Navigating complexities in implantable cardioverter-defibrillator therapy: insights, challenges, and patient-centred approaches

Abstract

Heart diseases are a leading cause of death worldwide. For patients at high risk of dangerous heart rhythm disorders, an implantable cardioverter-defibrillator (ICD) can save lives. This device monitors the heart's rhythm and delivers a shock when needed to restore normal function. While effective, ICDs involve complex decisions that are often challenging for patients.

My research focuses on improving decision-making around ICDs by promoting shared decision-making, where doctors and patients work together to make choices based on medical facts and the patient’s preferences. To support this, out tean developed a decision aid specifically for Dutch ICD patients. This tool helps patients better understand their options and make decisions aligned with their values. Our study found that patients using the tool were better informed and more satisfied with their decisions.

I also investigated specific issues faced by older ICD patients, whose needs differ from those of younger patients, and highlighted the need for more tailored care. Additionally, I studied how decisions are made to deactivate ICDs in severely ill patients, balancing emotional and medical considerations.

My thesis advocates for patient-centered care, ensuring that ICD treatments are better tailored to individual needs and preferences.