title: Refusing Implantable Cardioverter Defibrillator (ICD) Replacement in Elderly Persons-The Same as Giving Up Life: A Qualitative Study.
abstract: BACKGROUND
  More than 20% of implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices are implanted in the elderly population aged 80 years or older. In recent scientific literature it is suggested to consider termination of ICD therapy, rather than ICD replacement, in this patient group. The aim of this study was to explore the experiences of persons above 80 years of age concerning replacement of the ICD battery, and the shared communication and decision making with healthcare professionals.
  
  
  METHODS
  We performed a qualitative, explorative study, inspired by Ricoeur's narrative, with a phenomenological-hermeneutic approach, involving 11 ICD patients older than 80 years. The study period was 2011-2012.
  
  
  RESULTS
  The meaning of the patients' experiences of living with an ICD was formulated into two themes: (1) "Feeling safe with the ICD" with the subthemes: "The ICD-a life keeper," "The battery level is important," "ICD shock-no problem." (2) "The physician is an authority" with the subthemes: "Being trustful," "Feeling fine knowing nothing," "Criminal act to deactivate the ICD."
  
  
  CONCLUSIONS
  The elderly ICD recipients tended not to be aware of the option of declining replacement of their ICD. They tended to expect to have their ICD replaced and not to be involved actively in decision making concerning this. Healthcare professionals have an obligation to discuss options and ensure that every patient understands these. More research is needed to change practices and create more realistic, person-centered, ethically acceptable, and constructive healthcare for elderly persons with an ICD.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jette Rolf
authors.initials: JR
authors.lastname: Svanholm
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Mortensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Charlotte Fuglesang
authors.initials: CF
authors.lastname: Christensen
authors.affiliation: University of Southern Denmark, Odense, Denmark.
authors.forename: Regner
authors.initials: R
authors.lastname: Birkelund
mesh_terms: D000369:Aged, 80 and over; D001294:Attitude to Health; D000066491:Clinical Decision-Making; D003415:Crime; D017147:Defibrillators, Implantable / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D036301:Qualitative Research; D016079:Refusal to Treat / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires; D016312:Treatment Refusal
keywords: communication; decision making; elderly person; implantable cardioverter defibrillator; qualitative research; replacement