{
  "abstract": "Background\n\nIn 2018, the Center for Medicare and Medicaid Services (CMS) mandated the use of evidence-based shared decision-making (SDM) tools for cardiovascular decisions, including implantable cardioverter defibrillator (ICD) implantation for primary prevention in patients with systolic heart failure. Military Veterans are a unique population with experiences including combat, and heightened rates of anxiety, depression and post-traumatic stress disorder. Understanding Veteran perspectives on ICD decision-making processes is necessary to inform the Veteran Health Administration's (VHA) ICD care model.Study objective\n\nTo understand factors influencing Veterans' ICD decision-making, semi-structured interviews were conducted with Veteran patients with an ICD (Implanters), those referred for consideration (Deliberators), and those who declined (Decliners).Methods\n\nInterviews explored experiences with being offered an ICD, understanding of the device, and factors influencing personal decisions. Data were analyzed using content and thematic analysis.Results\n\nInterviews with 13 participants revealed four primary themes that guided ICD decision-making: (1) desire for information and involvement in personal decisions, (2) quality of life values, (3) views of spirituality (4) Decliners and Deliberators accepted natural death and expressed desire to not intervene medically to prolong life.Participants valued consultation with providers and personal networks, yet ultimately prioritized autonomy. The role of mental health experiences and cohort-level differences on decision-making was inconclusive.Conclusion\n\nParticipants' ICD implantation decision-making were influenced by considerations around quality of life, spiritual beliefs, and reluctance to invasively interfere with disease progression. These insights highlight the importance of personalized patient-provider interactions and the need for decision-support tools tailored to VHA Veteran care.",
  "abstract_shown": true,
  "affiliations": [
    "Seattle-Denver Center of Innovation, Veterans Health Administration, Aurora, CO, United States of America.",
    "VA Eastern Colorado Health Care System, Aurora, CO, United States of America.",
    "University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, United States of America.",
    "Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, United States of America."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Gretchen C Stage"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Marcie Lee"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Jazmin I Beltran"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Krysttel C Stryczek"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Daniel D Matlock"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Laura Scherer"
    },
    {
      "affs": [
        2
      ],
      "name": "Christopher E Knoepke"
    },
    {
      "affs": [
        1
      ],
      "name": "Wanda L Bernstein"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Paul D Varosy"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Amneet Sandhu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/aqfeb0g4mneaj.bib",
  "cited_by": 0,
  "doi": "10.1016/j.ahjo.2026.100953",
  "fulltext_url": "https://europepmc.org/articles/PMC13695228",
  "id": "aqfeb0g4mneaj",
  "issns": [
    "2666-6022"
  ],
  "landing_url": "https://europepmc.org/article/MED/42927334",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2705|Cardiac pacing and defibrillation studies"
    ]
  ],
  "openalex": "W7221448560",
  "pdf_url": "https://europepmc.org/articles/PMC13695228?pdf=render",
  "pmcid": "PMC13695228",
  "pmid": "42927334",
  "published": "2026-10-11",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/aqfeb0g4mneaj.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:18Z",
      "native_id": "MED:42927334",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42927334"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac pacing and defibrillation studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Understanding veteran perspectives surrounding implantable cardioverter- defibrillator decision-making.",
  "title_text": "Understanding veteran perspectives surrounding implantable cardioverter- defibrillator decision-making.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:18Z",
  "url": "https://research.draconitic.com/paper/aqfeb0g4mneaj",
  "venue": "American heart journal plus : cardiology research and practice",
  "versions": []
}