Key result
Declining an implantable cardioverter defibrillator despite a 7% 5-year risk of sudden cardiac death in a 45-year-old woman with hypertrophic cardiomyopathy highlights patient autonomy.
Case Report (n=1)
Upholds patient autonomy in HCM ICD decisions; leaves open prospective outcome data for decliners.
Hypertrophiccardiomyopathy (HCM) is common, whereas the decision not to have an implantable cardioverterdefibrillator (ICD) when probably falling into a 'high-risk' category is not. A solicitor aged 45 years attended the inherited cardiac conditions clinic for review of her HCM and discussion about ICD implantation for primary prevention of sudden cardiac death (SCD). Despite a predicted 7% risk of SCD within the next 5 years, according to the European Society of Cardiology endorsed HCM Risk-SCD risk stratification tool, the patient opted against implantation of an ICD and comprehensively justifies her decision. This report discusses ethical aspects of a consultation offering ICD protection against SCD in the context of HCM and emphasises the clinicians' role in respecting patient autonomy.
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Bray et al. (2018) conducted a case report in Hypertrophic cardiomyopathy (n=1). Implantable cardioverter defibrillator (ICD) was evaluated. Declining an implantable cardioverter defibrillator despite a 7% 5-year risk of sudden cardiac death in a 45-year-old woman with hypertrophic cardiomyopathy highlights patient autonomy.
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