In the Dark About Heart Devices

Cardiovascular disease patients may not get enough info from their doctor on risks of heart devices

(RxWiki News) Implantable cardioverter defibrillators (ICDs) treat irregular heartbeats. While the devices have benefits, they also pose risks that doctors may not explain to patients.

ICDs are similar to pacemakers. They are implanted in the chest to help control irregular heart rhythms (arrhythmia). When needed, they can deliver jolting shocks.

A new report has revealed that doctors may talk with patients more about ICD technology than the long-term risks and effects on quality of life.

"Ask your doctor about the risks of implantable cardioverter defibrillators."

Paul Hauptman, MD, principal investigator of the study and professor of internal medicine at the Saint Louis University School of Medicine in Missouri, based research on focus groups including 41 patients with ICDs and 11 cardiologists.

In the study, 80 percent of patients said that they did not discuss any potential long-term complications of the device with their physicians before the procedure. They also said that they were not warned about the changes they could expect in the quality of their lives after the device was implanted.

Multiple patients reported complications such as depression, anxiety and changes in body image, which their doctors had not previously mentioned.

Several patients also experienced difficulty in performing routine physical labor and stated that they now dislike flying because of extra security screening at airports.

Like many electronics, ICDs can malfunction and break down, requiring corrective procedures to replace parts, such as the lead and the generator.

The study authors stressed that most patients viewed the implantation as a cure, but soon realized that wasn't the case.

"Patients reported that their physicians described the device as a safety net, calling it absolutely necessary,” said Eric Armbrecht, PhD, co-principal investigator and director of consulting practice at Saint Louis University Center for Outcomes Research. “We found that many patients end up having unrealistic expectations of what the technology is going to do for them.”

Dr. Hauptman noted that patients who have not had a sudden death event or symptoms of life-threatening arrhythmias often receive ICDs. Seven to eight of these patients out of a 100 will improve their odds of survival, according to Dr. Hauptman.

“The majority [of these patients] will not gain a survival benefit over standard of care,” he said.

The researchers stated that patients who have already experienced life-threatening cardiac arrhythmias benefit more from an ICD.

"Unfortunately, the screening methodology used to identify patients who are at risk of sudden death is not very good," said Dr. Hauptman.

As health care continues to involve more expensive, complicated and invasive technologies like ICDs, it is crucial that patients have all of the information they need to make decisions, according to Dr. Armbrecht.

"Getting an ICD is clearly a life-changing event for the patient," said Dr. Hauptman. "Physicians not only have to point out the benefits of this device, but also let the patients know about its risks beyond those of the implantation procedure itself. Cardiologists need to be trained in communication with patients that will promote informed decision making and preempt threats to patient quality of life.”

The study was published February 18 in JAMA Internal Medicine (formerly Archives of Internal Medicine).

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Review Date: 
February 20, 2013