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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

Published on: February 28, 2012

Patients' perspectives on end-of-life issues and implantable cardioverter defibrillators

Patricia H Strachan1, Sandra L Carroll, Sonya de Laat

  • 1McMaster University, School of Nursing, HSC 2J20D, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5. strachan@mcmaster.ca

Journal of Palliative Care
|April 23, 2011
PubMed

Insights

Patients receiving implantable cardioverter defibrillators (ICDs) for sudden cardiac death (SCD) prevention often prioritize SCD prevention over other end-of-life concerns. Integrating ICDs into advance care planning is recommended.

Area of Science:

  • Cardiology
  • Medical Ethics
  • Patient Experience

Background:

  • Implantable cardioverter defibrillators (ICDs) are increasingly used for primary prevention of sudden cardiac death (SCD).
  • Understanding patient perspectives on end-of-life issues related to ICDs is crucial for comprehensive care.
  • Limited research exists on how patients perceive ICDs in the context of their overall end-of-life planning.

Purpose of the Study:

  • To explore patients' perspectives on end-of-life issues concerning implantable cardioverter defibrillators (ICDs).
  • To understand how patients weigh the benefits of ICDs against quality of life and preferred modes of death.
  • To identify implications for advance care planning and healthcare professional education.

Main Methods:

  • A grounded theory approach was employed.
  • Semi-structured, audiotaped interviews were conducted with 30 participants (24 ICD recipients, 6 decliners) from two ICD referral centers.
  • Data analysis involved interview transcripts, verification, researcher memos, literature review, and demographic analysis using NVivo7.

Main Results:

  • Participants were predominantly male, had comorbidities, ejection fraction <30%, and ranged in age from 26 to 87.
  • Three main themes emerged: quality versus quantity of life, preferred mode of death, and technical realities of the ICD.
  • Most participants focused on SCD prevention, with less emphasis on implications for death from other causes.

Conclusions:

  • Patients consider ICDs in the context of both life quantity and quality.
  • There is a strong patient advocacy for incorporating ICDs into advance care planning discussions.
  • Findings highlight the need for improved advance care planning and healthcare professional education regarding ICDs and end-of-life care.

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