Format

Send to

Choose Destination
Am Heart J. 2013 Jul;166(1):164-70. doi: 10.1016/j.ahj.2013.03.028. Epub 2013 Apr 28.

Consideration of patient age and life expectancy in implantable cardioverter-defibrillator referral.

Author information

1
Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, CA 94143-0124, USA.

Abstract

BACKGROUND:

Primary prevention implantable cardioverter-defibrillator (ICD) guidelines recommend device consideration for at-risk patients with a life expectancy of greater than 1 year regardless of age. We sought to assess the influence of patient age and prognosis on ICD referral.

METHODS:

A survey was mailed to a random, national sample of 3,000 physicians in the specialties of cardiology, family medicine, and internal medicine. Participants were asked focused questions regarding patient age, life expectancy, and ICD referral.

RESULTS:

The overall response rate was 64%. More than one quarter of physicians (n = 386 [27%], 95% CI 25%-30%) withhold primary prevention ICD referral solely because of patient age. Life expectancy is not considered by 23% (n = 324, 95% CI 20%-25%) of physicians before referral, whereas 13% (n = 144, 95% CI 11%-15%) refer patients with a prognosis of less than 1 year. Providers who refer patients for ICD implantation with a life expectancy of less than 1 year are less likely to be cardiologists (odds ratio [OR] 0.50, 95% CI 0.32-0.79, P = .003), are less often affiliated with a teaching hospital (OR 0.62, 95% CI 0.41-0.94, P = .025), and have a greater number of years in practice (OR 1.25 for each 10 years in practice, 95% CI 1.03-1.51, P = .026). Only a minority (n = 315 [22%], 95% CI 20%-24%) of physicians use a life expectancy threshold of 1 year to guide ICD referral.

CONCLUSION:

Physicians frequently withhold ICD referral because of patient age. The referral of patients with a prognosis of less than 1 year or without consideration of life expectancy is common.

PMID:
23816036
DOI:
10.1016/j.ahj.2013.03.028
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center