Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Feb;16(2):106-13.
doi: 10.1016/j.cardfail.2009.09.003. Epub 2009 Nov 4.

Patient expectations from implantable defibrillators to prevent death in heart failure

Garrick C Stewart  1 , Joanne R Weintraub, Parakash P Pratibhu, Marc J Semigran, Janice M Camuso, Kimberly Brooks, Sui W Tsang, Mary Susan Anello, Viviane T Nguyen, Eldrin F Lewis, Anju Nohria, Akshay S Desai, Michael M Givertz, Lynne W Stevenson
Affiliations
Comparative Study

Patient expectations from implantable defibrillators to prevent death in heart failure

Garrick C Stewart et al. J Card Fail. 2010 Feb.

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 >or=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.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: None.

Figures

Fig. 1
Fig. 1
Subjects were asked how many lives per 100 they would expect an implantable cardioverter-defibrillator (ICD) to save during the first 5 years after implantation. Heart failure patients surveyed overestimated the impact of ICDs on survival compared with Sudden Cardiac Death in Heart Failure Trial patients (7.2 lives per 100 over 5 years). Estimates were similar between ICD recipients and those without an ICD in place (P = .52).
Fig. 2
Fig. 2
Subjects were asked whether or not they expected an implantable cardioverter-defibrillator (ICD) to save their own lives. ICD recipients were more confident that the device would save their lives (P < .001).
Fig. 3
Fig. 3
Heart failure patients surveyed anticipated a long life when asked to estimate their life expectancy. There was no significant difference in estimates between patients with and without an implantable cardioverter-defibrillator (ICD) (P = .18).
Fig. 4
Fig. 4
Subjects were asked to estimate the number of inappropriate implantable cardioverter-defibrillator (ICD) shocks or complications that would occur per 100 ICD implanted. ICD recipients estimated fewer adverse events compared to patients without an ICD (P = .002).
Fig. 5
Fig. 5
Asked how the defibrillator feature of an implantable cardioverter-defibrillator (ICD) could be deactivated, most heart failure patients surveyed understood that an external programmer could be used. Subjects already with an in place ICD exhibited a better understanding of the simplicity of inactivating defibrillation. (P = .016).
Fig. 6
Fig. 6
Implantable cardioverter-defibrillator (ICD) recipients were asked to consider circumstances that might prompt ICD deactivation. ICD recipients anticipated reluctance to turn off defibrillator function.
See this image and copyright information in PMC

References

    1. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. 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. 2005;112:e154–235. - PubMed
    1. HFSA. 2006 Comprehensive Heart Failure Practice Guideline. J Cardiac Failure. 2006;12:e1–2. - PubMed
    1. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–37. - PubMed
    1. Hohnloser SH, Kuck KH, Dorian P, Roberts RS, Hampton JR, Hatala R, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. 2004;351:2481–8. - PubMed
    1. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–83. - PubMed