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Patient Preferences for Deactivation of Implantable Cardioverter-Defibrillators
Study Questions:
What are the preferences for implantable cardioverter-defibrillator (ICD) deactivation in the context of health outcomes such as functional and cognitive disabilities shown to matter most to patients?
Methods:
The authors recruited ICD patients 50 years and older who were followed in a single academic electrophysiology practice (Yale University). Eligible participants had received a new ICD implant or generator change between January 1, 2006, and December 31, 2009. They excluded patients who were cognitively impaired, had an initial device within the past year, or had a cardiac resynchronization therapy–capable device. Eligible participants were contacted by telephone, and those consenting were administered a 20-minute telephone survey.
Results:
Of 136 eligible patients contacted, 95 (70%) agreed to participate. The mean (standard deviation [SD]) age was 71.4 (10.6) years, 28% were female, and 19% were nonwhite. The mean (SD) duration of ICD placement was 4.0 (2.4) years prior, and 29% of participants had received a prior ICD shock. Sixty-seven participants (71%) wanted ICD deactivation in one or more scenarios. Responses to individual scenarios ranged from 61% wanting deactivation in the setting of advanced incurable disease, to 24% wanting deactivation if permanently unable to get out of bed. Participant characteristics associated with wanting deactivation included race and disability, but not age.
Conclusions:
The authors concluded that the majority of participants wanted ICD deactivation in at least one scenario describing health outcomes that are common in patients approaching the end of life.
Perspective:
The current study, in contrast to prior findings, reported that following an informational script, the majority (71%) of participants wanted ICD deactivation in at least one scenario describing health outcomes that are common in patients approaching the end of life. The finding that a sizeable number of participants did not have a good understanding of the benefits or potential burdens of their ICD highlights the critical importance of open physician communication. The study also emphasizes the importance of incorporating multiple patient-centered outcomes into advance care planning for ICD patients.
Keywords: Heart Diseases, Electrophysiology, Disabled Persons, Defibrillators, Shock, Heart Failure, Advance Care Planning, Terminal Care, Patient Preference, Cardiac Resynchronization Therapy
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