Understanding veteran perspectives surrounding implantable cardioverter- defibrillator decision-making

IF 2.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice Pub Date : 2026-10-11 DOI:10.1016/j.ahjo.2026.100953

Gretchen C. Stage, Marcie Lee, Jazmin I. Beltran, Krysttel C. Stryczek, Daniel D. Matlock, Laura Scherer, Christopher E. Knoepke, Wanda L. Bernstein, Paul D. Varosy, Amneet Sandhu

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Abstract

Background

In 2018, the Center for Medicare and Medicaid Services (CMS) mandated the use of evidence-based shared decision-making (SDM) tools for cardiovascular decisions, including implantable cardioverter defibrillator (ICD) implantation for primary prevention in patients with systolic heart failure. Military Veterans are a unique population with experiences including combat, and heightened rates of anxiety, depression and post-traumatic stress disorder. Understanding Veteran perspectives on ICD decision-making processes is necessary to inform the Veteran Health Administration's (VHA) ICD care model.

Study objective

To understand factors influencing Veterans' ICD decision-making, semi-structured interviews were conducted with Veteran patients with an ICD (Implanters), those referred for consideration (Deliberators), and those who declined (Decliners).

Methods

Interviews explored experiences with being offered an ICD, understanding of the device, and factors influencing personal decisions. Data were analyzed using content and thematic analysis.

Results

Interviews with 13 participants revealed four primary themes that guided ICD decision-making: (1) desire for information and involvement in personal decisions, (2) quality of life values, (3) views of spirituality (4) Decliners and Deliberators accepted natural death and expressed desire to not intervene medically to prolong life.

Participants valued consultation with providers and personal networks, yet ultimately prioritized autonomy. The role of mental health experiences and cohort-level differences on decision-making was inconclusive.

Conclusion

Participants' ICD implantation decision-making were influenced by considerations around quality of life, spiritual beliefs, and reluctance to invasively interfere with disease progression. These insights highlight the importance of personalized patient-provider interactions and the need for decision-support tools tailored to VHA Veteran care.

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了解关于植入式心律转复除颤器决策的资深观点

2018年，美国医疗保险和医疗补助服务中心（CMS）强制要求在心血管决策中使用基于证据的共享决策（SDM）工具，包括植入式心律转复除颤器（ICD）植入，用于收缩期心力衰竭患者的一级预防。退伍军人是一个独特的群体，他们经历过战斗，焦虑、抑郁和创伤后应激障碍的发病率更高。了解退伍军人对ICD决策过程的看法对于退伍军人健康管理局（VHA）的ICD护理模式是必要的。研究目的为了解影响退伍军人ICD决策的因素，采用半结构化访谈的方法，对使用ICD的退伍军人患者（植入者）、考虑者（审议者）和拒绝者（Decliners）进行访谈。方法访谈探讨了使用ICD的经历、对设备的理解以及影响个人决定的因素。数据分析采用内容分析和专题分析。结果对13名参与者的访谈揭示了指导ICD决策的四个主要主题：(1)对信息和参与个人决策的渴望；(2)生命质量价值观；(3)灵性观；(4)衰落者和深思者接受自然死亡，并表示不希望通过医学干预来延长生命。参与者重视与供应商和个人网络的咨询，但最终优先考虑自主。心理健康经历和群体水平差异对决策的作用尚无定论。结论受试者的ICD植入决策受生活质量、精神信仰和不愿侵入性干预疾病进展等因素的影响。这些见解强调了个性化患者与提供者互动的重要性，以及为VHA退伍军人护理量身定制决策支持工具的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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