Elsevier

Journal of Cardiac Failure

Volume 16, Issue 2, February 2010, Pages 106-113
Journal of Cardiac Failure

Clinical Investigation
Patient Expectations From Implantable Defibrillators to Prevent Death in Heart Failure

https://doi.org/10.1016/j.cardfail.2009.09.003Get rights and content

Abstract

Background

Indications for implantable cardioverter-defibrillators (ICDs) in heart failure (HF) are expanding and may include more than 1 million patients. This study examined patient expectations from ICDs for primary prevention of sudden death in HF.

Methods and Results

Study participants (n = 105) had an EF <35% and symptomatic HF, without history of ventricular tachycardia/fibrillation or syncope. Subjects completed a written survey about perceived ICD benefits, survival expectations, and circumstances under which they might deactivate defibrillation. Mean age was 58, LVEF 21%, 40% were New York Heart Association Class III-IV, and 65% already had a primary prevention ICD. Most patients anticipated more than10 years survival despite symptomatic HF. Nearly 54% expected an ICD to save ≥50 lives per 100 during 5 years. ICD recipients expressed more confidence that the device would save their own lives compared with those without an ICD (P < .001). Despite understanding the ease of deactivation, 70% of ICD recipients indicated they would keep the ICD on even if dying of cancer, 55% even if having daily shocks, and none would inactivate defibrillation even if suffering constant dyspnea at rest.

Conclusions

HF patients anticipate long survival, overestimate survival benefits conferred by ICDs, and express reluctance to deactivate their devices even for end-stage disease.

Section snippets

Study Population

Subjects were enrolled from 2 heart failure referral centers in Boston, Massachusetts, between February 2005 and January 2006. The study protocol was approved by an institutional review committee. Participants were both inpatients and outpatients, and could already have an ICD in place for primary prevention. Inclusion criteria were left ventricular ejection fraction (LVEF) <35% and symptomatic heart failure. To collect a primary prevention cohort, patients were excluded if they had a history

Baseline Characteristics

Baseline clinical characteristics are reported in Table 1 and have been stratified by the presence or absence of an ICD for primary prevention at the time of survey. The survey population (n = 105) had a mean age of 58 years, 70% were male, mean LVEF was 21%, 52% had heart failure more than 5 years, 40% were NYHA Class III or IV, and 35% had an ischemic etiology. In all, 65% of patients surveyed already had an ICD placed for primary prevention of sudden death. In aggregate, patients with or

Discussion

This study shows that symptomatic heart failure patients anticipate long survival and overestimate the survival benefits of ICDs for primary prevention of sudden death. Confidence in ICDs was robust and unrelated to the presence or absence of an existing ICD, NYHA functional class, or the value each subject placed on quality versus length of life as assessed by time tradeoff. Although patients with ICDs in place understood the ease of reprogramming, most indicated that they would not consider

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    Conflict of interests: None.

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