Key result
Most heart failure patients (68%) would consider ICD deactivation and identified three key stages for discussions: prior to implantation, upon significant clinical deterioration, and at end of life.
Why the study?
What are patient preferences regarding the timing of implantable cardioverter-defibrillator deactivation discussions in heart failure patients?
What are patient preferences regarding the timing of implantable cardioverter-defibrillator deactivation discussions in heart failure patients?
Patients with heart failure and ICDs prefer deactivation discussions to occur at multiple stages, including prior to implantation, during clinical deterioration, and at the end of life.
Supports patient-centered ICD discussions in HF; leaves open prospective trials on optimal timing and outcomes.
BACKGROUND: There is a class I recommendation for implantable cardioverter-defibrillator deactivation discussions to occur between physicians and heart failure patients. Few studies have reported the patient's perspective on the timing of implantable cardioverter-defibrillator deactivation discussions. AIM: To determine patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions. DESIGN: Grounded theory was used to collect and analyze interview data from 25 heart failure patients with an implantable cardioverter-defibrillator. SETTING AND PARTICIPANTS: Patients with an implantable cardioverter-defibrillator, from the Heart Function Clinic at University Health Network (Toronto, Canada). RESULTS: The sample (n = 25) was predominately male (76%) with an average age of 62 years. Patients identified three stages where they felt implantable cardioverter-defibrillator deactivation should be discussed: (1) prior to implantation, (2) with any significant deterioration but while they were of sound mind to engage in and communicate their preferences and (3) at end of life, where patients wished further review of their previously established preferences and decisions about implantable cardioverter-defibrillator deactivation. Most patients (n = 17, 68%) said they would consider deactivation, six (24%) were undecided and two (8%) were adamant they would never turn it off. CONCLUSION: The patient preferences identified in this study support the need to include information on implantable cardioverter-defibrillator deactivation at implant, with change in clinical status and within broader discussions about end-of-life treatment preferences. Using this process to help patients determine and communicate their implantable cardioverter-defibrillator deactivation preferences may reduce the number of patients experiencing distressing implantable cardioverter-defibrillator shocks at end of life.
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MacIver et al. (2016) studied Heart failure with an implantable cardioverter-defibrillator (n=25). Implantable cardioverter-defibrillator deactivation discussions was evaluated on Patient awareness, preferences and timing of implantable cardioverter-defibrillator deactivation discussions. Most heart failure patients (68%) would consider ICD deactivation and identified three key stages for discussions: prior to implantation, upon significant clinical deterioration, and at end of life.
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