부산대학교 도서관

Introduction:Patients eligible for primary prevention implantable cardioverter-defibrillator (ICD) are faced with a complex decision that needs a clear understanding of the risks/ benefits of such intervention.Hypothesis:ICD discussion in the medical records with a positive attitude from providers and patients are associated with higher likelihood of ICD implantation.Methods:In 1,523 patients who met criteria for primary prevention ICD (2013-2015), we reviewed patient charts for ICD-related documentation: ?mention? by physicians or ?discussion? with patient/ family. The documented attitude of the physician and the patient/ family towards ICD therapy during discussions was categorized into negative, neutral or positive. Patients were followed to the end-point of ICD implantation.Results:Over a median follow-up of 442 days, 486 patients (32%) received an ICD. ICD was mentioned in the charts of 1105 (73%) patients, and a discussion with the patient/ family about the risks/ benefits of ICD was documented in 706 (46%) charts. Among ICD recipients, there was no documentation of ICD discussion by any healthcare provider in 15% of the cases except for the informed consent form. On multivariable analyses, positive cardiologist (HR 7.9, 95% CI 1.0-59.7, P<0.05), electrophysiologist (HR 7.7, 95% CI 1.9-31.7, P<0.01) and patient/ family (HR 9.9, 95% CI 6.2-15.7, P<0.01) attitudes towards ICD therapy during the first documented ICD discussion were associated with ICD implantation (Figure).Conclusions:In a large cohort of patients eligible for primary prevention ICD, a discussion with the patient/ family about the risks and benefits of ICD implantation was documented in <50% of the charts. Positive attitudes from the cardiologist, electrophysiologist and patient/ family towards ICD therapy during the first documented ICD discussion were associated with ICD implantation. More consistent documentation of the shared decision making around ICD therapy is needed.