Moderated Poster Session 4

Purpose: Increasing numbers of patients with heart failure are being offered an Implantable Cardioverter Defibrillator (ICD) for primary prevention of sudden cardiac death (SCD).While those who opt for an ICD may not die of cardiac causes, their death from any other cause is certain at some point in the future.Failure to incorporate management of an ICD into advance planning has resulted in unnecessary suffering at the end-of-life (EOL).We undertook a study to explore how patients make a decision to accept or decline an ICD for primary prevention.This report focuses on patients' perspectives about EOL issues related to their decision to accept or decline the offer of an ICD for primary prevention.Methods: The study used a grounded theory approach.Following ethics approval, patients were recruited from three tertiary care centers in Ontario, Canada.Semistructured interviews were audiotaped with 42 participants who accepted or declined an ICD for primary prevention.Interviews were transcribed verbatim, entered into NViVo7, and analyzed by three research team members.Standard analysis techniques, including the constant comparative approach, were used to identify common themes.Results: Interviews were completed with 34 who accepted and 8 who declined the ICD.In total there were 9 women and 33 men ranging in age from 26 -87 years.Mean left ventricular ejection fraction was 27.5% (data unavailable for 4 patients): most had .one comorbidity.The primary focus for all was on the life-saving capacity of the ICD and prevention of a sudden and unwanted death.Most had not considered the ICD in relation to their eventual death.Few reported they had conversations with their health care provider about eventual death and the role of the ICD in it.Three main themes relating to the ICD and EOL were identified (1) Quality versus Quantity of Life; (2) Mode of Death and (3) Technical Realities of the ICD.Differences in perspective existed between those who accepted and declined the ICD.Conclusions: The compelling imperative to avoid SCD eclipses conversations about the implications of ICD on other EOL issues that should be considered.Findings reflect the urgent need for practitioners and patients to address the gap between ICD therapy and comprehensive advance planning.

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