Putting the “Informed” in the informed consent process for implantable cardioverter‐defibrillators: Addressing the needs of the elderly patient

Abstract

Implantable cardioverter defibrillator (ICD) management complexities challenge the ethos of fully informed consent, particularly for the typically multimorbid elderly patient considering the device for primary prevention. The Heart Rhythm Society recommends providers include discussion on the potential need for later device deactivation or nonreplacement at the time of first implant, and to revisit this at appropriate intervals. The initial consent procedure could meet this standard by incorporating the future need to discuss further such issues when the recipient's clinical condition changes to such an extent that defibrillation would no longer be beneficial. At the time of obtaining consent, some patients may lack the will or capacity to make medically complex decisions when it would be necessary for healthcare surrogate decision-makers to contribute to this process. Ensuring an appropriate level of understanding and response may be enhanced by the use of information and decision aids. With improved communication regarding the nuances of ICD therapy, device eligible patients, and those close to them, will be empowered with a better understanding of the nature, benefits, and risks of ICD implantation, allowing them to make treatment decisions consistent with their values.

Implantable cardioverter defibrillator deactivation and advance care planning: a focus group study

“…Although this should be respected to some extent, since ACP conversations should be tailored to the readiness and the phase of life of the patients,9 we do feel that the healthcare professional also has an informative role, in which all benefits, harms and future perspectives of a treatment should be discussed. Also, patients should have the opportunity to elicit general treatment preferences and goals of care in addition to their deactivation preferences, since these might play a role in their later decisions about ICD deactivation 25…”

Hardwired for Life? Implantable Defibrillator Dilemmas in Older Patients

“…5 Such matters have been the theme of a recent review, primarily focused on improving the consent process pertinent to ICD-eligible elderly patients through an enhanced communicative and reflective process. 6 Decision making in older individuals tends to be more intuitive than deliberative, and they are prone to accept the counsel of authority figures such as clinicians. Thus, advice from those responsible for their care may significantly influence the receivers' views.…”