Among patients with an active ICD for chronic heart failure, 84% wanted to be involved in the deactivation decision, and 40% felt this discussion should occur prior to implantation.
Cross-Sectional (n=54)
What are the attitudes and preferences of patients with ICDs for chronic heart failure regarding device deactivation and end-of-life discussions?
Most patients with ICDs are unaware of deactivation options but strongly desire to be involved in these decisions, highlighting a need for earlier and more comprehensive communication.
BACKGROUND: Patients receiving implantable cardioverter-defibrillators (ICDs) often have severely impaired left ventricular function and a poor prognosis. Having an ICD in situ effectively denies them the possibility of a quick, arrhythmic death. It is still unclear if and when the end of life and device deactivation should be discussed with patients and how much patients want to know prior to ICD implantation. METHODS: Patients with an active ICD for chronic heart failure were interviewed regarding their attitude toward the ICD, their recollection of the consent procedure, and how they felt the end of life should be discussed with ICD patients (n = 54). Patients who had received ICD therapies (n = 25) were reviewed as a subgroup with extended questions regarding attitudes toward device deactivation. RESULTS: Fifty-four patients were recruited. Most patients were not aware that the ICD could be deactivated. The vast majority of patients (84%) wanted to be involved in the deactivation decision; 40% felt this discussion should be prior to ICD implantation but others felt the discussion should only occur if the patient was terminally ill (16%) or in the last few days of life (5%). CONCLUSION: Patients with ICDs are routinely counseled about the benefits of ICDs, but options for device deactivation are not well understood by patients. Most patients would like to be involved in deactivation decisions and we feel this should be discussed well in advance.
Raphael et al. (Wed,) conducted a cross-sectional in Chronic heart failure with an active ICD (n=54). Active implantable cardioverter-defibrillator (ICD) was evaluated on Attitude toward device deactivation and end-of-life discussions. Among patients with an active ICD for chronic heart failure, 84% wanted to be involved in the deactivation decision, and 40% felt this discussion should occur prior to implantation.