Patient expectations from implantable defibrillators to prevent death in heart failure

J Card Fail. 2010 Feb;16(2):106-13. doi: 10.1016/j.cardfail.2009.09.003. Epub 2009 Nov 4.


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.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable*
  • Female
  • Heart Failure / mortality
  • Heart Failure / psychology*
  • Heart Failure / therapy*
  • Humans
  • Life Expectancy / trends
  • Male
  • Middle Aged
  • Patient Education as Topic* / trends
  • Patient Satisfaction
  • Survival Rate / trends