Implantable cardioverter-defibrillators (ICDs) can save lives. These are devices that are surgically placed in a patient’s chest to monitor heart rhythm and shock the heart back into proper rhythm if it stops or if the heart rhythm becomes abnormal. Despite their benefits, however, ICDs are invasive and can be very uncomfortable. Experts worry that some patients who do not need them may be getting them, perhaps because the doctor is assertive in promoting the benefits.
Investigators recruited 41 patients with ICDs and 11 cardiologists to participate in standardized interviews and patient focus groups. Of the 41 patients, 33 could not remember their doctors telling them anything about long-term complications or even the risk of the operation to implant the device. In 15 of the 22 standardized interviews, cardiologists used specialized terms without explaining them. The researchers concluded that patient-physician communication about ICDs needs a lot of improvement, especially with regard to psychological or long-term risks. Cardiologists may need training in communication to facilitate shared decision-making about this important device.
[JAMA Internal Medicine, online Feb. 18, 2013]