Abstract 318: Potential Primary Prevention Implantable Cardioverter-Defibrillator Patients Lack Understanding, Want More Information and Are Willing to Reconsider Implant Refusal
Background: Underutilization of ICD’s for primary prevention of sudden cardiac death has been previously reported in our practice. Factors leading to acceptance or refusal of device implant have not been well studied.
Method: Prospective standardized interview and use of a 1-10 rating scale of randomly selected heart failure (HF) pts in a suburban outpatient cardiology practice.
Results: Of the 533 HF pts identified with an ejection fraction of <35%, we randomly interviewed 50. Of these 54% were Caucasian (C), 36% African American (AA), 10% Asian (A). 29 pts (58%) accepted an ICD and 21 pts (42%) refused, the “no ICD” group. The mean age was 62+11 yrs, The mean EF was 24+7%. No significant differences in patient demographics, cardiac risk factors, HF medications or baseline labwork was seen.
Comparing ICD pts to no ICD pts - in both groups understanding of HF was poor, 4.5 on a scale of 1-10. The no ICD pts had less understanding of ICD purpose p<0.0003 , were less likely to have been given written ICD information (71 vs 38%, p=0.02) and were less likely to recall a recent discussion on the topic of ICD’s (52%). In both groups quality of life was more important than quantity 7.7+3 out of 10. Although 93% were Christian, religious belief (3.3+3 out of 10) and cultural values (3.2+3 out of 10) did not play a major role in decision making. Both group felt they had great access to health care resources and physicians (8.5+2 out of 10). Only 2 (7%) of ICD pts would not accept an ICD again, while 18 no ICD (86%) pts would now reconsider implant, p<0.001
Women were less likely to be married 26 vs 63%, p=0.02. A pts were younger than C, 56 vs 66 yrs, p=0.04. AA pts had less understanding of low EF vs C, p=0.02 and trended towards having less access to best medications p=0.1.
Conclusions: Our qualitative study suggest that underutilization of ICD’s for primary prevention of SCD may in part be related to limited communication and poor understanding of HF, sudden death, and the devices. Furthermore the majority of pts initially refusing a device are willing to reconsider implant. These findings, with further validation, offers a potential approach to improving ICD underutilization in these high risk patients.
- Implantable cardioconvert defibrillator
- Heart failure
- Quality of medical care
- Behavioral aspects
- Sudden cardiac death
- © 2012 by American Heart Association, Inc.