Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study

Life Situation Related to The ICD Implantation; Self-Reported Uncertainty and Satisfaction in Swedish and US Samples

The aim of the study was to describe changes in the life situation related to the ICD implantation of Swedish and US samples with regard to uncertainty and satisfaction. The life situation was measured by reference to the uncertainty caused by the condition and satisfaction with the life situation. Inferential statistics were used to analyse changes within and between the Swedish and US samples. Uncertainty showed a statistically significant difference between the Swedish and US samples before as well as after the ICD implantation. A higher level of uncertainty was indicated for the US sample prior to the ICD implantation and for the Swedish sample following the implantation. In the Swedish sample, satisfaction with life showed a statistically significant difference within the socio-economic domain, indicating a higher degree of satisfaction 3 months after implantation. Satisfaction within the domains of health and functioning, socio-economics and psychological-spiritual showed a statistically significant difference between the Swedish and US samples both before and after ICD implantation, indicating a higher degree of satisfaction in the US sample. The previous study shows that the ICD-patient's life situation is changed after the implantation and that it is necessary to provide the patient with information and education based on their own preconditions. The fact that US sample was investigated at a later stage after ICD implantation than the Swedish sample may have influenced the results of the study.

Partners of ICD Patients—An Exploratory Study of Their Experiences

BACKGROUND

The experiences of partners who care for and support the needs of a loved one with an implantable cardiac defibrillator (ICD) remain largely unknown within Europe.

AIMS

This study explored the nature of partner's experiences from the pre-ICD implantation phase up until a maximum of 20 months at home.

METHODS

Eight partners cohabiting with a recipient of an ICD were interviewed using a semistructured schedule. All interviews were transcribed and content analysed for emerging categories and themes.

FINDINGS

Four themes representing 11 categories conceptualised the partners' experiences, these included: Acknowledging the patient's need for the device, reactions to the device, safeguarding the patient, and returning to normality.

CONCLUSION

This qualitative study suggests that partners of ICD recipients progress through various difficult and adaptive stages when learning how best to support the patient. A point is reached when most are able to assume control and normalise their lives. This transformation is slow; however, to improve this process and empower partners, nurses should provide relevant information and include them in decisions affecting the patient. Further research into the unique needs of partners, which includes international perspectives, would be significant in developing practice and theory in this area.

Long-term Effects of Implanted Cardioverter-Defibrillators on Health Status, Quality of Life, and Psychological State

Background Living with an implanted cardioverter-defibrillator increases survival, but the effects of the device on health status, quality of life, and psychological state over time are not clear.

Objectives To investigate changes in health status, quality of life, and psychological state associated with implantation of a cardioverter-defibrillator from implantation to 4 years later.

Methods A prospective, longitudinal design was used to measure changes in scores on the Short Form 36 of the Medical Outcomes Study, the Quality of Life Index–Cardiac III, and the Profile of Moods States short form at implantation, 6 months, and 1, 2, 3, and 4 years later.

Results A total of 30 men and 11 women (mean age, 60.4 years) completed all 4 years of follow-up. The physical and mental health composite summary scores of the Short Form 36 changed significantly over time; the mental health score improved (F = 2.95; P = .03), and the physical score worsened (F = 3.69; P = .003). Scores on the Quality of Life Index–Cardiac III did not change significantly. Negative moods were significantly fewer, and the total psychological distress score was significantly lower (F = 10.21; P < .001) during the 4 years of follow-up.

Conclusions Patients had improved mental health and reduced psychological distress by 6 months after implantation. Perception of physical health declined during the 4 years after implantation; the role physical subscore of the Short Form 36 indicated significant improvement in functioning at 6 months and a trend toward reduced functioning at 3 and 4 years after implantation.

Supraventricular tachycardia and the struggle to be believed

BACKGROUND

Little research exists examining patient experiences of life with supraventricular tachycardia (SVT). Realistic expectations of symptoms, patient management strategies, and treatment options are important components of patient education and treatment decisions.

AIM

This descriptive qualitative study explored patients' experiences living with SVT.

METHODS

Grounded theory methodology was used with semi-structured interviews of 25 SVT patients undergoing radiofrequency ablation treatment.

RESULTS

The main core category that emerged from the data was the "struggle to be believed". The struggle or work of living with SVT entails: (1) living with the uncertainty of the occurrence and duration of an episode, (2) "covering up" to manage symptoms and appear normal, (3) searching for causative factors to prevent further episodes, and (4) experimenting with management techniques to shorten or end episodes.

CONCLUSION

Clinical diagnosis and referral for ablation treatment were more difficult for women suggesting existence of a gender bias. As with many other chronic conditions, the illness trajectory work is formidable. Patients in this study with SVT, however, reported facing the additional difficulty of being believed. Disruptions in self-esteem and personal relationships are the effects of not being believed. Providers could avoid minimizing women's symptoms by listening seriously and offering realistic expectations; including insight into patient experiences and the trajectory of the dysrhythmia; and efficacy of drug and ablation treatments.

Ways of Experiencing the Life Situation Among United States Patients With an Implantable Cardioverter‐Defibrillator: A Qualitative Study

The purpose of this paper is to describe how a selected group of United States patients with an implantable cardioverter-defibrillator perceived their life situation. A qualitative design based on the phenomenographic approach was chosen to describe the patients' conceptions of their life situation. Fourteen patients-eight men and six women, aged 21-84-were strategically selected to obtain as broad a variation as possible. The descriptive categories to emerge from the analysis of the interviews were trust, adaptability, and empowerment. The category labeled trust describes how patients trusted in the organization around them. The category labeled adaptability describes how patients adapted to living with an implantable cardioverter-defibrillator device. The category entitled empowerment describes how patients considered that they received support from family and friends as well as from health care professionals. This study suggests the need for a holistic intervention program comprising family, work, and leisure, focusing on patients' future life situation.

Quality of life and psychological status of patients with implantable cardioverter defibrillators

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.

Costs and quality-of-life effects of implantable cardioverter-defibrillators

Although the clinical efficacy of implantable cardioverter-defibrillators (ICDs) has been convincingly demonstrated in clinical trials, the impact of ICDs on health care costs and recipients' quality of life (QOL) is less certain. The existing medical research on the health care costs and QOL effects of ICDs was reviewed and summarized. Medline and the Institute for Scientific Information's Web of Knowledge were searched for publications reporting costs of care and QOL assessments of ICD recipients. Unpublished and non-peer-reviewed "gray" publications were excluded. Reports were included if they reported primary, original patient data that were collected after 1993, when nonthoracotomy defibrillators entered clinical practice. Two reviewers independently evaluated publications for relevance and quality, abstracted study data, and summarized the findings. Excessive heterogeneity among studies prevented formal meta-analysis, so a narrative synthesis was performed, and key themes were identified from the published research. There were limited published data on the costs of ICD care, especially for the primary prevention of sudden cardiac death. The published research on ICD QOL lacked large, multicenter, longitudinal studies. Many ICD QOL studies were performed in small numbers of patients at single centers. Initial ICD implantation costs ranged (in 2006 United States dollars) from $28,500 to $55,200, with annual follow-up costs ranging from $4,800 to $17,000. QOL was higher for ICD recipients than for patients treated with antiarrhythmic drugs, but there was a substantial prevalence of anxiety, depression, and "loss of control" in ICD recipients, particularly in those who had received ICD shocks. In conclusion, ICD implantation remains costly but may be becoming less expensive over time, and ICD recipients' QOL is significantly affected by their devices.

Quality of Life and Psychological Status of Patients With Implantable Cardioverter Defibrillators

• Background Implantable cardioverter defibrillators reduce mortality in patients at high risk for sudden cardiac death and in patients with heart failure. Patients with defibrillators often experience psychological distress and poor quality of life, which can potentiate pathological processes that increase the risk for sudden cardiac death. To achieve the full benefits of the defibrillators, patients must maintain their psychological status and quality of life.

• Objectives To review the research on psychological status and quality of life of patients with implantable cardioverter defibrillators and suggest nursing interventions to improve the patients’ health.

• Method Searches of PubMed were used to find articles on depression, anxiety, and quality of life in patients with implantable cardioverter defibrillators.

• Results Poor quality of life is associated with anxiety and depression in patients with implantable cardioverter defibrillators. Discharges of the devices have adverse consequences for patients’ psychological status and quality of life. Younger patients are at highest risk for psychological distress and poor quality of life after implantation. Longitudinal research would facilitate determining the course of the changes in psychological status and quality of life during the time patients have the defibrillators. More intensive intervention may be necessary for the most vulnerable recipients: patients who are young, have experienced shocks, and are in psychological distress.

• Conclusions Poor quality of life and depression are common in patients with implantable cardioverter defibrillators. Nursing interventions to reduce psychological distress and improve quality of life may reduce morbidity and mortality in these patients. Additional research is needed to determine effective interventions.

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.

Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator

PURPOSE

This study describes the quality of life (QOL) and uncertainty in patients who have an implantable cardioverter defibrillator (ICD) and predicts QOL at long-term follow-up.

METHODS

Long-term follow-up was defined as 6.9 years +/- 1 year (range 4.11-8.7 years). QOL was measured with the Quality of Life Index, and uncertainty was measured with the Mishel Uncertainty in Illness Scale.

RESULTS

The overall QOL and health/functioning were unchanged over time. QOL in the socioeconomic (P = .002) and psychologic/spiritual domains (P = .012) decreased in the first year. From baseline to long-term follow-up, the QOL in the family domain (P = .011) and uncertainty (P = .002) decreased. Uncertainty was a predictor of low QOL.

CONCLUSION

QOL was reasonably good 6.9 years post-ICD implantation. Patients felt less uncertain once they had passed the first year of their illness.

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.

Ventricular Dysrhythmias

Cardiovascular nurses contribute significantly to health outcomes and frequently assume responsibility for the clinical and organizational processes to ensure positive outcomes for patients and families. In ventricular dysrhythmia populations, nurses have provided evidence for practices that influence outcomes and have studied patient outcomes related to mortality, morbidity, quality of life, psychological and physical functioning, symptoms, and family responses. Additionally, nurses have contributed to understanding organizational outcomes, such as costs and resource use related to patients with dysrhythmias. Most ventricular dysrhythmia outcome studies are descriptive. More intervention research is needed to develop a cohesive and comprehensive body of evidence upon which to base dysrhythmia nursing care to improve patient outcomes.