Knowledge that implantable cardioverter defibrillators prevent sudden cardiac death independently increased the likelihood of patients reconsidering ICD implantation after initial refusal (OR 6.197).
Cross-Sectional (n=240)
No
What factors influence patients' decision to decline or reconsider ICD implantation for primary prevention of sudden cardiac death in HFrEF?
Knowledge of the preventive role of ICDs is the strongest factor influencing patients with HFrEF to reconsider their decision after initially declining ICD implantation.
Effect estimate: OR 6.197 (95% CI 1.899-20.227)
Absolute Event Rate: 79% vs 32%
p-value: p=0.003
INTRODUCTION: Device therapy is efficacious in preventing sudden cardiac death (SCD) in patients with reduced ejection fraction. However, few who need the device eventually opt to undergo implantation and even fewer reconsider their decisions after deliberation. This is due to many factors, including unresolved patient barriers. This study identified the factors that influenced patients' decision to decline implantable cardioverter defibrillator (ICD) implantation, and those that influenced patients who initially declined an implant to reconsider having one. METHODS: A single-centre survey was conducted among 240 patients who had heart failure with reduced ejection fraction and met the ICD implantation criteria, but had declined ICD implantation. RESULTS: Participants who refused ICD implantation were mostly male (84%), Chinese (71%), married (72%), currently employed (54%), and had up to primary or secondary education (78%) and monthly income of < SGD 3,000 (51%). Those who were more likely to reconsider their decision were aware that SCD was a consequence of heart failure with reduced ejection fraction, knowledgeable of the preventive role of ICDs, currently employed and aware that their doctor strongly recommended the implant. Based on multivariate analysis, knowledge of the role of ICDs for primary prophylaxis was the most important factor influencing patient decision. CONCLUSION: This study identified the demographic and social factors of patients who refused ICD therapy. Knowledge of the role of ICDs in preventing SCD was found to be the strongest marker for reconsidering ICD implantation. Measures to address this information gap may lead to higher rates of ICD implantation.
Chan et al. (Fri,) conducted a cross-sectional in Heart failure with reduced ejection fraction (n=240). Knowledge that ICDs prevent sudden cardiac death vs. Lack of knowledge was evaluated on Likelihood of reconsidering ICD implantation (OR 6.197, 95% CI 1.899-20.227, p=0.003). Knowledge that implantable cardioverter defibrillators prevent sudden cardiac death independently increased the likelihood of patients reconsidering ICD implantation after initial refusal (OR 6.197).