From the Guidelines
A LifeVest wearable defibrillator can typically be discontinued when the patient's risk of sudden cardiac death has significantly decreased or resolved, usually after 40-90 days following a cardiac event, or when the patient's heart function has improved to an ejection fraction greater than 35% 1. The decision to discontinue a LifeVest should always be made by a cardiologist after a thorough evaluation including echocardiogram, stress testing, or other cardiac assessments. Some key considerations for discontinuation include:
- Successful cardiac treatment such as implantation of a permanent implantable cardioverter-defibrillator (ICD)
- Improvement in heart function to an ejection fraction greater than 35%
- Passage of the temporary high-risk period following a cardiac event (usually 40-90 days) Patients should not stop wearing their LifeVest without explicit medical approval, even if they feel better, as sudden cardiac death risk may persist despite symptom improvement 1. The LifeVest serves as a critical bridge therapy, protecting patients during periods of highest risk until either their heart function recovers or a permanent solution is implemented. Once discontinued, patients should return the device to the manufacturer and follow any additional cardiac care instructions from their physician. It is essential to anticipate and discuss the option for discontinuation through the continuum of care, including at the time of initiation, and reassess with changing medical conditions and shifting goals of care 1.
From the Research
Discontinuation of LifeVest
The decision to discontinue LifeVest, a wearable cardioverter-defibrillator, depends on various factors, including the patient's underlying heart condition, risk of sudden cardiac death, and the presence of other treatment options.
- The LifeVest is often used as a temporary measure to provide protection against sudden cardiac death while the patient is waiting for an implantable cardioverter-defibrillator (ICD) or until their heart function improves 2.
- Studies have shown that the risk of sudden cardiac death is highest in the first months after myocardial infarction or first diagnosis of severe non-ischemic cardiomyopathy, and the LifeVest can provide protection during this period 3.
- However, patient compliance and education play a crucial role in the effective use of the LifeVest, and discontinuation should only be considered when the patient's risk of sudden cardiac death has decreased or when an ICD has been implanted 3.
- In some cases, the LifeVest may be discontinued when the patient's left ventricular function has improved to the point where an ICD is no longer needed, but this decision should be made on a case-by-case basis and under the guidance of a healthcare professional 3.
Factors Influencing Discontinuation
Several factors can influence the decision to discontinue LifeVest, including:
- Improvement in left ventricular function: If the patient's heart function has improved, the risk of sudden cardiac death may decrease, and the LifeVest may no longer be necessary 3.
- Implantation of an ICD: Once an ICD has been implanted, the LifeVest can be discontinued, as the ICD will provide ongoing protection against sudden cardiac death 2.
- Change in clinical status: If the patient's clinical status changes, such as an improvement in heart failure symptoms or a decrease in arrhythmic events, the LifeVest may be discontinued 4.