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August 30, 2007Journal of Medical EthicsOpen Access

Views of patients with heart failure about their role in the decision to start implantable cardioverter–defibrillator treatment: prescription rather than participation

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Population

31 outpatients with chronic heart failure and previous episodes of malignant arrhythmia receiving their…

Design

Other

Follow-up

mean 40 months

Authors

AÅAnders ÅgårdUniversity of GothenburgRLRurik LöfmarkLinköping UniversityNENils EdvardssonElectrophysiology

Discussion

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Implication

Clinicians should explicitly discuss alternatives and prognosis in ICD decisions; Level 5 evidence leaves open effects on regret or satisfaction.

Structured PICO

P
Population
31 outpatients with chronic heart failure (NYHA class III and/or LVEF <40%) and previous episodes of malignant arrhythmia receiving their first implantable cardioverter-defibrillator (ICD) as a secondary preventive measure. Mean age 65, 25 men and 6 women. Conducted at Sahlgrenska University Hospital, Göteborg, Sweden.
I
Intervention
Implantable cardioverter-defibrillator (ICD) implantation (focus on the decision-making and informed consent process)
O
Outcome
Patient experiences and views on their role in the decision to initiate ICD treatment, assessed via qualitative content analysis of semistructured interviewspatient reported

Heart failure patients receiving secondary prevention ICDs often view the decision as a medical necessity rather than a shared choice, relying heavily on physician recommendations without detailed discussion of alternatives or prognosis.

Limitations

  • Difficult for respondents to recall in detail what they were informed about at the time of the decision
  • Considerable variation in the way consent procedures are carried out depending on the setting and individual doctor

Cite This Study

Ågård et al. (2007) studied this question.

synapsesocial.com/papers/6a70e0ab5d37378ac1de0abchttps://doi.org/10.1136/jme.2006.017723

Topics

Cardiac device therapyHeart failureHFrEF treatment
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Patient Acceptance of the Implantable Cardioverter Defibrillator in Ventricular Tachyarrhythmias1993 · 141 citations
  2. 2QUALITY OF LIFE AND PSYCHOLOGICAL FUNCTIONING OF ICD PATIENTS2002 · 394 citations
  3. 3Indications for implantable cardioverter defibrillator (ICD) therapy. Study Group on Guidelines on ICDs of the Working Group on Arrhythmias and the Working Group on Cardiac Pacing of the European Society of Cardiology2001 · 82 citations
  4. 4Implantable Cardioverter–Defibrillators2003 · 292 citations
  5. 5Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005)2005 · 2,271 citations