Purpose: Decision making for patients eligible for Implantable Cardioverter-Defibrillators (ICDs) is complicated.� In addition to the potential reduction in mortality, ICDs come with a host of potential risks including a lower quality of life if shocked, more hospitalizations, and potential suffering at the end of life. Further, sudden cardiac death can also be framed as �dying in your sleep,� and perhaps some patients do not wish to forgo this option of a quick demise. The objective of this study was to explore two ways of measuring preferences related to dying of sudden death or progressive illness.�� ��
Methods: We conducted a mailed survey of 412 patients with ICDs from a managed care organization regarding their experiences in ICD decision making. The survey explored the value trade-off between dying of sudden cardiac death and dying of a progressive illness in two ways: a) by separately measuring the values using ratings from 1-10; and b) by measuring the values together using a visual analog scale (VAS).� ��
Results: A total of 295 patients with ICDs responded to this survey (response rate 72%, 295 out of 412).� When asked separately, both the value of dying quickly and living as long as possible were rated highly (8.0 and 7.6 out of 9, respectively).� When asked together on a VAS, the majority of patients preferred to die quickly (Figure).� Patients preferring to �die quickly� on the VAS also rated the corresponding single item (8.6 vs. 7.0, P<0.001).� Likewise, patients preferring to �live as long as possible� on the VAS rated the corresponding single item more highly (8.1 vs. 7.1, p=0.001).� Further examination revealed that 61% of patients preferring to die quickly were unaware that it was possible to deactivate their ICD.� ��
Conclusions: When asked as individual items, people prefer to avoid all modes of death.� When forced to choose on a visual analog scale, respondents were able to make this tradeoff in a way that reflected their scores on the single items, suggesting that people do indeed have a preferred mode of dying. Finally, the patients who preferred to die quickly and who were unaware that their ICD could be deactivated raised concerns about value/treatment discordance.�
See more of: The 34th Annual Meeting of the Society for Medical Decision Making