Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Card Fail. 2010 Feb;16(2):106-13. doi: 10.1016/j.cardfail.2009.09.003. Epub 2009 Nov 4.
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.
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.
HF patients anticipate long survival, overestimate survival benefits conferred by ICDs, and express reluctance to deactivate their devices even for end-stage disease.
植入式心脏复律除颤器（ICD）在心衰（HF）中的适应证正在扩大，可能包括超过 100 万患者。本研究探讨了 HF 患者对 ICD 进行一级预防心源性猝死的期望。
研究参与者（n = 105）EF <35%，有症状性 HF，无室性心动过速/颤动或晕厥病史。受试者完成了一份关于 ICD 感知益处、生存预期以及他们可能停用除颤的情况下的书面调查。平均年龄为 58 岁，LVEF 21%，40%为纽约心脏协会（NYHA）心功能分级 III-IV 级，65%已经有了一级预防 ICD。尽管有症状性 HF，大多数患者仍预计能存活超过 10 年。近 54%的患者预计 ICD 在 5 年内每 100 人能挽救>或=50 条生命。与没有 ICD 的患者相比，ICD 接受者表示对设备挽救自己生命的信心更大（P <.001）。尽管了解到 ICD 很容易停用，但 70%的 ICD 接受者表示即使死于癌症也会保留 ICD，55%即使每天都有电击也会保留，即使在休息时经常感到呼吸困难，也没有人会停用除颤。
HF 患者预计能长期存活，高估了 ICD 带来的生存益处，并表示不愿停用设备，即使是在终末期疾病。
