Decision-making regarding primary prevention implantable cardioverter-defibrillators among older adults.

Journal Article (Journal Article;Review)

Most implantable cardioverter defibrillators (ICDs) are implanted for the purpose of primary prevention of sudden cardiac death among older patients with heart failure with reduced ejection fraction. Shared decision-making prior to device implantation is guideline-recommended and payer-mandated. This article summarizes patient and provider attitudes toward device placement, device efficacy and effectiveness, potential periprocedural complications, long-term events such as shocks, quality of life, costs, and shared decision-making principles and recommendations. Most patients eligible for an ICD anticipate more than 10 years of survival. Physicians are less likely to offer an ICD to patients ≥80 years of age given a perceived lack of benefit. There is a dearth of data from randomized clinical trials addressing device efficacy among older patients; there is a need for more research in this area. However, currently available data support the use of ICDs irrespective of age provided life expectancy exceeds 1 year. Advanced age is independently associated with complications at the time of device placement but not the risk of device infection. The risk of inappropriate shock may be comparable or lower than that of younger patients. While quality of life is generally not adversely impacted by an ICD, a subset of patients experience post-traumatic stress disorder. ICDs are cost-effective from societal and health care sector perspectives; however, out-of-pocket costs vary according to insurance type and level. Shared decision-making encounters may be incremental and iterative in nature. Providers are encouraged to partner with their patients, providing them counsel tailored to their values, preferences, and clinical presentation inclusive of age.

Full Text

Duke Authors

Cited Authors

  • Hess, PL; Matlock, DD; Al-Khatib, SM

Published Date

  • February 2020

Published In

Volume / Issue

  • 43 / 2

Start / End Page

  • 187 - 195

PubMed ID

  • 31867773

Pubmed Central ID

  • PMC7021655

Electronic International Standard Serial Number (EISSN)

  • 1932-8737

Digital Object Identifier (DOI)

  • 10.1002/clc.23315

Language

  • eng

Conference Location

  • United States