Understanding veteran perspectives surrounding implantable cardioverter- defibrillator decision-making.
4 affiliations
- 1Seattle-Denver Center of Innovation, Veterans Health Administration, Aurora, CO, United States of America.
- 2VA Eastern Colorado Health Care System, Aurora, CO, United States of America.
- 3University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, United States of America.
- 4Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, United States of America.
Abstract
Background
In 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
To 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
Interviews 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
Interviews 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
Participants' 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.
Related
- Radiofrequency ablation with a conventional solid tip catheter in contact with an implantable cardioverter-defibrillator coil causing inadvertent ventricular fibrillation.
- Ventricular fibrillation treated by an implantable cardioverter-defibrillator in antimitochondrial M2 antibody-positive myocarditis.
- Transient defibrillation threshold elevation associated with air in the generator pocket after extravascular implantable cardioverter-defibrillator implantation.
- Intraoperative preservation of an extravascular implantable cardioverter-defibrillator lead during coronary artery bypass grafting.
- Electrode perforation of a silicone breast implant in a subcutaneous implantable cardioverter-defibrillator carrier: A previously unreported device complication.
BibTeX
@article{stage2026understanding,
title = {{Understanding veteran perspectives surrounding implantable cardioverter- defibrillator decision-making.}},
author = {Gretchen C Stage and Marcie Lee and Jazmin I Beltran and Krysttel C Stryczek and Daniel D Matlock and Laura Scherer and Christopher E Knoepke and Wanda L Bernstein and Paul D Varosy and Amneet Sandhu},
journal = {American heart journal plus : cardiology research and practice},
year = {2026},
month = oct,
doi = {10.1016/j.ahjo.2026.100953},
url = {https://europepmc.org/article/MED/42927334},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Understanding veteran perspectives surrounding implantable cardioverter- defibrillator decision-making.
AU - Gretchen C Stage
AU - Marcie Lee
AU - Jazmin I Beltran
AU - Krysttel C Stryczek
AU - Daniel D Matlock
AU - Laura Scherer
AU - Christopher E Knoepke
AU - Wanda L Bernstein
AU - Paul D Varosy
AU - Amneet Sandhu
PY - 2026
DA - 2026/10/11
JO - American heart journal plus : cardiology research and practice
DO - 10.1016/j.ahjo.2026.100953
UR - https://europepmc.org/article/MED/42927334
AB - Background In 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 To 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 Interviews 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 Interviews 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 Participants' 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.
SN - 2666-6022
ER -