Heart Devices & Awareness
Study Title: Heart Devices & Awareness

Study Description: The purpose of this study is to evaluate patients' awareness, knowledge and medical habits related to implantable devices.  We hope to use this data to educate our patients who have implantable heart devices.

Risks/Benefits: There are no risks involved in the study. There are also no benefits involved.

Confidentiality: Your information collected for this study is completely confidential and no individual participant will ever be identified with his/her research information. Data from this study will be stored on a password protected computer, and only the PIs will have access to this information.

Voluntary Participation: Your participation in the study is voluntary. You may choose not to take part in this study. If you do decide to participate, you may change your mind and withdraw from the study at any time.

Who do I contact for questions about the study: For more information about the study, contact Dr. Gloria Wu at gloria_wumd@sbcglobal.net.

Do you agree to the above terms? By going forward, you consent that you are willing to answer the questions in this survey. If under the age 18, your parents must consent for you.
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1. What is your gender?
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2. What is your age?
3. What is the highest level of education that you have completed?
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Do you have heart disease or see a cardiologist regularly?
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Do you have an implantable heart device, pacemaker or defibrillator?
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In an emergency, can you list the names of all your medications, dose, and frequency (e.g., 81 mg of aspirin, once a day)?
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I know the exact name of my allergies to medicines.
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I know the make and serial number of my implantable device.
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I know the year the device was implanted.
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I know how to reach the cardiologist if the device is not functioning properly.
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Has the pacemaker or implantable device ever "gone off" (sets off alarm)?
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I know which conditions interfere with the function of the device.
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Does your immediate family have a placard, bracelet, or necklace with pacemaker information?
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