Patients’ and Family Members’ Views on Pacemaker Reuse: an International Survey

Abstract

Introduction The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice. Methods and Results A paper questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients’ family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon. There were 945 responses (Nicaragua – 100; Pakistan – 493; Ecuador – 252; Lebanon – 100). A majority of respondents agreed or strongly agreed that they would be willing to accept a reused pacemaker if risks were similar to a new device (707, 75%), if there were a higher risk of device failure compared to a new device (584, 70%), or if there were a higher risk of infection compared to a new device (458, 56%). A large majority would be willing to donate their own pacemaker at the time of their death (884, 96%) or the device of a family member (805, 93%). Respondents who were unable to afford a new device were more likely to be willing to accept a reused device (79% vs. 63%, P<0.001). Conclusions Patients and their family members support the concept of pacemaker reuse for patients who cannot afford new devices.

Reuse of cardiac implantable electronic devices in developing countries perspectives: A literature review

“…It is profitable, consistent with the principles of beneficence, non‐maleficence and justice with a commitment to the administration of resources and the common good 37 . However, CIED donation initiatives require participation of device carrier patients, their families, funeral industry, local authorities, specialists, and potential recipients 35 . This review synthesizes the studies carried out to date, underlining the social acceptability of donating postmortem explanted CIEDs from developed countries to developing countries, reprocessing and reimplanting them in patients who cannot access a new one.…”

“…On the other hand, patients with CIEDs generally do not know how devices are handled after death 34–36 . Stands out the observation that the vast majority wish to have their device explanted after death 36 .…”

“…Finally, potential recipient patients, and family members in developing countries, most of them unable to afford a new device are in favor of getting a reconditioned device, even if the risks of infection or malfunction of the reprocessed device are higher 35 . In addition, the majority indicated their willingness to donate their device or the device of a relative after death, so it could be reconditioned and reused in another patient again.…”

Postmortem pacemaker reuse: Charity for most but not all

“…However, to date, there has been no published study examining the attitudes of the prospective LMIC recipient population itself. Fortunately, Dr. Hughey et al have helped to remedy this gap in knowledge in this issue of the Journal with their paper; “Patients' and Family Members' Views on Pacemaker Reuse: An International Survey” 6 …”

“…Fortunately, Dr. Hughey et al have helped to remedy this gap in knowledge in this issue of the Journal with their paper; "Patients' and Family Members' Views on Pacemaker Reuse: An International Survey". 6 Their study was conducted between 2012 and 2015 in outpatient medical clinics in four countries (Ecuador, Nicaragua, Lebanon, and Pakistan) where patients and family members were approached for participation. Final results included 945 completed surveys from a patient population with a mean age of 48 years (62% female); 77% had a personal or family history of a heart condition.…”