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Journal of Interventional Cardiac Electrophysiology
Published in: Journal of Interventional Cardiac Electrophysiology 2/2013

01-03-2013

Incorporating the patient perspective: a critical review of clinical practice guidelines for implantable cardioverter defibrillator therapy

Authors: Kerry E. Joyce, Stephen Lord, Daniel D. Matlock, Janet M. McComb, Richard Thomson

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2013

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Abstract

Purpose

Implantable cardioverter defibrillators (ICDs) are recommended for patients with heart failure and/or ventricular arrhythmias at risk of sudden cardiac death. Guidelines for ICD implantation are derived from robust clinical data. However, critical factors which might influence treatment decisions include patient preferences. We set out to determine how clinical practice guidelines (CPGs) incorporate the patient perspective into supporting decision making about ICDs.

Methods

CPGs on ICD implantation were purposively selected from national and professional bodies in Europe, North America and Australasia. CPGs were then appraised according to three key domains of shared decision making: (a) informing patients about the risks, benefits and consequences known to be important to patients; (b) personalising risks and benefits and (c) involvement of patient (plus family/significant others if desired) in decision making.

Results

Appraisal of six current CPGs found major deficiencies or inconsistencies in guidance. CPGs tended to focus on evidence of device effectiveness, with sparse consideration of other outcomes important to patients such as impacts on quality of life and psychosocial well-being. Little reference was made to involvement of the patient in decision making.

Conclusions

This suggests that embedding shared decision in CPGs will improve the patient-centeredness of ICD treatment by enabling patients to make informed, value-based decisions. Specific recommendations for CPG development include the need for signposting to preference sensitive decision points as well as inclusion of a broader range of outcomes which are known to be important to patients when deciding whether or not to have a device fitted.
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Metadata
Title
Incorporating the patient perspective: a critical review of clinical practice guidelines for implantable cardioverter defibrillator therapy
Authors
Kerry E. Joyce
Stephen Lord
Daniel D. Matlock
Janet M. McComb
Richard Thomson
Publication date
01-03-2013
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2013
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-012-9762-6

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