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Published on: February 28, 2012
Patient expectations from implantable defibrillators to prevent death in heart failure
Garrick C Stewart1, Joanne R Weintraub, Parakash P Pratibhu
1Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. gcstewart@partners.org
Insights
Heart failure patients expect long survival and overestimate implantable cardioverter-defibrillator (ICD) benefits. Many patients with ICDs for primary prevention of sudden cardiac death are reluctant to deactivate them, even in end-stage disease.
Area of Science:
- Cardiology
- Medical Devices
- Patient Expectations
Background:
- Implantable cardioverter-defibrillators (ICDs) are increasingly indicated for heart failure (HF) patients.
- Over one million HF patients may be eligible for ICDs for primary prevention of sudden cardiac death.
Purpose of the Study:
- To examine patient expectations from ICDs in heart failure (HF).
- To assess survival expectations and attitudes towards deactivation among HF patients.
Main Methods:
- A survey was administered to 105 symptomatic HF patients with LVEF <35%.
- Participants reported perceived ICD benefits, survival expectations, and deactivation scenarios.
- Data included patient demographics, HF severity, and prior ICD implantation.
Main Results:
- Most patients expected over 10 years of survival despite symptomatic HF.
- Nearly 54% believed ICDs would save at least 50 lives per 100 over 5 years.
- ICD recipients showed greater confidence in the device's life-saving potential compared to non-recipients.
Conclusions:
- Heart failure patients often anticipate prolonged survival and overestimate the survival benefits of ICDs.
- A significant majority of ICD recipients expressed unwillingness to deactivate their devices, even in severe end-stage disease or during palliative care.
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 >or=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.
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