A Qualitative Analysis of Patient-Related Factors Associated With Implantable Cardioverter Defibrillator Acceptance
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ORIGINAL RESEARCH
A Qualitative Analysis of Patient-Related Factors Associated With Implantable Cardioverter Defibrillator Acceptance Amber E. Johnson
. Yamira K. Bell . Megan E. Hamm .
Samir F. Saba . Larissa Myaskovsky
Received: April 9, 2020 The Author(s) 2020
ABSTRACT Introduction: Patient-related factors determining implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in patients with cardiomyopathy have not been well explored. To assess race and sex differences regarding ICD preferences in this patient population, we sought to analyze a diverse cohort of patients with heart failure (HF) with reduced ejection fraction. Methods: We conducted qualitative interviews of 28 adults with severe HF and either (1) an ICD or (2) no ICD. Interviews were recorded, Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12311384. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40119020-00180-9) contains supplementary material, which is available to authorized users. A. E. Johnson (&) M. E. Hamm S. F. Saba Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA e-mail: [email protected] Y. K. Bell School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA L. Myaskovsky Internal Medicine and Psychiatry, University of Pittsburgh, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
transcribed, and coded using an inductively developed codebook by independent investigators. Coding was fully adjudicated and transcripts were reviewed to identify themes. Results: We recruited patients between 12/2015 and 06/2017, primarily from the outpatient cardiology clinic (24/28 = 86%). Half were women (50%) and 13/28 (46%) were black. Eight did not have an ICD. Neither race nor sex was associated with ICD. Four themes emerged: (1) HF requiring an ICD is profoundly disruptive to patients’ lives; (2) patients had positive, yet unrealistic opinions of ICDs; or (3) Patients had negative/ambivalent opinions of ICDs; (4) medical decision-making included aspects of shared decision-making and informed consent. Conclusions: Patients without ICDs perceived less benefit from ICDs and had less decision support. Participants viewed conversations with providers as insufficient. Needed interventions include the development and validation of processes for informed decisions about ICDs. Keywords: Implantable defibrillator; Practice decision-making
cardioverter guidelines; Shared
Cardiol Ther
Key Points Why carry out this study? Patients with severe heart failure face many decisions about their care. It is unknown how patients feel when deciding about ICD implantation. What was learned from this study? Some patients with ICD have either unrealistic expectations or negative opinions of ICDs. Accepting ICD implantation requires informed consent and patient decision support. Current communication may be insufficient to explain IC
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