title: Attitudes of older adults with serious competing health risks toward their implantable cardioverter-defibrillators: a pilot study.
abstract: BACKGROUND
  In elderly heart failure patients, the survival benefit of implantable cardioverter-defibrillators (ICDs) may be attenuated due to competing health risks, and the risk of adverse outcomes magnified. Our objective was to examine older adults' attitudes towards ICD implantation in the context of competing health risks, exploring the determinants of ICD decision-making among a group of patients who had faced the decision in the past.
  
  
  METHODS
  Telephone survey with a qualitative component. Patients were age ≥70 with single- or dual-chamber ICDs from a single academic cardiac device clinic. Health status was assessed with the Vulnerable Elders Survey (VES-13). Responses to open-ended questions were transcribed verbatim; an "editing analysis" approach was used to extract themes.
  
  
  RESULTS
  Forty-four ICD recipients participated (mean age 77.5 years). Nineteen participants (43%) had VES-13 scores ≥3, indicating a 50% likelihood of death or functional decline within 2 years. Twenty-one participants (48%) had received prior ICD shocks. Forty participants (91%) said they would "definitely" choose to get an ICD again in their current health. By and large, patients revealed a strong desire to extend life, expressed complete confidence in the lifesaving capabilities of their ICDs, and did not describe consideration of competing health risks.
  
  
  CONCLUSIONS
  In this pilot telephone survey with a qualitative component, nearly all older adults with ICDs would still choose to get an ICD despite high short-term risk of death or health deterioration. These findings suggest the need to partner more effectively with patients and families to decide how best to use medical technologies, particularly for older adults with competing risks.
authors.affiliation: Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, 7th floor, Baltimore, MD, 21224, USA. ariel@jhmi.edu.
authors.forename: Ariel R
authors.initials: AR
authors.lastname: Green
authors.affiliation: Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, 7th floor, Baltimore, MD, 21224, USA. cyboyd@jhmi.edu.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 301 building, Baltimore, MD, 21224, USA. jrickar5@jhmi.edu.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 301 building, Baltimore, MD, 21224, USA. rgomon1@jhmi.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Gomon
authors.affiliation: Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, 7th floor, Baltimore, MD, 21224, USA. bleff@jhmi.edu.|Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA. bleff@jhmi.edu.|Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, USA. bleff@jhmi.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003657:Decision Making; D017147:Defibrillators, Implantable / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011795:Surveys and Questionnaires