Patients' Perspectives Regarding Generator Exchanges of Implantable Cardioverter Defibrillators.

Area of Science:

• Cardiology
• Medical Decision Making
• Health Psychology

Background:

• Shared decision-making is standard for primary prevention implantable cardioverter defibrillators (ICDs).
• Decisions regarding ICD generator exchange receive less attention, despite potential changes in patient risk, prognosis, and quality of life.
• This study explored patient decision-making processes for ICD generator exchanges.

Purpose of the Study:

• To investigate how patients make decisions about ICD generator exchange.
• To understand patient benefit thresholds for undergoing generator exchange.
• To identify barriers and facilitators in shared decision-making for ICD generator exchange.

Main Methods:

• Qualitative interviews were conducted with 50 patients with primary prevention ICDs.
• Patients were presented with hypothetical scenarios involving varying sudden cardiac death risks to assess willingness for generator exchange.
• Interviews were transcribed and coded using multilevel template analytic methods.

Main Results:

• Willingness to undergo generator exchange decreased as sudden cardiac death risk lowered (48/42/33 patients at 10%/5%/1% risk).
• Physician recommendations, prior ICD therapy experience, and risk aversion significantly influenced patient decisions.
• Therapeutic inertia and misconceptions about ICD therapy were identified as common barriers.

Conclusions:

• Defaults may favor continued generator exchange, even in lower-risk patients.
• Updated risk stratification and clinician-targeted interventions could reduce unnecessary exchanges in very low-risk individuals.
• Interventions addressing therapeutic inertia are crucial for improving shared decision-making in ICD management.