# Prospective Investigation of Palliative and End-of-Life ExpeRiences with ICDs (PIPER-ICD) Study

> **NIH NIH R01** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2024 · $710,090

## Abstract

Summary X
Implantable cardioverter-defibrillator (ICD) guidelines draw on trials with few older patients, yet ~50,000 ICDs
are implanted annually in patients ≥65 years old. Half of older ICD recipients will either be dead or enrolled in
hospice within 5 years of implantation, and little evidence supports critical long-term decisions including (1)
whether to replace ICDs when the battery declines, or (2) timing of ICD deactivation to avoid painful shocks at
the end of life. There is therefore a pressing need for longitudinal data on patient health status and clinical
experiences in the years after ICD implantation to support patient-centered decisions. To extend our prior work
and further improve the care of patients living and dying with ICDs, we now propose the Prospective
Investigation of Palliative and End-of-Life ExpeRiences with ICDs (PIPER-ICD) Study, a rigorous, multi-
center cohort with the goal of defining patient-centered experiences of older ICD patients >5 years post
implantation. We will prospectively collect data on geriatric conditions and quality of life from 1200 patients at
5 sites, enriched with remote monitoring data on arrhythmias and physical activity, to evaluate clinical and
functional trajectories (Aim 1). This cohort will support novel application of a semi-competing risks approach to
personalizing individualized outcome profiles for death and ICD shocks (Aim 2). Lastly, we will apply mixed
methods to the decedent cohort (N~200) to quantify ICD shocks at the end of life and identify potential targets
for interventions to improve their care (Aim 3). This proposal is led by cardiac electrophysiologist with expertise
in geriatrics, outcomes research, and bioethics, supported by an experienced research team with a strong record
of collaboration. IMPACT: As the first comprehensive, prospective study of older ICD patients focused on long-
term and end-of-life experiences, PIPER-ICD will generate patient-centered and personalized data essential for
evidence-based guidance to serve a vulnerable population. PIPER-ICD will thus serve as a rich resource to
support decision-making for millions of patients considering replacement or deactivation of their ICDs.

## Key facts

- **NIH application ID:** 10877751
- **Project number:** 5R01HL161697-03
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** Daniel Bruce Kramer
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $710,090
- **Award type:** 5
- **Project period:** 2022-07-15 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10877751

## Citation

> US National Institutes of Health, RePORTER application 10877751, Prospective Investigation of Palliative and End-of-Life ExpeRiences with ICDs (PIPER-ICD) Study (5R01HL161697-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10877751. Licensed CC0.

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