Among 25 interviewed ICD-eligible patients (12 acceptors, 13 refusers), refusal was driven by a lack of insight into personal sudden cardiac death risk and weak perceived physician recommendation.
Observational (n=25)
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What are the patient-related barriers to appropriate utilization of ICDs for primary prophylaxis?
Patient understanding of sudden cardiac death risk and the perceived strength of physician recommendation are key factors influencing the acceptance or refusal of primary prevention ICDs.
Background: Primary prophylaxis with implantable cardioverter‐defibrillators (ICDs) improves mortality in patients at risk for sudden cardiac death (SCD). However, ICDs are highly underutilized. We explored patients’ attitudes and perceptions of ICDs to better understand potential patient‐related barriers to appropriate utilization. Methods: Records of patients visiting three outpatient cardiology clinics (June 2009–January 2010) were reviewed and 133 with ejection fractions ≤35% and without an ICD were identified. Seventy‐two met criteria for ICD placement. Twenty‐five consented and were interviewed by telephone using a semistructured open‐ended interview guide. Twelve individuals had accepted ICD referral, and 13 had declined. We analyzed transcripts of ICD refusers and acceptors using the constant comparative method of grounded theory. Results: Five major themes emerged: (1) Patients who refused ICD referral demonstrated a lack of insight into their own risk potential. (2) Many patients who accepted ICD referral perceived that this was strongly recommended by their physicians, although many patients refusing did not. (3) Concerns over recall, malfunction, and surgical risk were common in both. (4) Many patients demonstrated inaccurate perceptions of ICD‐related risks and lifestyle changes. Acceptors often reported these perceptions being addressed by their physician. (5) Feelings regarding invasive life‐prolonging interventions played an important role in ICD referral refusal for some individuals. Conclusions: Refusal of ICD is common among primary prevention candidates. Common themes in the decision‐making process include insight into personal risk of SCD, and perceived strength of the physician recommendation. Providers may want to consider assessment of patients’ individual understanding and perceptions when discussing ICD prophylaxis. (PACE 2012; 35:1179–1187)
Yuhas et al. (Thu,) conducted a observational in Risk for sudden cardiac death (EF ≤35%) (n=25). Implantable Cardioverter-Defibrillator (ICD) referral vs. Refusal of ICD referral was evaluated on Patient attitudes and perceptions of ICDs (qualitative themes). Among 25 interviewed ICD-eligible patients (12 acceptors, 13 refusers), refusal was driven by a lack of insight into personal sudden cardiac death risk and weak perceived physician recommendation.