantable cardiac defibrillators to prevent sudden cardiac death.

"Most expect more than 50 per 100 lives will be saved, compared to 7 or 8 per 100 predicted based on clinical trials," said co-author Dr. Garrick Stewart, cardiology fellow at Brigham and Women's Hospital. "We cannot stop reminding our patients and ourselves that heart failure remains a fatal disease, from which most deaths occur slowly."

Amongst other heart news reported at the AHA meeting Sunday, new research found that current wireless levels do not interfere with implantable devices but can interfere with emergency programming and telemetry signals, indicating that hospitals should locate services away from high-output access points.

And patients who received information and counseling on symptom management and cognitive behavioral techniques had less anxiety and depression.

Finally, a French study found a high number of deaths from heart failure, indicating that implanting defibrillators with cardiac resynchronization therapy (CRT) might help reduce the number of deaths due to heart failure.

More information

Visit the American Heart Association for more on implantable defibrillators.

SOURCES: Nov. 12, 2006, American Heart Association news conference with James Kirkpatrick, M.D., University of Chicago; Lynne Warner Stevenson, M.D., Brigham and Women's Hospital, Boston; Garrick Stewart, cardiology fellow, Brigham and Women's Hospital; Nov. 12, 2006, presentation, American Heart Association, annual meeting, Chicago
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