# Development of a Veteran-Centered Approach to ICD Decision-making in the VA

> **NIH VA IK2** · VA EASTERN COLORADO HEALTH CARE SYSTEM · 2024 · —

## Abstract

Background: Aligned with the VA Strategic Plan and Blueprint for Excellence1, it is critical to ensure Veteran-
centered, values-concordant care (extent to which Veterans receive therapies that reflect their goals and
treatment preferences) through informed, shared decision-making. This is especially important with regards to
ICDs (implantable cardioverter-defibrillators) - permanent, surgically implanted cardiac devices with intent to
monitor and treat life-threatening heart rhythms with an electrical shock. ICDs present a complicated balance
of patient benefit (ie. detection and treatment of dangerous heart rhythms), procedural risk, long-term
maintenance (ie. battery and lead monitoring) and impact on psychological health (ie. heightened levels of
PTSD, anxiety and depression from ICD shocks).2,3
Significance / Impact: Given high rates of heart failure among Veterans4,5, ICD implantation rates across the
VA have risen sharply over the past decade with over 25,000 ICDs implanted at an average per-procedure
cost of $64,5006. However, this rise may not be indicative of well-informed, values-concordant care.
Numerous prior studies show patients poorly comprehend risks, benefits, psychological effects and
complications associated with ICD implantation - often left with false impressions such as ICD is a “cure” for
heart failure, requires no maintenance, and does not lead to inappropriate shocks. Prior data also demonstrate
that providers overemphasize the benefit of ICDs and patients markedly overestimate benefit.7 In February
2018, CMS mandated use and documentation of shared decision prior to ICD implantation. Likely an
underestimation, currently there are approximately 135,000 ICD-eligible Veterans in the VA system.
Innovation: Nationally and within the VHA, this discord has led to a call for decision-support tools to aid
patients in making informed, personalized decisions, particularly for invasive therapies with complex risk-
benefit tradeoffs such as ICDs.8 Innovative aspects include: (1) a significantly improved, comprehensive tool
to support ICD communications, (2) designed for routine implementation within VA clinical care, (3) study of
transition of tools from a non-VA to VA setting, (4) addressing a high-stakes decision (national mandate by
CMS for SDM tools) and (5) integration into existing VA quality-improvement infrastructure (CART-EP).
Specific Aims: The central hypothesis of this proposal is that current ICD decision-making processes are
heterogeneous and lack sufficient Veteran perspective. We will address this through:
Aim 1: Determine Veteran and VA-provider specific factors surrounding ICD decision-making.
Aim 2: Develop an VA-provider led tool that meets Veteran needs for routine use within the VA.
Aim 3: Feasibility testing of the newly developed tools designed to support ICD communications.
Methodology: This project will target Veterans that are (1) ICD-eligible, (2) have ICDs in situ or (3) have
refused ICD therapy and VA-p...

## Key facts

- **NIH application ID:** 10934508
- **Project number:** 5IK2HX003253-03
- **Recipient organization:** VA EASTERN COLORADO HEALTH CARE SYSTEM
- **Principal Investigator:** Amneet Sandhu
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-07-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10934508

## Citation

> US National Institutes of Health, RePORTER application 10934508, Development of a Veteran-Centered Approach to ICD Decision-making in the VA (5IK2HX003253-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10934508. Licensed CC0.

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