Patient Expectations From Implantable Defibrillators to Prevent Death in Heart Failure

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 ejection fraction <35% and symptomatic HF without history of ventricular tachycardia/fibrillation or syncope. Participants completed a written survey about perceived ICD benefits, survival expectations, and circumstances under which they might deactivate defibrillation. Mean age was 58 years, mean left ventricular ejection fraction was 21%, 40% had New York Heart Association class III or IV disease, and 65% already had a primary prevention ICD. Most patients anticipated more than 10 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 experiencing 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.—Stewart GC, Weintraub JR, Pratibhu PP, et al. Patient expectations from implantable defibrillators to prevent death in heart failure. J Card Fail. 2010;16:106–113.