Patients' Needs and Preferences for Cardiac Pacemaker Implantation: A Qualitative Study on Disease and Medical Device Characteristics to Inform a Quantitative Preference Study.

Background: Cardiac pacemakers are the only long-term treatment for symptomatic bradyarrhythmia. Despite technological advances, conventional pacemakers still face significant device and procedure-related complications. Recently, leadless pacing systems have been developed to address these issues.

Objective: Given the benefits and risks of both pacemaker devices, patient preference studies (PPS) are valuable to understand patients' priorities. This study reports qualitative insights that are fundamental to informing the development of attributes and levels of a subsequent quantitative PPS.

Methods: This qualitative phase of a PPS consisted of semi-structured interviews with pacemaker patients. To enhance preference validation, we applied a novel combined approach where patients both scored and ranked disease and treatment-related characteristics. Interviews were transcribed ad verbatim and analyzed using thematic framework analysis.

Results: The study included 18 Belgian pacemaker patients (median age = 81 years, 56% being male). Our combined approach identified a stable set of six consistently prioritized characteristics: improvements in (i) dyspnea, (ii) fatigue, (iii) exercise intolerance, alongside device features including (iv) a long battery lifetime, (v) limited risk of long-term complications, and (vi) integration of the latest technology. In contrast, characteristics such as the device location and physical appearance were considered less important compared with the life-saving functionality and quality of life improvements. Patients generally trusted their physicians and showed relatively little interest in deciding the device type.

Conclusions: Although patients were not actively concerned about their pacemaker treatment, they valued specific disease and treatment-related characteristics important to them. The patient-relevant characteristics identified in this study, derived directly from patients themselves, can inform device development and guide downstream evaluations to foster more informed, patient-centered decision-making that reflects patients' needs and preferences.