Patients Preferences for Cardiac Pacemaker Implementation: A Qualitative Study to Investigate Patients’ Views Towards Medical Device Characteristics

OBJECTIVES: Cardiac pacemakers are the only long-term treatment for symptomatic bradycardia. Despite technological advances, conventional pacemakers still face significant device and procedure-related complications. Recently, leadless pacing systems have been developed to address these issues. Given the benefits and risks of both systems, patient preference studies are valuable to understand the perspectives and needs of patients indicated for cardiac pacemaker implementation (CPI).

METHODS: This qualitative study consisted of semi-structured interviews with patients indicated for CPI and patients who have already undergone CPI. During the interviews, patients ranked disease and device-related characteristics they considered most important. Interviews were transcribed ad verbatim and analysed qualitatively using the thematic framework analysis.

RESULTS: The study included 18 Belgian patients indicated for CPI (mean age= 75, age range= 31-87). Patients highlighted several disease-related characteristics needing improvements, including shortness of breath, fatigue during physical activities, and heart palpitations. Although most patients did not experience symptoms at the time of the interview due to effective treatment, they still desired improvements in potential future symptoms to enhance their overall well-being and quality of life. Patients generally trusted their physicians and showed relatively little interest in the type of device used. When considering device-related characteristics, patients prioritized the durability of the pacemaker battery, a limited risk of long-term complications, and use of the latest technology. Patients considered the location of the pacemaker implantation and visibility of a scar or lump after the procedure to be less important.

CONCLUSIONS: Although patients were not actively concerned about their pacemaker treatment, they still valued specific disease and treatment-related characteristics important to them. The patient-relevant characteristics identified in this study, from the perspective of patients themselves, can inform clinical trial endpoint selection and guide downstream drug development, evaluation, and clinical decision making to address the unmet medical needs and important treatment outcomes for CPI patients.