Yuhas Jennifer, Mattocks Kristin, Gravelin Laura, Remetz Michael, Foley John, Fazio Richard, Lampert Rachel
Yale University School of Medicine, New Haven, Connecticut, USA.
Pacing Clin Electrophysiol. 2012 Oct;35(10):1179-87. doi: 10.1111/j.1540-8159.2012.03497.x. Epub 2012 Aug 16.
Primary prophylaxis with implantable cardioverter-defibrillators (ICDs) improves mortality in patients at risk for sudden cardiac death (SCD). However, ICDs are highly underutilized. We explored patients' attitudes and perceptions of ICDs to better understand potential patient-related barriers to appropriate utilization.
Records of patients visiting three outpatient cardiology clinics (June 2009-January 2010) were reviewed and 133 with ejection fractions ≤35% and without an ICD were identified. Seventy-two met criteria for ICD placement. Twenty-five consented and were interviewed by telephone using a semistructured open-ended interview guide. Twelve individuals had accepted ICD referral, and 13 had declined. We analyzed transcripts of ICD refusers and acceptors using the constant comparative method of grounded theory.
Five major themes emerged: (1) Patients who refused ICD referral demonstrated a lack of insight into their own risk potential. (2) Many patients who accepted ICD referral perceived that this was strongly recommended by their physicians, although many patients refusing did not. (3) Concerns over recall, malfunction, and surgical risk were common in both. (4) Many patients demonstrated inaccurate perceptions of ICD-related risks and lifestyle changes. Acceptors often reported these perceptions being addressed by their physician. (5) Feelings regarding invasive life-prolonging interventions played an important role in ICD referral refusal for some individuals.
Refusal of ICD is common among primary prevention candidates. Common themes in the decision-making process include insight into personal risk of SCD, and perceived strength of the physician recommendation. Providers may want to consider assessment of patients' individual understanding and perceptions when discussing ICD prophylaxis.
植入式心脏复律除颤器（ICD）的一级预防可降低心脏性猝死（SCD）高危患者的死亡率。然而，ICD的使用严重不足。我们探讨了患者对ICD的态度和看法，以更好地了解与患者相关的潜在障碍，这些障碍影响了ICD的合理使用。
回顾了在三家门诊心脏病诊所就诊的患者记录（2009年6月至2010年1月），确定了133例射血分数≤35%且未植入ICD的患者。72例符合ICD植入标准。25例同意并通过电话进行了半结构化开放式访谈。12例患者接受了ICD转诊，13例拒绝。我们使用扎根理论的持续比较法分析了ICD拒绝者和接受者的访谈记录。
出现了五个主要主题：（1）拒绝ICD转诊的患者对自身风险潜力缺乏认识。（2）许多接受ICD转诊的患者认为这是医生强烈推荐的，而许多拒绝的患者则不这么认为。（3）双方都普遍担心召回、故障和手术风险。（4）许多患者对ICD相关风险和生活方式改变的认识不准确。接受者通常表示医生解决了这些认识问题。（5）对于一些人来说，对侵入性延长生命干预措施的感受在拒绝ICD转诊中起重要作用。
在一级预防候选患者中，拒绝ICD很常见。决策过程中的常见主题包括对SCD个人风险的认识以及医生推荐的力度。在讨论ICD预防时，医疗服务提供者可能需要考虑评估患者的个人理解和看法。
