Clinical InvestigationPatient Expectations From Implantable Defibrillators to Prevent Death in Heart Failure
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
References (51)
- et al.
Cardiac failure and sudden death in the Framingham Study
Am Heart J
(1988) - et al.
Review of the registry's first year, data collected, and future plans
Heart Rhythm
(2007) - et al.
A critical appraisal of implantable cardioverter-defibrillator therapy for the prevention of sudden cardiac death
J Am Coll Cardiol
(2008) - et al.
Repeated hospitalizations predict mortality in the community population with heart failure
Am Heart J
(2007) - et al.
Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial
J Am Coll Cardiol
(2005) - et al.
Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact
J Am Coll Cardiol
(2008) - et al.
Implantable cardioverter-defibrillators, induced anxiety, and quality of life
Mayo Clin Proc
(2005) - et al.
Changing preferences for survival after hospitalization with advanced heart failure
J Am Coll Cardiol
(2008) - et al.
Temporal aspects of improved survival with the implanted defibrillator (MADIT-II)
Am J Cardiol
(2004) - et al.
The cost effectiveness of implantable cardioverter-defibrillators: results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II
J Am Coll Cardiol
(2006)
Risk stratification for primary implantation of a cardioverter-defibrillator in patients with ischemic left ventricular dysfunction
J Am Coll Cardiol
Implantable cardioverter-defibrillator efficacy in patients with heart failure and left ventricular dysfunction (from the MADIT II population)
American J Cardiol
Characteristics of patients who die with heart failure and a low ejection fraction in the new millennium
J Cardiac Failure
Withdrawing implantable defibrillator shock therapy in terminally ill patients
Am J Med
Ethical analysis of withdrawal of pacemaker or implantable cardioverter-defibrillator support at the end of life
Mayo Clin Proc
Selecting patients for discussion of the ICD as primary prevention for sudden death in heart failure
J Cardiac Failure
Preferences for quality of life or survival expressed by patients with heart failure
J Heart Lung Transplant
ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
Circulation
2006 Comprehensive Heart Failure Practice Guideline
J Cardiac Failure
Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure
N Engl J Med
Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction
N Engl J Med
Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction
N Engl J Med
Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy
N Engl J Med
Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials
JAMA
Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Circulation
Cited by (0)
Conflict of interests: None.