Prevention of self-harm through shared decision making among cardiac
patients with implantable electronic devices
Abstract
We present the case of a patient with anxiety who attempted suicide by
self-removal of her permanent pacemaker (PPM). Self-harm involving a
pacemaker is associated with significantly endangering patient
well-being and often with greatly increased health care costs. It is an
indication that the numbers of patients with a PPM who are clinically
depressed and anxious has been underestimated. Early detection of
depression, using a validated questionnaire, followed by ongoing care
and shared decision making (SDM), a focus on psychosocial stressors,
medication adherence, somatic complaints and attention to any adverse
drug reactions, are likely to improve clinical outcomes.