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      “It's Not Broke, So Let's Not Try to Fix It”: Why Patients Decline a Cardiovascular Implantable Electronic Device : REASONS FOR REFUSING CIED THERAPY

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Few patients decline therapy of a cardiovascular implantable electronic device (CIED), and little is known about the characteristics or reasoning of those who do. Our objective was to describe the reasons why patients decline CIED implantation using qualitative methods.

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          Pacemaker and defibrillator lead extraction.

          Scott Boyle, Eric Buch, P Belott (2011)
          Article 0 comments Cited 26 times – based on 0 reviews     Review now
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            Patient and cardiologist perceptions on decision making for implantable cardioverter-defibrillators: a qualitative study.

            Dan Matlock, Carolyn Nowels, Frederick Masoudi … (2011)
            Although implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients, they are also associated with potential risks. Periprocedural decision making requires understanding both benefits and risks.
            Article 0 comments Cited 21 times – based on 0 reviews     Review now
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              Ironic technology: Old age and the implantable cardioverter defibrillator in US health care.

              Sharon Kaufman, Paul Mueller, Abigale L Ottenberg … (2011)
              We take the example of cardiac devices, specifically the implantable cardioverter defibrillator, or ICD, to explore the complex cultural role of technology in medicine today. We focus on persons age 80 and above, for whom ICD use is growing in the U.S. We highlight an ironic feature of this device. While it postpones death and 'saves' life by thwarting a lethal heart rhythm, it also prolongs living in a state of dying from heart failure. In that regard the ICD is simultaneously a technology of life extension and dying. We explore that irony among the oldest age group -- those whose considerations of medical interventions are framed by changing societal assumptions of what constitutes premature death, the appropriate time for death and medicine's goals in an aging society. Background to the rapidly growing use of this device among the elderly is the 'technological imperative' in medicine, bolstered today by the value given to evidence-based studies. We show how evidence contributes to standards of care and to the expansion of Medicare reimbursement criteria. Together, those factors shape the ethical necessity of physicians offering and patients accepting the ICD in late life. Two ethnographic examples document the ways in which those factors are lived in treatment discussions and in expectations about death and longevity.
              Article 0 comments Cited 16 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Title: Pacing and Clinical Electrophysiology
                Abbreviated Title: Pacing and Clinical Electrophysiology
                Publisher: Wiley
                ISSN: 01478389
                Publication date Created: October 2014
                Publication date (Print): October 2014
                Publication date (Electronic): June 01 2014
                Volume: 37
                Issue: 10
                Pages: 1306-1314
                Affiliations
                [1 ]Program in Professionalism and Ethics; Mayo Clinic; Rochester Minnesota
                [2 ]Division of General Internal Medicine; Mayo Clinic; Rochester Minnesota
                [3 ]Department of Anthropology, History, and Social Medicine; University of California; San Francisco California
                Article
                DOI: 10.1111/pace.12433
                PMC ID: 4393709
                PubMed ID: 24889010
                SO-VID: b6530ea0-37f6-4d5e-b968-a1ef36d181a1
                Copyright © © 2014
                License:

                http://doi.wiley.com/10.1002/tdm_license_1.1

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