How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families?

The body electric: a review of literature on implantable cardioverter defibrillators

The number of scientific research studies expounding the efficacy and effectiveness of the implantable cardioverter defibrillator (ICD) in the treatment of cardiac arrhythmias and the prevention of sudden cardiac death (SCD) is prolific. The results from clinical trials that have led to the acceptance of implanting the human heart with an ICD are not as convincing as medical science would have health-care consumers believe. There are many other scientific studies that deal with the hazards involved in heart implantation with an ICD. It is argued in this paper that the impact of heart implantation with an ICD is hazardous to a person's being in significant ways. Heart implantation with an ICD is hazardous to physiological wellbeing, to psychosocial wellbeing, and to quality-of-life wellbeing. It is also argued that although humanistic studies are beginning to filter through the maze of scientific studies, many gaps remain in ICD research. Scientific researchers agree that there remains much needed knowledge for cardiac patients, their family members, and for health professionals.

Health-related quality of life of patients with implantable cardioverter defibrillators compared with that of pacemaker recipients

AIMS

Studies indicate a poorer quality of life (QoL) for implantable cardioverter defibrillator (ICD) patients than for the general population. However, studies comparing the QoL of ICD patients with that of patients with other implantable cardiac devices are scarce. We hypothesized that ICD patients had a poorer QoL than pacemaker patients.

METHODS AND RESULTS

All ICD patients living in Iceland at the beginning of 2002 (44 subjects), and a comparison group of 81 randomly selected patients with pacemakers were invited to participate. The Icelandic Quality of Life Questionnaire (IQL), the General Health Questionnaire (GHQ), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) were submitted to measure QoL, psychiatric distress, and symptoms of anxiety and depression. The ICD and pacemaker groups did not differ on IQL, BAI, BDI, or GHQ scores. ICD patients were as a group more fearful of death (P = 0.056) and showed more concerns about returning to work (P = 0.072), although these items fell just short of statistical significance.

CONCLUSION

Contrary to our expectations, ICD patients had a comparable QoL with pacemaker recipients and were not more likely to suffer from anxiety, depression, or general psychiatric distress. These findings are encouraging in view of expanding ICD indications.

Sexual concerns and educational needs after an implantable cardioverter defibrillator

BACKGROUND

Patients with an implantable cardioverter defibrillator (ICD) describe anxiety, fears, and other psychosocial issues, although sexual concerns are not well understood.

PURPOSE

The purpose of this descriptive study was to explore the experiences of patients and partners with return to sexual activity post-ICD implantation.

PARTICIPANTS

Subjects were 12 patients with an ICD (10 men, 2 women) and 4 partners (1 man, 3 women). Most patients with an ICD and partners were age 55 years or older, with a mean age of 62 years for patients and 47 years for partners.

METHODS

A semistructured interview was used to explore the meaning and influence of the ICD on the sexual relationship. Interviews were recorded, transcribed verbatim, and analyzed using a qualitative descriptive approach.

RESULTS

Themes identified were (1) anxiety and apprehension, with subthemes of partner overprotectiveness and fear of ICD discharge with sexual activity; (2) varying interest and pattern of sexual activity; (3) powerfulness of ICD discharge; and (4) a need for information and sexual counseling.

IMPLICATIONS

Additional research is needed to further understand the experience of ICD discharge with sexual activity and to develop educational strategies.

Quality of life in implanted cardioverter defibrillator recipients: the impact of a device shock

BACKGROUND

The success of the implanted cardioverter defibrillator (ICD) in prolonging the life of patients with arrhythmia suggests a need to assess quality of life (QOL), especially in those who receive an ICD shock.

OBJECTIVES

The purpose of this study was to compare QOL in a group who received an ICD shock with a group who did not receive an ICD shock during the first year.

METHODS

Fifty-nine subjects, 42 men and 17 women with a mean age 63 years, completed the Medical Outcomes Study Short Form-36, Ferrans and Powers QOL Index, Profile of Mood States at implantation and 1 year, and the Brodsky ICD Questionnaire at 1 year.

RESULTS

Thirty-seven percent received an ICD shock. Those in the shock group had worse mental health ( P < or = .04) and vitality scores ( P < or = .03) on the Short Form-36, increased anxiety ( P < or = .015), fatigue ( P < or = .005), and psychologic distress ( P < or = .02), as measured by Profile of Mood States, compared with the no shock group at 1 year.

CONCLUSIONS

Shocked ICD recipients demonstrate mental health concerns.

The patient with an implantable cardioverter defibrillator

Electrophysiologic technology developed over the past 20 years has improved the life expectancy of patients who have survived sudden cardiac death events. Use of an implantable cardioverter defibrillator (ICD) continues to increase as more indications for the device are researched. Patients with ICDs will be cared for in the postanesthesia care unit following cardiac and noncardiac surgery and require PACU nurses to be knowledgeable about this advanced and changing technology as well as provide for emotional and psychological needs.