Patient Expectations From Implantable Defibrillators to Prevent Death in Heart Failure
Received 11 February 2009; received in revised form 25 August 2009; accepted 8 September 2009. published online 05 November 2009.
Abstract
Background
Indications for implantable cardioverter-defibrillators (ICDs) in heart failure (HF) are expanding and may include more than 1 million patients. This study examined patient expectations from ICDs for primary prevention of sudden death in HF.
Methods and Results
Study participants (n = 105) had an EF <35% and symptomatic HF, without history of ventricular tachycardia/fibrillation or syncope. Subjects completed a written survey about perceived ICD benefits, survival expectations, and circumstances under which they might deactivate defibrillation. Mean age was 58, LVEF 21%, 40% were New York Heart Association Class III-IV, and 65% already had a primary prevention ICD. Most patients anticipated more than10 years survival despite symptomatic HF. Nearly 54% expected an ICD to save ≥50 lives per 100 during 5 years. ICD recipients expressed more confidence that the device would save their own lives compared with those without an ICD (P < .001). Despite understanding the ease of deactivation, 70% of ICD recipients indicated they would keep the ICD on even if dying of cancer, 55% even if having daily shocks, and none would inactivate defibrillation even if suffering constant dyspnea at rest.
Conclusions
HF patients anticipate long survival, overestimate survival benefits conferred by ICDs, and express reluctance to deactivate their devices even for end-stage disease.
1Divisions of Cardiovascular Medicine, Brigham and Women's Hospital
2Massachusetts General Hospital, Harvard Medical School, Boston, MA
3Department of Biostatistics, School of Epidemiology and Public Health, Yale University, New Haven, CT
Reprint requests: Garrick C. Stewart, MD, Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115. Fax: (866) 720-1883.
ABSTRACT