Deficiencies in patients' comprehension of implantable cardioverter defibrillator therapy.
BACKGROUND
Patients receive education before implantable cardioverter defibrillator (ICD) implantation. Patients' understanding of ICD therapy requires investigation.


METHODS
A retrospective cohort study was carried out at two implant centers where patients are educated during a consenting process pre-ICD implantation. Questionnaires examining understanding of ICD therapy were completed during telephone interviews of patients with ICDs.


RESULTS
Of 75 patients interviewed, 62 (83%) were male. The median age at time of ICD implantation was 64 years (standard deviation [SD] = 9.4; range: 29-82 years). The median interval from implantation to interview was 3 years (SD = 1.9; range: 0.1-9.0 years). Despite 83% (62 of 75) claiming to understand the reason for ICD implantation, no patient suggested arrhythmia termination when describing the indication. Of shock recipients, 60% (12 of 20) felt poorly prepared for shock therapy. Of patients who experienced a device-related complication, 83% (10 of 12) reported feeling inadequately forewarned of complications. Excluding patients with cardiac resynchronization therapy defibrillators (n = 6), 65% (45 of 69), 52% (36 of 69), 50% (35 of 69), and 61% (42 of 69) believe their ICD reduces risk of heart attack and improves breathing, exercise capacity, and heart function, respectively. Ninety-three percent (70 of 75) are satisfied with their decision to accept ICD therapy. Only 12% (9 of 75) believe they will want to inactivate therapies in setting of terminal illness.


CONCLUSIONS
Despite preimplantation education, patient comprehension of the risks and benefits of ICD therapy is poor. Patients' expectations of ICD therapy may be inappropriate. Education strategies before and after implantation require improvement.
Department of Cardiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. johngroarke1@eircom.net
John
J
Groarke
Avril
A
Beirne
Una
U
Buckley
Elisabeth
E
O'Dwyer
Declan
D
Sugrue
Ted
T
Keelan
James
J
O'Neill
Joe
J
Galvin
Niall
N
Mahon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007258:Informed Consent / Q000706:statistics & numerical data*; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D012189:Retrospective Studies