1
|
Dougherty CM, Liberato ACS, Streur MM, Burr RL, Kwan KY, Zheng T, Auld JP, Thompson EA. Physical function, psychological adjustment, and self-efficacy following sudden cardiac arrest and an initial implantable cardioverter defibrillator (ICD) in a social cognitive theory intervention: secondary analysis of a randomized control trial. BMC Cardiovasc Disord 2022; 22:369. [PMID: 35948889 PMCID: PMC9364545 DOI: 10.1186/s12872-022-02782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sudden cardiac arrest (SCA) survivorship results in unique issues in return to physical and psychological function. The purpose of the study was to compare recovery across the first year between SCA survivors and other arrhythmia patients who received a first-time implantable cardioverter defibrillator (ICD) for secondary prevention, participating in a social cognitive theory (SCT) intervention. METHODS 168 (129 males, 39 females) who received an ICD for secondary prevention (SCA N = 65; other arrhythmia N = 103) were randomized to one of two study conditions: SCT intervention (N = 85) or usual care (N = 83). Outcomes were measured at baseline hospital discharge, 1, 3, 6, & 12 months: (1) Physical Function: Patient Concerns Assessment (PCA), SF-36 (PCS); (2) Psychological Adjustment: State Trait Anxiety (STAI), CES-D depression, SF-36 (MCS); (3) Self-Efficacy: Self-Efficacy (SCA-SE), Self-management Behaviors (SMB), Outcome Expectations (OE). Outcomes were compared over 12 months for intervention condition x ICD indication using general estimating equations. RESULTS Participants were Caucasian (89%), mean age 63.95 ± 12.3 years, EF% 33.95 ± 13.9, BMI 28.19 ± 6.2, and Charlson Index 4.27 ± 2.3. Physical symptoms (PCA) were higher over time for SCA survivors compared to the other arrhythmia group (p = 0.04), ICD shocks were lower in SCA survivors in the SCT intervention (p = 0.01); psychological adjustment (MCS) was significantly lower in SCA survivors in the SCT intervention over 6 months, which improved at 12 months (p = 0.05); outcome expectations (OE) were significantly lower for SCA survivors in the SCT intervention (p = 0.008). CONCLUSIONS SCA survivors had greater number of physical symptoms, lower levels of mental health and outcome expectations over 12 months despite participation in a SCT intervention. Trial registration Clinicaltrials.gov: NCT04462887.
Collapse
Affiliation(s)
- Cynthia M. Dougherty
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Ana Carolina Sauer Liberato
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
- Evidera PPD, London, England, UK
| | - Megan M. Streur
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Robert L. Burr
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Ka Yee Kwan
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Tao Zheng
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Jon P. Auld
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| | - Elaine A. Thompson
- School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA 98195 USA
| |
Collapse
|
2
|
Joshi VL, Christensen J, Lejsgaard E, Taylor RS, Zwisler AD, Tang LH. Effectiveness of rehabilitation interventions on the secondary consequences of surviving a cardiac arrest: a systematic review and meta-analysis. BMJ Open 2021; 11:e047251. [PMID: 34475160 PMCID: PMC8413927 DOI: 10.1136/bmjopen-2020-047251] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM The aim of this systematic review was to assess the effectiveness of rehabilitation interventions on the secondary physical, neurological and psychological consequences of cardiac arrest (CA) for adult survivors. METHODS A literature search of electronic databases (MEDLINE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Psychological Information Database, Web of Science and Cochrane Central Register of Controlled trials) was conducted for randomised controlled trials (RCTs) and observational studies up to 18 April 2021. The primary outcome was health-related quality of life (HRQoL) and main secondary outcome was neurological function with additional secondary outcomes being survival, rehospitalisation, safety (serious and non-serious adverse events), psychological well-being, fatigue, exercise capacity and physical capacity. Two authors independently screened studies for eligibility, extracted data and assessed risk of bias. RESULTS Three RCTs and 11 observational studies were included (total 721 participants). Study duration ranged from 8 weeks to 2 years. Pooled data from two RCTs showed low-quality evidence for no effect on physical HRQoL (standardised mean difference (SMD) 0.19, (95% CI: -0.09 to 0.47)) and no effect on mental HRQoL (SMD 0.27 (95% CI: -0.01 to 0.55)).Regarding secondary outcomes, very low-quality evidence was found for improvement in neurological function associated with inpatient rehabilitation for CA survivors with acquired brain injury (SMD 0.71, (95% CI: 0.45 to 0.96)) from five observational studies. Two small observational studies found exercise-based rehabilitation interventions to be safe for CA survivors, reporting no serious or non-serious events. CONCLUSIONS Given the overall low quality of evidence, this review cannot determine the effectiveness of rehabilitation interventions for CA survivors on HRQoL, neurological function or other included outcomes, and recommend further high-quality studies be conducted. In the interim, existing clinical guidelines on rehabilitation provision after CA should be followed to meet the high burden of secondary consequences suffered by CA survivors. PROSPERO REGISTRATION NUMBER CRD42018110129.
Collapse
Affiliation(s)
- Vicky L Joshi
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Jan Christensen
- Department of Occupational- and Physiotherapy, Copenhagen University Hospital, København, Denmark
| | - Esben Lejsgaard
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Rod S Taylor
- 3MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, UK
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Odense, Denmark
| | - Lars H Tang
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Sjaelland, Denmark
- The Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| |
Collapse
|
3
|
Liberato ACS, Thompson EA, Dougherty CM. Intervention mediating effects of self-efficacy on patient physical and psychological health following ICD implantation. J Behav Med 2021; 44:842-852. [PMID: 34302228 DOI: 10.1007/s10865-021-00244-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
This study examined mechanisms by which social cognitive theory (SCT) interventions influence health outcomes and the importance of involving partners in recovery following the patients' receipt of an initial implantable cardioverter defibrillator (ICD). We compared direct and indirect intervention effects on patient health outcomes with data from a randomized clinical trial involving two telephone-based interventions delivered during the first 3 months post-ICD implant by experienced trained nurses: P-only conducted only with patients, and P + P conducted with patients and their intimate partners. Each intervention included the patient-focused component. P + P also included a partner-focused intervention component. ICD-specific SCT-derived mediators included self-efficacy expectations, outcome expectations, self-management behavior, and ICD knowledge. Outcomes were assessed at discharge, 3- and 12-months post ICD implant. Patients (N = 301) were primarily Caucasian, male, 64 (± 11.9) years of age with a mean ejection fraction of 34.08 (± 14.3). Intervention effects, mediated through ICD-specific self-efficacy and outcome expectations, were stronger for P + P compared to P-only for physical function (β = 0.04, p = 0.04; β = 0.02, p = 0.04, respectively) and for psychological adjustment (β = 0.06, p = 0.04; β = 0.03, p = 0.04, respectively). SCT interventions show promise for improving ICD patient physical and psychological health outcomes through self-efficacy and outcome expectations. Including partners in post-ICD interventions may potentiate positive outcomes for patients.Trial registration number (TRN): NCT01252615 (Registration date: 12/02/2010).
Collapse
Affiliation(s)
- Ana C S Liberato
- Evidera PPD Inc., Patient Centered Research, London, UK.,Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA
| | - Elaine A Thompson
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA
| | - Cynthia M Dougherty
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific Street, 357266, Seattle, WA, 98195, USA.
| |
Collapse
|
4
|
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. Postreanimationsbehandlung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00892-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
5
|
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47:369-421. [PMID: 33765189 PMCID: PMC7993077 DOI: 10.1007/s00134-021-06368-4] [Citation(s) in RCA: 453] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
Collapse
Affiliation(s)
- Jerry P. Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL UK
- Royal United Hospital, Bath, BA1 3NG UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique R. M. Moulaert
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
| |
Collapse
|
6
|
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Mariero Olasveengen T, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161:220-269. [PMID: 33773827 DOI: 10.1016/j.resuscitation.2021.02.012] [Citation(s) in RCA: 358] [Impact Index Per Article: 119.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.
Collapse
Affiliation(s)
- Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK; Royal United Hospital, Bath, BA1 3NG, UK.
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W Böttiger
- University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC) Université Catholique de Louvain, Brussels, Belgium; Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Room A108, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Véronique R M Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| |
Collapse
|
7
|
Miller JL, Thylén I, Elayi SC, Etaee F, Fleming S, Czarapata MM, Lennie TA, Moser DK. Multi-morbidity burden, psychological distress, and quality of life in implantable cardioverter defibrillator recipients: Results from a nationwide study. J Psychosom Res 2019; 120:39-45. [PMID: 30929706 DOI: 10.1016/j.jpsychores.2019.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence of multi-morbidity in implantable cardioverter defibrillator (ICD) recipients is approximately 25%. Multi-morbidity is associated with poor health and psychological outcomes in this population and may affect ICD recipients' quality-of-life (QOL). The purpose of this study was to determine the prevalence of psychological distress (anxiety, depressive symptoms, and Type-D personality) in ICD recipients with varying levels of comorbidities, and to examine the association between multi-morbidity burden and QOL in this population. METHODS All adults listed in the Swedish ICD and Pacemaker Registry in 2012 with an ICD implanted for at least one year were invited to participate in this study. Binary logistic regression was used to predict QOL using the EQ-5D mean index dichotomized based on median QOL scores. Multi-morbidity burden scores were based on quartile groupings. RESULTS A total of 2658 ICD recipients participated in the study (with a mean age of 65, 20.6% female, mean implant duration of 4.7 years, with 35.4% implanted for primary prevention of sudden cardiac arrest). Greater multi-morbidity burden, female sex, not working outside the home, history of ICD shock, negative ICD experience, higher levels of ICD-related concerns, and the presence of anxiety, depression, or Type D personality were associated with worse QOL in ICD recipients. Predictors differed by multi-morbidity burden level. CONCLUSIONS Multi-morbidity burden and psychological distress is an essential factor related to QOL. This issue should be discussed with potential ICD recipients prior to implant. Further exploration of increased recognition and treatment of psychological distress in ICD recipients is warranted.
Collapse
Affiliation(s)
- Jennifer L Miller
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| | - Ingela Thylén
- Department of Cardiology, Department of Medical Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Samy C Elayi
- University of Florida, Jacksonville, FL, United States
| | - Farshid Etaee
- Division of Cardiology, University of Kentucky College of Medicine, Gill Heart Institute, 800 Rose St, Lexington, KY 40536, United States.
| | - Steve Fleming
- University of Kentucky College of Public Health, Lexington, KY, United States
| | - Mary M Czarapata
- Division of Cardiology, University of Kentucky College of Medicine, Gill Heart Institute, 800 Rose St, Lexington, KY 40536, United States
| | - Terry A Lennie
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| | - Debra K Moser
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| |
Collapse
|
8
|
Nielsen KM, Zwisler A, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Jakobsen JC, Berg SK. Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Cochrane Database Syst Rev 2019; 2:CD011828. [PMID: 30746679 PMCID: PMC6953352 DOI: 10.1002/14651858.cd011828.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND An effective way of preventing sudden cardiac death is the use of an implantable cardioverter defibrillator (ICD). In spite of the potential mortality benefits of receiving an ICD device, psychological problems experienced by patients after receiving an ICD may negatively impact their health-related quality of life, and lead to increased readmission to hospital and healthcare needs, loss of productivity and employment earnings, and increased morbidity and mortality. Evidence from other heart conditions suggests that cardiac rehabilitation should consist of both exercise training and psychoeducational interventions; such rehabilitation may benefit patients with an ICD. Prior systematic reviews of cardiac rehabilitation have excluded participants with an ICD. A systematic review was therefore conducted to assess the evidence for the use of exercise-based intervention programmes following implantation of an ICD. OBJECTIVES To assess the benefits and harms of exercise-based cardiac rehabilitation programmes (exercise-based interventions alone or in combination with psychoeducational components) compared with control (group of no intervention, treatment as usual or another rehabilitation programme with no physical exercise element) in adults with an ICD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and four other databases on 30 August 2018 and three trials registers on 14 November 2017. We also undertook reference checking, citation searching and contacted study authors for missing data. SELECTION CRITERIA We included randomised controlled trials (RCTs) if they investigated exercise-based cardiac rehabilitation interventions compared with no intervention, treatment as usual or another rehabilitation programme. The trial participants were adults (aged 18 years or older), who had been treated with an ICD regardless of type or indication. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. The primary outcomes were all-cause mortality, serious adverse events and health-related quality of life. The secondary outcomes were exercise capacity, antitachycardia pacing, shock, non-serious adverse events, employment or loss of employment and costs and cost-effectiveness. Risk of systematic errors (bias) was assessed by evaluation of predefined bias risk domains. Clinical and statistical heterogeneity were assessed. Meta-analyses were undertaken using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS We identified eight trials published from 2004 to 2017 randomising a total of 1730 participants, with mean intervention duration of 12 weeks. All eight trials were judged to be at overall high risk of bias and effect estimates are reported at the end of the intervention with a follow-up range of eight to 24 weeks.Seven trials reported all-cause mortality, but deaths only occurred in one trial with no evidence of a difference between exercise-based cardiac rehabilitation and control (risk ratio (RR) 1.96, 95% confidence interval (CI) 0.18 to 21.26; participants = 196; trials = 1; quality of evidence: low). There was also no evidence of a difference in serious adverse events between exercise-based cardiac rehabilitation and control (RR 1.05, 95% CI 0.77 to 1.44; participants = 356; trials = 2; quality of evidence: low). Due to the variation in reporting of health-related quality of life outcomes, it was not possible to pool data. However, the five trials reporting health-related quality of life at the end of the intervention, each showed little or no evidence of a difference between exercise-based cardiac rehabilitation and control.For secondary outcomes, there was evidence of a higher pooled exercise capacity (peak VO2) at the end of the intervention (mean difference (MD) 0.91 mL/kg/min, 95% CI 0.60 to 1.21; participants = 1485; trials = 7; quality of evidence: very low) favouring exercise-based cardiac rehabilitation, albeit there was evidence of substantial statistical heterogeneity (I2 = 78%). There was no evidence of a difference in the risk of requiring antitachycardia pacing (RR 1.26, 95% CI 0.84 to 1.90; participants = 356; trials = 2; quality of evidence: moderate), appropriate shock (RR 0.56, 95% CI 0.20 to 1.58; participants = 428; studies = 3; quality of evidence: low) or inappropriate shock (RR 0.60, 95% CI 0.10 to 3.51; participants = 160; studies = 1; quality of evidence: moderate). AUTHORS' CONCLUSIONS Due to a lack of evidence, we were unable to definitively assess the impact of exercise-based cardiac rehabilitation on all-cause mortality, serious adverse events and health-related quality of life in adults with an ICD. However, our findings do provide very low-quality evidence that patients following exercise-based cardiac rehabilitation experience a higher exercise capacity compared with the no exercise control. Further high-quality randomised trials are needed in order to assess the impact of exercise-based cardiac rehabilitation in this population on all-cause mortality, serious adverse events, health-related quality of life, antitachycardia pacing and shock.
Collapse
Affiliation(s)
- Kim M Nielsen
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Ann‐Dorthe Zwisler
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Jesper H Svendsen
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Jane Lindschou
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
| | - Selina K Berg
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | | |
Collapse
|
9
|
Postreanimationsbehandlung. Notf Rett Med 2017. [DOI: 10.1007/s10049-017-0331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
10
|
Nolan JP, Soar J, Cariou A, Cronberg T, Moulaert VRM, Deakin CD, Bottiger BW, Friberg H, Sunde K, Sandroni C. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015: Section 5 of the European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2016; 95:202-22. [PMID: 26477702 DOI: 10.1016/j.resuscitation.2015.07.018] [Citation(s) in RCA: 746] [Impact Index Per Article: 93.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jerry P Nolan
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK.
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Alain Cariou
- Cochin University Hospital (APHP) and Paris Descartes University, Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Véronique R M Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care and NIHR Southampton Respiratory Biomedical Research Unit, University Hospital, Southampton, UK
| | - Bernd W Bottiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
| | - Hans Friberg
- Department of Clinical Sciences, Division of Anesthesia and Intensive Care Medicine, Lund University, Lund, Sweden
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| |
Collapse
|
11
|
|
12
|
Anxiety and risk of ventricular arrhythmias or mortality in patients with an implantable cardioverter defibrillator. Psychosom Med 2013. [PMID: 23197843 DOI: 10.1097/psy.0b013e3182769426] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences anxiety after device implantation. The purpose of the present study was to evaluate whether anxiety is predictive of ventricular arrhythmias and all-cause mortality 1 year post ICD implantation. METHODS A total of 1012 patients completed the state version of the State-Trait Anxiety Inventory at baseline. The end points were ventricular arrhythmias and mortality the first year after ICD implantation. RESULTS Within the first year after ICD implantation, 19% of patients experienced a ventricular arrhythmia, and 4% died. Anxiety was associated with an increased risk of ventricular arrhythmias (hazard ratio [HR] = 1.017; 95% confidence interval [CI] = 1.005-1.028; p = .005) and mortality (HR = 1.038; 95% CI = 1.014-1.063; p = .002) in adjusted analysis. Patients with anxiety (highest tertile) had a 1.9 increased risk for ventricular arrhythmias (95% CI = 1.329-2.753; p =.001) and a 2.9 increased risk for mortality (95% CI = 1.269-6.677; p = .01) compared with patients with low anxiety (lowest tertile). Among 257 patients with cardiac resynchronization therapy, anxiety was associated with mortality (HR = 5.381; 95% CI = 1.254-23.092; p = .02) after adjusting for demographic and clinical covariates. CONCLUSIONS Anxiety was associated with an increased risk of ventricular arrhythmias and mortality 1 year after ICD implantation, independent of demographic and clinical covariates. Monitoring and treatment of anxiety may be warranted in a selected subgroup of high-risk patients with an ICD.
Collapse
|
13
|
Development and testing of an intervention to improve outcomes for partners following receipt of an implantable cardioverter defibrillator in the patient. ANS Adv Nurs Sci 2012; 35:359-77. [PMID: 23107992 DOI: 10.1097/ans.0b013e318271d2e8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to describe 3 foundational studies and how their results were used to formulate, design, and test a novel partner intervention for implementation in the immediate post-ICD (implantable cardioverter defibrillator) period after returning home. Nursing's expanding role into chronic illness management in the creation of evidence-based practice is highlighted. A randomized clinical trial comparing 2 intervention programs is being conducted with patients who receive an ICD for the first time and their intimate partners. Primary outcomes are physical functioning, psychological adjustment, relationship impact, and health care utilization.
Collapse
|
14
|
Bolse K, Thylén I, Strömberg A. Healthcare professionals’ experiences of delivering care to patients with an implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2012; 12:346-52. [DOI: 10.1177/1474515112457133] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kärstin Bolse
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- School of Social and Health Sciences, Halmstad University, Sweden
| | - Ingela Thylén
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Molde University College, Faculty of Health Sciences, Molde, Norway
| | - Anna Strömberg
- Department of Medical and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| |
Collapse
|
15
|
Moulaert VR, Verbunt JA, Bakx WG, Gorgels AP, de Krom MC, Heuts PH, Wade DT, van Heugten CM. 'Stand still ... , and move on', a new early intervention service for cardiac arrest survivors and their caregivers: rationale and description of the intervention. Clin Rehabil 2011; 25:867-79. [PMID: 21565869 PMCID: PMC3255518 DOI: 10.1177/0269215511399937] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee demonstrates a knowledge of diagnostic approaches for specific impairments including cognitive dysfunction as a result of cardiac arrest.’ Abstract Objective: To describe a new early intervention service for survivors of cardiac arrest and their caregivers, and to explain the evidence and rationale behind it. Rationale: A cardiac arrest may cause hypoxic–ischaemic brain injury, which often results in cognitive impairments. Survivors of cardiac arrest can also encounter emotional problems, limitations in daily life, reduced participation in society and a decreased quality of life. A new early intervention service was designed based on literature study, expert opinion and patient experiences. Description of the intervention: The early intervention service is an individualized programme, consisting of one to six consultations by a specialized nurse for the patient and their caregiver. The intervention starts soon after discharge from the hospital and can last up to three months. The intervention consists of screening for cognitive and emotional problems, provision of information and support, promotion of self-management strategies and can include referral to further specialized care if indicated. Discussion: This intervention is assumed to reduce future problems related to hypoxic–ischaemic brain injury in the patient and caregiver, and its effectiveness is currently being investigated in a randomized controlled multicentre trial.
Collapse
Affiliation(s)
- Véronique Rmp Moulaert
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Bolse K, Johansson I, Strömberg A. Organisation of care for Swedish patients with an implantable cardioverter defibrillator, a national survey. J Clin Nurs 2010; 20:2600-8. [DOI: 10.1111/j.1365-2702.2010.03540.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
17
|
Abstract
Atrial fibrillation (AF) is a life-complicating illness adversely affecting morbidity, health-related quality of life (HRQOL), and healthcare use. Studies using HRQOL instruments suggest that patients diagnosed with AF experience more psychological distress than do healthy controls. Psychological distress in forms of anxiety and depression in patients with heart failure or coronary artery disease is related to increased mortality, morbidity, and consumption of healthcare. However, there is a critical lack of knowledge regarding the type and extent of psychological distress and its consequences in patients diagnosed with AF. This article will review the current state of scientific knowledge regarding psychological distress in patients with AF and offer suggestions for future studies. Medline, CINAHL, PscyhInfo, and Psychology and Behavioral Sciences Collection databases up to June 2009 were reviewed for key terms atrial fibrillation, psychological distress, affective distress, mood, emotional distress, psychological stress, negative affect, anxiety, depression, anger, and hostility. Ten studies using tested instruments to measure psychological distress were retained. The prevalence of psychological distress was not consistently reported. Combined findings revealed that psychological distress in the form of depression and/or anxiety uniquely contributed to greater AF symptom severity, diminished HRQOL, and recurrence of AF. Studies describing interventions to address psychological distress were not found. Lack of conceptual clarity and diversity of study purposes, designs, participants, and instruments limit the ability to draw coherent conclusions from findings. Nevertheless, findings suggest that psychological distress is present in a substantial portion of patients diagnosed with AF and its presence is related to adverse outcomes. Further study to identify the prevalence, characteristics, and consequences of psychological distress in patients diagnosed with AF is required to extend our knowledge and provide a foundation for development of interventions to address psychological distress in this rapidly increasing population.
Collapse
|
18
|
Alconero-Camarero AR, Cobo-Sánchez JL, Muñoz-Cacho P, Sainz-Laso R, Mancebo-Salas N, Casaus-Pérez M, Gutiérrez-Caloca N, Olalla-Antolín JJ. [Quality of life analysis in patients with an implantable cardioverter-defibrillator]. ENFERMERIA CLINICA 2009; 19:275-9. [PMID: 19766519 DOI: 10.1016/j.enfcli.2009.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 04/28/2009] [Accepted: 05/05/2009] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe possible changes in the quality of life (QL) and to identify possible differences associated to sociodemographic and clinical variables after being given an implantable cardioverter-defibrillator (ICD). METHOD Descriptive cross-sectional study, selecting 241 consecutive patients for a subcutaneous or subpectoral ICD implantation. One-hundred and fifty-seven patients met inclusion criteria. Introduction letter along with the assessment tool was mailed to them. Assessment tool used was the Euroqol-5D (EQ5D), validated and translated for a Spanish population. EQ5D describes health status in 5 domains: mobility (MO), self-care (SC), usual activity (UA), pain/discomfort (PD) and anxiety/depression (AD). It included a visual analogue scale (VAS) where the endpoints are labelled 'Best imaginable health state' and 'Worst imaginable health state'; one before and another after ICD implantation. RESULTS Ninety valid assessments were received: 80 males, mean age 61.2+/-13.1 years. Patients with EQ5D problems: MO 25 (27.7%), SC 8 (8.8%), UA 32 (35.5%), PD 22 (24.4%) and AD 29 (32.2%). Patients with ICD discharges had a higher percentage of problems in all EQ5D domains, being significant in PD and AD. Fifty four patients (60%) experienced a significant improvement in QL after ICD implant using the visual analogue scale score (75 points after vs. 50 points before; P<0.001). CONCLUSIONS The majority of ICD patients gain QL after implantation, but this gain is more limited in younger patients and those who have received discharges.
Collapse
|
19
|
SERBER EVAR, FINCH NANCYJ, LEMAN ROBERTB, STURDIVANT LACYJ, BARNES TAMMY, CLARKE ELIZABETH, GARRY JENNIFER, GOLD MICHAELR. Disparities in Preferences for Receiving Support and Education Among Patients with Implantable Cardioverter Defibrillators. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:383-90. [DOI: 10.1111/j.1540-8159.2008.02248.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Abstract
BACKGROUND Sudden cardiac death is a leading cause of death in the Americas and Europe. Although the implantable cardioverter defibrillator (ICD) has decreased mortality from sudden cardiac death, it may be associated with psychosocial adjustment (PSA) problems and be a source of uncertainty for some recipients. The purpose of this study was to explore uncertainty and PSA among first-time ICD recipients during the first 2 months after hospital discharge. METHODS Ninety-four adult, first-time ICD recipients recruited from 4 New England hospitals were studied at 1 week (S1) and 8 weeks (S2) after hospital discharge using a repeated-measures, correlational survey design. Mishel Uncertainty in Illness Scale, Psychosocial Adjustment to Illness Scale, and a demographic questionnaire were administered. Data were analyzed using descriptive and inferential statistics, including Pearson correlations, repeated-measures analysis of variance, multivariate canonical analysis, multiple regression, hierarchical regression, and 1-way analysis of variance. RESULTS There was no change in the nature or level of uncertainty over time. Uncertainty at S1 explained a significant amount (39%) of the variance in overall PSA at S2. Psychosocial adjustment domains at S1 explained a large proportion (62%) of the variance in overall PSA at S2. Education, employment status, and functional status were related to uncertainty. Younger recipients, people with a lower functional status, and those with disability had more PSA problems. Time since discharge was not correlated with uncertainty or PSA. Uncertainty was a strong predictor of PSA at both S1 and S2. CONCLUSIONS First-time ICD recipients who have greater uncertainty or less PSA at 1 week after hospital discharge may have more PSA problems during the first 2 months after implant. Age, education, and severity of illness may influence uncertainty and/or PSA. Further research is needed to determine the relationship between uncertainty and PSA over time.
Collapse
|
21
|
Pedersen SS, van den Broek KC, Sears SF. Psychological Intervention Following Implantation of an Implantable Defibrillator: A Review and Future Recommendations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1546-54. [PMID: 18070312 DOI: 10.1111/j.1540-8159.2007.00905.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Susanne S Pedersen
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
| | | | | |
Collapse
|
22
|
Friedmann E, Thomas SA, Inguito P, Kao CW, Metcalf M, Kelley FJ, Gottlieb SS. Quality of life and psychological status of patients with implantable cardioverter defibrillators. J Interv Card Electrophysiol 2007; 17:65-72. [PMID: 17235681 DOI: 10.1007/s10840-006-9053-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2006] [Accepted: 10/20/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Implantable cardioverter defibrillators (ICDs) are effective at reducing mortality in patients at high risk for sudden cardiac death (SCD) but can cause psychological distress and reduce quality of life (QOL). The full benefits of ICDs can only be achieved when the patient's QOL and psychological status are maintained. We examined psychological status and QOL post ICD implantation; the relationship of psychological status to QOL; the relationship of time since implantation to psychological status and QOL; and the relationship of time since ICD implantation and age of patient to these variables. METHODS AND RESULTS A cross-sectional self-administered assessment of QOL, depression, anxiety, demographic characteristics and cardiovascular health history of patients (n = 48) who had received ICDs within the past 10 years at an urban hospital. Patients who had ICDs for longer experienced worse depression and QOL. Patients who were younger had worse depression, anxiety, and QOL. The combination of anxiety, depression, age, and time since ICD implant significantly predicted overall QOL and the psychosocial and physical dimensions of QOL explaining 55.5, 54, and 34.9% of the variance, respectively. CONCLUSION Younger ICD patients are at highest risk for psychological distress and poor QOL. Longitudinal research would facilitate determination of the trajectory of changes in psychological status and QOL over the duration of the ICD experience.
Collapse
Affiliation(s)
- E Friedmann
- University of Maryland School of Nursing, 655 W. Lombard Street, Baltimore, MD 21201-1579, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Álvarez-Leiva MI, Jesús Albar-Marín M, Eugenia Acosta-Mosquera M, Dolores Maestre-Guzmán M, Rosa Martín-García M, Nieto-Gutiérrez P. Evaluación de la calidad asistencial y posterior ajuste a la nueva situación tras el implante de un desfibrilador en pacientes ingresados en la Unidad Coronaria del Hospital Virgen Macarena (Sevilla). ENFERMERIA CLINICA 2006. [DOI: 10.1016/s1130-8621(06)71237-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Dougherty CM, Thompson EA, Lewis FM. Long-Term Outcomes of a Telephone Intervention After an ICD. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1157-67. [PMID: 16359281 DOI: 10.1111/j.1540-8159.2005.09500.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to determine the long-term benefits of participating in a structured, 8-week educational telephone intervention delivered by expert cardiovascular nurses post-ICD. The intervention was aimed to (1) increase physical functioning, (2) increase psychological adjustment, (3) improve self-efficacy in managing the challenges of ICD recovery, and (4) lower levels of health care utilization over usual care in the first 12 months post-ICD. This article reports on the 6- and 12-month outcomes of the nursing intervention trial. METHODS AND RESULTS A two-group (N = 168) randomized control group design was used to evaluate intervention efficacy with persons receiving an ICD for the secondary prevention of sudden cardiac arrest. Measures were obtained at baseline, 6 and 12 months post hospitalization. Outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI], Centers for Epidemiologic Studies-Depression [CES-D], fear of dying), (3) self-efficacy (Sudden Cardiac Arrest-Self-Efficacy [SCA-SE], Sudden Cardiac Arrest-Behavior [SCA-B], Sudden Cardiac Arrest-Knowledge [SCA-K]), and (4) health care utilization (emergency room [ER] visits, outpatient visits, hospitalizations). Using repeated measures ANOVA, the 6- and 12-month benefits of the intervention over usual care were in reductions in physical concerns (P = 0.006), anxiety (P = 0.04), and fear of dying (P = 0.01), with enhanced self-confidence (P = 0.04) and knowledge (P = 0.001) to manage ICD recovery. There were no statistically significant differences between the groups on total outpatient visits, hospitalizations, or ER visits over 12 months. CONCLUSION A structured 8-week post-hospital telephone nursing intervention after an ICD had sustained 12-month improvements on patient concerns, anxiety, fear of dying, self-efficacy, and knowledge. Results may not apply to individuals with congestive heart failure who receive an ICD for primary prevention of sudden cardiac arrest.
Collapse
|
25
|
Steinke EE, Gill-Hopple K, Valdez D, Wooster M. Sexual concerns and educational needs after an implantable cardioverter defibrillator. Heart Lung 2005; 34:299-308. [PMID: 16157184 DOI: 10.1016/j.hrtlng.2005.03.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Revised: 02/28/2005] [Accepted: 03/04/2005] [Indexed: 11/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Elaine E Steinke
- Wichita State University, School of Nursing, Wichita, Kansas 67260, USA
| | | | | | | |
Collapse
|
26
|
Abstract
Use of implantable cardioverter defibrillators has become standard therapy for patients at high risk for life-threatening ventricular arrhythmias. Although acceptance of the device is generally high among patients and their families, quality of life and psychosocial issues associated with use of the defibrillators deserve greater attention to improve outcomes. Psychosocial issues, their ramifications, and theory-and evidence-based approaches to improving outcomes are described.
Collapse
Affiliation(s)
- Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| |
Collapse
|
27
|
Dougherty CM, Lewis FM, Thompson EA, Baer JD, Kim W. Short-Term Efficacy of a Telephone Intervention by Expert Nurses After An Implantable Cardioverter Defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1594-602. [PMID: 15613121 DOI: 10.1111/j.1540-8159.2004.00691.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The ICD is a common therapy for treatment of ventricular arrhythmias and prevention of sudden cardiac death. After ICD therapy, 50% of survivors are known to have significantly elevated anxiety, depression, anger, and fear in getting back to normal physical activities. Despite these problems, few interventions to improve adjustment have been rigorously evaluated within a clinical trial format. This article reports the short-term efficacy of a structured weekly educational telephone intervention (8 weeks) delivered by expert cardiovascular nurses to recipients of an ICD. To test these effects, a two-group (n = 84/group) randomized clinical trial design was used with measures at baseline (hospital discharge), 1 month, and 3 months after ICD therapy. The study sample were first time ICD recipients for secondary prevention of sudden cardiac arrest. Primary outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short-Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI]), Centers for Epidemiologic Studies-Depression (CES-D), (3) knowledge (Sudden Cardiac Arrest [SCA] knowledge assessment), and (4) health care use (emergency room visits, outpatient visits, hospitalizations). The intervention group, as compared to the control group, significantly reduced mean PCA symptoms at 1 month (11.3-8.8 vs 9.7-9.3, respectively, P < 0.02), and reduced state anxiety (36.1-31.9 vs 33.1-33.0, respectively, P < 0.08), and enhanced knowledge (21.8-22.4 vs 21.4-21.7, respectively, P < 0.02) at 3 months. The intervention did not significantly impact short-term health care use. A structured telephone intervention delivered during the first 8 weeks after ICD therapy by expert cardiovascular nurses decreased ICD related physical symptoms and anxiety, and increased SCA knowledge over 3 months.
Collapse
MESH Headings
- Adaptation, Psychological
- Aged
- Anxiety/nursing
- Anxiety/psychology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/psychology
- Depression/nursing
- Depression/psychology
- Emergency Service, Hospital/statistics & numerical data
- Female
- Health Knowledge, Attitudes, Practice
- Heart Arrest/nursing
- Heart Arrest/psychology
- Hospitalization/statistics & numerical data
- Humans
- Longitudinal Studies
- Male
- Middle Aged
- Nurse Clinicians
- Outcome and Process Assessment, Health Care
- Patient Education as Topic/methods
- Primary Health Care/statistics & numerical data
- Self Care/psychology
- Sick Role
- Tachycardia, Ventricular/nursing
- Tachycardia, Ventricular/psychology
- Telephone
- Utilization Review
Collapse
Affiliation(s)
- Cynthia M Dougherty
- School of Nursing, University of Washington, Seattle, Washington 98195, USA.
| | | | | | | | | |
Collapse
|