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Pallangyo P, Mgopa LR, Bhalia SV, Mkojera ZS, Komba M, Mayala HA, Kisenge PR. Psychopathology associated with cardiac pacing in Tanzania: A case series. SAGE Open Med Case Rep 2023; 11:2050313X231207563. [PMID: 37869585 PMCID: PMC10585990 DOI: 10.1177/2050313x231207563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Emotional disarray linked to interventional procedures may potentially aggravate previous psychiatric conditions or even precipitate new psychopathologies. Despite of the well-known deleterious impact of mental health disorders on cardiac outcomes, psychological disturbances are relatively understudied yet of vital importance to the overall health of post-pacing patients. In this case series we present a spectrum of mental illnesses observed in a cohort of patients who underwent permanent pacemaker implantation in Tanzania's national referral cardiac centre. Five individuals of African origin aged between 58 and 81 years presented to Jakaya Kikwete Cardiac Institute with clinical conditions warranting permanent pacemaker implantation. All five denied prior history of mental illness, however, after thorough psychiatric reviews; organic brain syndrome, panic disorder, brief psychotic disorder, adjustment disorder and major depressive disorder diagnoses were reached. All five were successfully channeled for medical psychotherapy. To conclude, this case series illustrates variable consequences of poor psychological adaptation to implantable cardiac devices, and it underscores the importance of continued psychological evaluation to such patients.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Lucy R Mgopa
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Smita V Bhalia
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Zabella S Mkojera
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Makrina Komba
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Henry A Mayala
- Department of Clinical Support Services, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Peter R Kisenge
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
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van den Heuvel LM, Sarina T, Sweeting J, Yeates L, Bates K, Spinks C, O’Donnell C, Sears SF, McGeechan K, Semsarian C, Ingles J. A Prospective Longitudinal Study of Health-Related Quality of Life and Psychological Wellbeing after an Implantable Cardioverter Defibrillator in Patients with Genetic Heart Diseases. Heart Rhythm O2 2022; 3:143-151. [PMID: 35496461 PMCID: PMC9043389 DOI: 10.1016/j.hroo.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Genetic heart diseases (GHDs) can be clinically heterogeneous and pose an increased risk of sudden cardiac death (SCD). The implantable cardioverter-defibrillator (ICD) is a lifesaving therapy. Impacts on prospective and long-term psychological and health-related quality of life (HR-QoL) after ICD implant in patients with GHDs are unknown. Objectives Investigate the psychological functioning and HR-QoL over time in patients with GHDs who receive an ICD, and identify risk factors for poor psychological functioning and HR-QoL. Methods A longitudinal, prospective study design was used. Patients attending a specialized clinic, diagnosed with a GHD for which they received an ICD between May 2012 and January 2015, were eligible. Baseline surveys were completed prior to ICD implantation with 5-year follow-up after ICD implant. We measured psychological functioning (Hospital Anxiety Depression Scale, Florida Shock Anxiety Scale), HR-QoL (Short-Form 36v2), and device acceptance (Florida Patient Acceptance Scale). Results Forty patients were included (mean age 46.3 ± 14.2 years; 65.0% male). Mean psychological and HR-QoL measures were within normative ranges during follow-up. After 12 months, 33.3% and 19.4% of participants showed clinically elevated levels of anxiety and depression, respectively. Longitudinal mixed-effect analysis showed significant improvements from baseline to first follow-up for the overall cohort, with variability increasing after 36 months. Nontertiary education and female sex predicted worse mental HR-QoL and anxiety over time, while comorbidities predicted depression and worse physical HR-QoL. Conclusion While the majority of patients with a GHD adjust well to their ICD implant, a subset of patients experience poor psychological and HR-QoL outcomes.
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Catalan-Matamoros D, Lopez-Villegas A, Leal Costa C, Bautista-Mesa R, Robles-Musso E, Rocamora Perez P, Lopez-Liria R. A non-randomized clinical trial to examine patients' experiences and communication during telemonitoring of pacemakers after five years follow-up. PLoS One 2021; 16:e0261158. [PMID: 34941904 PMCID: PMC8699982 DOI: 10.1371/journal.pone.0261158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with pacemakers need regular follow-ups which are demanding. Telemonitoring for pacemaker can provide a new opportunity to avoid follow-up visits. On the other hand, in-person visits could help patients with pacemakers to cope better with the anxiety linked to their condition and maintain better communication with their doctors than simple remote control of their device status. Therefore, our objective was to analyze the experiences and communication comparing telemonitoring (TM) versus conventional monitoring (CM) of patients with pacemakers. A single-center, controlled, non-randomized, non-blinded clinical trial was designed. Data were collected five years after implantation in a cohort of 89 consecutive patients assigned to two different groups: TM and CM. The ‘Generic Short Patient Experiences Questionnaire’ (GS-PEQ) was used to assess patients’ experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. Additionally, an ad-hoc survey including items from the ‘Telehealth Patient Satisfaction Survey’ and a ‘costs survey’ was used. After five years, 55 patients completed the study (TM = 21; CM = 34). Participants’ mean (±SD) age was 81 (±6.47), and 31% were females. No differences in baseline characteristics between groups were found. The comparative analyses TM versus CM showed some significant differences. According to GS-PEQ, TM users received adequate information about their diagnosis or afflictions (p = .035) and the treatment was better adapted to their situation (p = .009). Both groups reported negative experiences regarding their involvement in their treatment decisions, the waiting time before admission, and perceived a low-benefit. According to HCCQ, the TM group experienced poorer consultation management by the healthcare provider (p = .041). Participants reported positive overall communication experiences. The study provides insights into the experiences and communication in PM monitoring services as well as specific areas where users reported negative experiences such as the consultation management by clinicians. Trial registration: ClinicalTrials.gov NCT02234245.
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Affiliation(s)
- Daniel Catalan-Matamoros
- Health Research Centre, University of Almeria, Almeria, Spain
- Department of Communication Studies, University Carlos III of Madrid, Madrid, Spain
| | - Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, El Ejido-Almeria, Spain
- * E-mail:
| | | | | | | | - Patricia Rocamora Perez
- Health Research Centre, University of Almeria, Almeria, Spain
- Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | - Remedios Lopez-Liria
- Health Research Centre, University of Almeria, Almeria, Spain
- Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
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4
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Europace 2021; 23:1336-1337o. [PMID: 33636723 DOI: 10.1093/europace/euaa427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
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5
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Pedretti RFE, Iliou MC, Israel CW, Abreu A, Miljoen H, Corrà U, Stellbrink C, Gevaert AB, Theuns DA, Piepoli MF, Reibis R, Schmid JP, Wilhelm M, Heidbuchel H, Völler H, Ambrosetti M, Deneke T, Cornelissen V, R Heinzel F, Davos CH, Kudaiberdieva G, Frederix I, Svendsen JH, Hansen D. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA). Eur J Prev Cardiol 2021; 28:1736-1752. [PMID: 34038513 DOI: 10.1093/eurjpc/zwaa121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increasing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive special attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommendations for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset of patients.
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Affiliation(s)
- Roberto F E Pedretti
- Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy
| | - Marie-Christine Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France
| | - Carsten W Israel
- Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany
| | - Ana Abreu
- Servico de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Hielko Miljoen
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany
| | - Andreas B Gevaert
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Dominic A Theuns
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Rona Reibis
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany
| | - Jean Paul Schmid
- Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hein Heidbuchel
- Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium
| | - Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany.,Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf, Germany
| | | | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d'Adda, Italy
| | - Thomas Deneke
- Heart Center Rhön-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany
| | - Veronique Cornelissen
- Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Frank R Heinzel
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Gulmira Kudaiberdieva
- SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey
| | - Ines Frederix
- Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium.,Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium.,Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Dominique Hansen
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
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Rafsanjani MHAP, Masoudi S, Radmanesh M, Bostani Z. Comparison of depression and anxiety among pacemaker and implantable cardioverter-defibrillator recipients: A cross-sectional study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 44:235-239. [PMID: 33372277 DOI: 10.1111/pace.14152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anxiety and depression among implantable cardioverter-defibrillator (ICD) recipients can lead to physical or psychological consequences and reduce the quality of life of these patients. Few studies have compared the frequency and severity of depressive and anxiety disorders in the pacemaker (PM) and ICD recipients. The aim of the present study was to compare depression and anxiety among PM and ICD recipients. METHODS This cross-sectional study was performed on 296 patients referred to a specialized cardiology teaching hospital from October 1, 2019 to July 1, 2020. Patients were selected using convenience sampling method. RESULTS Regarding anxiety, the results showed that the overall prevalence of anxiety in PM, ICD, and control groups was 23.5%, 28%, and 8%, respectively. Results showed no significant difference between PM and ICD recipients regarding the anxiety prevalence (p = .46). With regard to depression, the results showed that the overall prevalence of depression in the PM, ICD, and control groups was 7.1%, 23%, and 4.1%, respectively. The results showed a significant difference between PM and ICD recipients in terms of depression prevalence (p = .03). The results also showed that the prevalence of depression was significantly higher among PM and ICD recipients than the control group (p = .01). CONCLUSION Considering the results of the present study and the high prevalence of anxiety and depression, it seems necessary to focus more on educating patients about the effectiveness of PM and ICD devices in reducing anxiety and depression.
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Affiliation(s)
| | - Sima Masoudi
- Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Majid Radmanesh
- Department of Psychiatry, School of Medicine, Razi Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Zahra Bostani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Science, Urmia, Iran
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Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207678. [PMID: 33096736 PMCID: PMC7589429 DOI: 10.3390/ijerph17207678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/12/2022]
Abstract
As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.
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Quality of life and psychological co-morbidities in children and adolescents with cardiac pacemakers and implanted defibrillators: a cohort study in Eastern Germany. Cardiol Young 2020; 30:549-559. [PMID: 32279696 DOI: 10.1017/s104795112000061x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The implantation of a pacemaker or an implantable cardioverter-defibrillator during childhood may reduce quality of life and lead to mental health problems. This study aimed to evaluate potential mental health problems (i.e., depressive and anxiety symptoms) and quality of life in children with cardiac active devices in comparison to healthy peers. METHODS We analysed data of children with pacemakers or implantable cardioverter-defibrillators aged 6-18 years. Quality of life, depressive and anxiety symptoms were assessed by standardised questionnaires. The results were compared to age-matched reference groups. RESULTS Children with implantable cardioverter-defibrillator showed significant lower quality of life in comparison to reference group (p = 0.03), but there was no difference in quality of life between children with pacemaker and reference group. There was no significant difference in depressive symptoms between children with a cardiac rhythm device compared to reference group (self-report: p = 0.67; proxy report: p = 0.49). There was no significant difference in anxiety (p = 0.53) and depressive symptoms (p = 0.86) between children with pacemaker and children with implantable cardioverter-defibrillator. CONCLUSIONS Living with an implantable cardioverter-defibrillator in childhood seems to decrease the patients' quality of life. Although children with pacemaker and implantable cardioverter-defibrillator don't seem to show more depressive and anxiety symptoms in comparison to their healthy peers, there still can be an increased risk for those children to develop mental health problems. Therefore, treating physicians should be aware of potential mental health problems and provide the patients and their families with appropriate therapeutic offers.
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Pallangyo P, Mgopa L, Millinga J, Bhalia S, Hemed NR, Mkojera Z, Swai HJ, Seraphine P, Mulashani R, Ndelwa B, Shemu T, Janabi M. Suicide Attempt Following Pacemaker Implantation in an Eighty-Three-Year-Old Male: A Case Report. J Med Cases 2019; 10:345-347. [PMID: 34434306 PMCID: PMC8383566 DOI: 10.14740/jmc3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/29/2019] [Indexed: 12/03/2022] Open
Abstract
As the global population ages, cardiac pacing procedures are rising exponentially to keep pace with the increasing incidence of bradyarrhythmias. The efficacy of pacemakers is well established, but recipients may have poor psychosocial adaptation leading to development or exacerbation of mental disorders, that may manifest with anxiety, depressive symptoms or rarely suicidal tendencies. An 83-year-old male of African descent was referred to us for evaluation and expert management. He came with chief complaints of general body malaise, light-headedness, chest pain and fainting spells for about 6 months. He was diagnosed with hypertension 4 years prior, and there was no history of mental illness in the patient or his family. Echocardiography (ECHO) revealed features of hypertensive heart disease while electrocardiogram (ECG) showed features of third-degree heart block. He underwent successful pacing with a resultant ventricular paced rhythm. The patient was stable and symptom free post pacing, but on the fourth day he jumped off the window of the ward in the hospital’s second floor. Post suicide attempt examination revealed epistaxis, right periorbital hematoma with a temporal lacerated wound and deformed ankles bilaterally. ECG showed a ventricular paced rhythm and the chest radiograph showed an intact pacemaker. Ophthalmological review was evident for right sided blepharospasm with massive chemosis and bilateral constricted reactive pupils. Radiological investigations showed right orbital fracture, stable C5 and C6 fractures, and bilateral bimalleolar fractures with ankle dislocation. Neurosurgical review was unremarkable and psychiatric review could not be performed. The patient died 18 h after the suicide attempt incidence. Emotional disturbances post pacing impairs the quality of life and in the worst case scenario could lead to unanticipated cessation of life. In view of this, thorough evaluation and monitoring of the patient’s psychological well-being both pre and post pacing is paramount.
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Affiliation(s)
- Pedro Pallangyo
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania.,Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Lucy Mgopa
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Naairah R Hemed
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Happiness J Swai
- Department of Research and Training, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Polycarp Seraphine
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Rydiness Mulashani
- Department of Nursing, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Baraka Ndelwa
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Tulizo Shemu
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, PO Box 65141, Dar es Salaam, Tanzania
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Fumagalli S, Pieragnoli P, Haugaa KH, Potpara TS, Rasero L, Ramacciati N, Ricciardi G, Solimene F, Mascia G, Mascioli G, Zuo G, Roberts AT, Marchionni N, Lenarczyk R, Boveda S, Dagres N. The influence of age on the psychological profile of patients with cardiac implantable electronic devices: results from the Italian population in a multicenter study conducted by the European Heart Rhythm Association. Aging Clin Exp Res 2019; 31:1219-1226. [PMID: 30552563 DOI: 10.1007/s40520-018-1088-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/26/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Cardiac implantable electronic devices (CIEDs) are widely used to treat bradyarrhythmias or improve the prognosis of patients with heart failure (HF). AIMS To evaluate age-related (≤ 75 vs. > 75 years) attitudes, worries, psychological effects and needs in an Italian CIEDs population. METHODS Patients attending their periodical ambulatory evaluation received a questionnaire conceived by the European Heart Rhythm Association Scientific Initiatives Committee as part of a multicenter, multinational snapshot survey. Seven countries participated in the study, and 1646 replies were collected. Of these, 437 (27%) were from Italy. Present results refer to the Italian population only. CIEDs were stratified into devices to treat bradycardia or HF. RESULTS The use of CIEDs was more common in advanced age. Older patients needed less information about CIEDs than younger ones (p = 0.044), who would prefer to be better informed about CIEDs-related consequences on psychologic profile (p = 0.045), physical (p < 0.001) and sexual (p < 0.001) activities, and driving limitations (p = 0.003). When compared to older subjects, younger individuals experienced more difficulties (p = 0.035), especially in their professional (p < 0.001) and private life (p = 0.033), feeling their existence was limited by the device (p < 0.001). Conversely, quality of life (HRQL) more often improved in the elderly (p = 0.001). Information about what to do with CIEDs at the end of life is scant independently of age. CONCLUSIONS HRQL after CIEDs implantation improves more frequently in older patients, while the psychological burden of CIEDs is usually higher in younger patients. End of life issues are seldom discussed.
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Affiliation(s)
- Stefano Fumagalli
- Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Viale Pieraccini, 6, 50139, Florence, Italy.
| | - Paolo Pieragnoli
- Electrophysiology Laboratory, University of Florence and AOU Careggi, Florence, Italy
| | | | | | - Laura Rasero
- Department of Health Sciences, Department of Health Professions, University of Florence and AOU Careggi, Florence, Italy
| | - Nicola Ramacciati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Ricciardi
- Electrophysiology Laboratory, University of Florence and AOU Careggi, Florence, Italy
| | | | | | | | - Giulia Zuo
- Department of Health Sciences, Department of Health Professions, University of Florence and AOU Careggi, Florence, Italy
| | - Anna T Roberts
- Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Niccolò Marchionni
- Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, Viale Pieraccini, 6, 50139, Florence, Italy
| | | | - Serge Boveda
- Cardiology Department, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center of Leipzig, Leipzig, Germany
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Catalan-Matamoros D, Lopez-Villegas A, Tore-Lappegard K, Lopez-Liria R. Patients' experiences of remote communication after pacemaker implant: The NORDLAND study. PLoS One 2019; 14:e0218521. [PMID: 31220146 PMCID: PMC6586402 DOI: 10.1371/journal.pone.0218521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The concept of 'patient experience' has become central to how to improve healthcare. Remote communication with patients is today a frequent practice in healthcare services, showing similar outcomes to standard outpatient care while enabling cost reduction in both formal and informal care. The purpose of this study was to analyse the experiences of people with telemonitoring pacemakers. METHODS Patients were randomly allocated to either the telemonitoring or hospital monitoring follow-ups. Using the 'Generic Short Patient Experiences Questionnaire' (GS-PEQ), as well as an ad-hoc survey from the 'telehealth patient satisfaction survey' and 'costs survey', patients' experiences were measured six months after the pacemaker implant in a cohort of 50 consecutive patients. The mean age was 74.8 (± 11.75) years and 26 (52%) patients were male of which 1 was lost in follow-up. Finally, 24 patients were followed up with standard hospital monitoring, while 25 used the telemonitoring system. Differences in baseline characteristics between groups were not found. RESULTS Findings showed overall positive and similar experiences in patients living with telemonitoring and hospital monitoring pacemakers. Significant differences were found in GS-PEQ concerning how telemonitoring patients received less information about their diagnosis/afflictions (p = 0.046). We did not find significant differences in other items such as 'confidence in the clinicians' professional skills', 'treatment perception adapted to their situation', 'involvement in decisions regarding the treatment', 'perception of hospital organisation', 'waiting before admission', 'satisfaction of help and treatment received', 'benefit received', and 'incorrect treatment'. CONCLUSIONS The remote communication of pacemakers was met with positive levels of patients' experiences similarly to patients in the hospital monitoring follow-up. However, telemonitoring patients received less information. Thus, improving the quality and timing of information is required in telemonitoring patients in the planning and organisation of future remote communication healthcare services for people living with a pacemaker implant.
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Affiliation(s)
- Daniel Catalan-Matamoros
- Health Sciences CTS-451 Research Group, University of Almeria, Almeria, Spain
- Department of Journalism and Communication, University Carlos III of Madrid, Madrid, Spain
| | - Antonio Lopez-Villegas
- Division of Medicine, Nordland Hospital, Bodø, Norway
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Almeria, Spain
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- * E-mail:
| | - Knut Tore-Lappegard
- Division of Medicine, Nordland Hospital, Bodø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Remedios Lopez-Liria
- Nursing, Physiotherapy and Medicine Department, Faculty of Health Sciences, University of Almeria, Almeria, Spain
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Allam LE, Nabih MAE, El-Missiry MA. The psychological impact of permanent cardiac pacemakers on pediatric patients and their parents: A case control study. Indian Heart J 2018; 70:872-878. [PMID: 30580859 PMCID: PMC6306355 DOI: 10.1016/j.ihj.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/05/2018] [Accepted: 02/28/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This study assessed anxiety and depression in children with permanent pacemakers (PPM) and quality of life of their parents. METHODS Ninety children (63.3% males and 36.6% females) and their parents were included in the study and were divided into three groups. The control group (Group 1) included 30 normal healthy children (57% males and 43% females), the PPM group (Group 2) included 30 age-matched children (70% males and 30% females) with PPM and structurally normal heart, while the Group 3 included 30 children (63% males and 37% females) with PPM and congenital heart disease (PPM+CHD). Psychological assessment of children and their parents was carried out using an interview-based questionnaires. RESULTS Psychiatric disorders were more prevalent in PPM+CHD group including depression (P=0.04), anxiety (P=0.02) and lower parents' QoL (P=0.01). The PPM group had higher depression and lower parents' QoL than the control group. Family income was independent factor for depression (r2=-6.3, with P<0.05). Sex of the child and CCU admission were independent factors for anxiety (r2=-9.5, P<0.05 & r2=10.5, P=0.001) in PPM group. CONCLUSION Children with pacemakers have higher psychiatric disorders and their parents have lower QoL.
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Affiliation(s)
- Lamyaa Elsayed Allam
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Marwa Adel El-Missiry
- Department of Neuro-psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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13
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Lampert R. No Further Question. JACC Clin Electrophysiol 2017; 3:127-128. [DOI: 10.1016/j.jacep.2016.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022]
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Figueroa C, Alcocer L, Ramos B. Psychological Intervention to Modify Anxiety, Depression and Quality of Life in Patients with an Implantable Pacemaker. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/psych.2016.73040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tomzik J, Koltermann KC, Zabel M, Willich SN, Reinhold T. Quality of Life in Patients with an Implantable Cardioverter Defibrillator: A Systematic Review. Front Cardiovasc Med 2015; 2:34. [PMID: 26664905 PMCID: PMC4671346 DOI: 10.3389/fcvm.2015.00034] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/20/2015] [Indexed: 12/02/2022] Open
Abstract
Despite the indisputable mortality advantages of implantable cardioverter defibrillators (ICDs), no consensus exists regarding their impact on quality of life (QoL). This systematic review investigates differences in QoL between patients with ICDs and controls. We systematically searched the MEDLINE, EMBASE, Cochrane, Web of Science, and PsychINFO databases. Articles were included if they were published after the year 2000 and reported on original studies with a control group. Five randomized controlled trials with a total of 5,138 patients and 10 observational studies with a total of 1,513 patients met the inclusion criteria. Nine studies found comparable QoL for ICD recipients and patients in the control groups, three studies found an increased QoL for ICD patients, and three studies found a decreased QoL for ICD patients. The question of whether QoL relates to ICD therapy cannot be answered conclusively due to the heterogeneity of the existing studies. Lower QoL was apparent among patients with an ICD who experienced several device discharges. Medical staff should be particularly aware of the signs of both psychological and physical disorders in these patients. Further investigations on QoL in ICD patients are desirable, but ethical reasons restrict the conduct of randomized trials.
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Affiliation(s)
- Juliane Tomzik
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Katharina C Koltermann
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Markus Zabel
- Department of Cardiology and Pneumology, University of Göttingen , Göttingen , Germany
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin , Berlin , Germany
| | - Thomas Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin , Berlin , Germany
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Manzoni GM, Castelnuovo G, Compare A, Pagnini F, Essebag V, Proietti R. Psychological effects of implantable cardioverter defibrillator shocks. A review of study methods. Front Psychol 2015; 6:39. [PMID: 25698991 PMCID: PMC4316692 DOI: 10.3389/fpsyg.2015.00039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background: The implantable cardioverter defibrillator (ICD) saves lives but clinical experience suggests that it may have detrimental effects on mental health. The ICD shock has been largely blamed as the main offender but empirical evidence is not consistent, perhaps because of methodological differences across studies. Objective: To appraise methodologies of studies that assessed the psychological effects of ICD shock and explore associations between methods and results. Data Sources: A comprehensive search of English articles that were published between 1980 and 30 June 2013 was applied to the following electronic databases: PubMed, EMBASE, NHS HTA database, PsycINFO, Sciencedirect and CINAHL. Review Methods: Only studies testing the effects of ICD shock on psychological and quality of life outcomes were included. Data were extracted according to a PICOS pre-defined sheet including methods and study quality indicators. Results: Fifty-four observational studies and six randomized controlled trials met the inclusion criteria. Multiple differences in methods that were used to test the psychological effects of ICD shock were found across them. No significant association with results was observed. Conclusions: Methodological heterogeneity of study methods is too wide and limits any quantitative attempt to account for the mixed findings. Well-built and standardized research is urgently needed.
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Affiliation(s)
- Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Verbania, Italy ; Department of Psychology, Catholic University of Milan Milano, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Verbania, Italy ; Department of Psychology, Catholic University of Milan Milano, Italy
| | - Angelo Compare
- Department of Psychology, University of Bergamo Bergamo, Italy
| | - Francesco Pagnini
- Department of Psychology, Catholic University of Milan Milano, Italy
| | - Vidal Essebag
- McGill University Health Center Montreal, QC, Canada
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Webster G, Panek KA, Labella M, Taylor GA, Gauvreau K, Cecchin F, Martuscello M, Walsh EP, Berul CI, DeMaso DR. Psychiatric functioning and quality of life in young patients with cardiac rhythm devices. Pediatrics 2014; 133:e964-72. [PMID: 24664095 PMCID: PMC3966499 DOI: 10.1542/peds.2013-1394] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices. METHODS A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years). RESULTS Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population. CONCLUSIONS Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.
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Affiliation(s)
- Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Madelyn Labella
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | | | - Kimberlee Gauvreau
- Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Cecchin
- Division of Cardiology, NYU Langone Medical Center, New York University, New York, New York; and
| | - Maria Martuscello
- Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward P. Walsh
- Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles I. Berul
- Division of Cardiology, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - David R. DeMaso
- Departments of Psychiatry, and,Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW Advanced heart failure (AHF) is an increasingly important field. Both the population of AHF patients and the therapeutic and diagnostic interventions available are expanding, creating a host of difficult ethical challenges. This article discusses these important issues and proposes an approach to caring for AHF patients. RECENT FINDINGS Recent guidelines and clinical trials describe the benefits of costly and invasive therapies for AHF, such as ventricular assist devices and cardiac resynchronization therapy which prolong life and improve symptoms but may create burdens and conflict over deactivation at the end of life. Prognostication, informed consent, and early involvement of palliative care are central to addressing the decision-making challenges raised by these devices. Societal concerns such as cost-effectiveness and distributive justice will play an increasingly important role in the dissemination of these devices. SUMMARY More research, increased end-of-life education, emphasis on advance directives, a more comprehensive informed consent process, and a true multidisciplinary approach are needed to provide optimal care for patients with AHF.
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Lampert R. Is Electricity Useful When the Pump Is Failing? J Am Coll Cardiol 2013; 61:2151-2. [DOI: 10.1016/j.jacc.2013.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
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de Ornelas Maia ACC, Soares-Filho G, Pereira V, Nardi AE, Silva AC. Psychiatric disorders and quality of life in patients with implantable cardioverter defibrillators: a systematic review. Prim Care Companion CNS Disord 2013; 15:PCC.12r01456. [PMID: 23930235 PMCID: PMC3733528 DOI: 10.4088/pcc.12r01456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/16/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To systematically review the literature with regard to psychiatric disorders and quality of life in patients with an implantable cardioverter defibrillator. DATA SOURCES Research was conducted in 3 databases (ISI Web of Science, PubMed, and PsycINFO) using the terms implantable, cardioverter, defibrillator, quality of life, psych *, anxiety, and depression. STUDY SELECTION The search yielded 1,399 references. Non-English and repeated references were excluded. After abstract analysis, 42 references were recovered for full-text reading, and 25 articles were selected for this review. DATA EXTRACTION Research took place in April 2012, and no time restriction was placed on any of the database searches. Review or theoretical articles were excluded, and only clinical trials and epidemiologic studies were selected for this review. RESULTS A systematic review of the literature revealed mostly observational prospective cohort studies followed by cross-sectional observational studies and randomized clinical trials. Few studies included in the review were observational retrospective cohort or case-control studies. There are prominent signs and symptoms of anxiety and depression in patients with an implantable cardioverter defibrillator. Disorders include phobic anxiety, posttraumatic stress disorder, panic disorder, somatoform disorder, agoraphobia, and depression. Quality of life in the physical, social, and psychological domains is affected and is related to the intensity and the frequency of the device's electrical discharge. CONCLUSIONS Work regarding psychiatric comorbidity in patients with an implantable cardioverter defibrillator has shown that anxiety and depression are common. The patients and their families should be informed by their doctors that the presence of the device minimizes risk of sudden death and allows them to have a normal life.
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Affiliation(s)
- Ana Claudia C de Ornelas Maia
- Laboratory of Panic and Respiration, Institute of Psychiatry (Drs Soares-Filho and Silva and Mss Ornelas Maia and Pereira) and National Institute for Science and Technology, Translational Medicine (Drs Nardi and Silva), Federal University of Rio de Janeiro; and National Institute for Science and Technology, Translational Medicine, Federal University Fluminense (Dr Silva), Rio de Janeiro, Brazil
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Lampert R. Quality of Life and End-Of-Life Issues for Older Patients with Implanted Cardiac Rhythm Devices. Clin Geriatr Med 2012; 28:693-702. [DOI: 10.1016/j.cger.2012.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Implantable cardioverter defibrillator shocks are prospective predictors of anxiety. Heart Lung 2012; 42:105-11. [PMID: 23110854 DOI: 10.1016/j.hrtlng.2012.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the temporal contingency of anxiety and implantable cardioverter defibrillator (ICD) therapy (anti-tachycardia-pacing and shocks to prevent ventricular tachycardia and/or fibrillation). BACKGROUND It is under debate whether anxiety is a precursor and/or consequence of ICD-therapy. METHODS In a prospective longitudinal study, fifty-four patients undergoing first-time ICD-implantation were assessed for anxiety, frequency of ICD-shocks and anti-tachycardia-pacing up to two days before ICD-implantation (T0) and twelve months later (T1). RESULTS Anxiety at T0 did not predict frequency of ICD-shocks at T1, but ICD-shocks significantly predicted increased anxiety at T1. In contrast, anxiety at T0 and T1 was unrelated to frequency of anti-tachycardia-pacing. Effects remained stable when we controlled for potentially confounding variables (e.g. age, sex, cardiac health and depression at T0). CONCLUSION Our findings indicate that repeated ICD-shocks are a cause of anxiety in ICD-patients rather than a consequence, thus shock frequency should be minimized.
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Habibović M, Versteeg H, Pelle AJ, Theuns DA, Jordaens L, Pedersen SS. Poor health status and distress in cardiac patients: the role of device therapy vs. underlying heart disease. ACTA ACUST UNITED AC 2012; 15:355-61. [DOI: 10.1093/europace/eus295] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: a systematic review. J Psychosom Res 2011; 71:223-31. [PMID: 21911099 DOI: 10.1016/j.jpsychores.2011.02.014] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/08/2011] [Accepted: 02/09/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The implantable cardioverter defibrillator (ICD) is used to treat life-threatening ventricular arrhythmias and in the prevention of sudden cardiac death. A significant proportion of ICD patients experience psychological symptoms including anxiety, depression or both, which in turn can impact adjustment to the device. The objective of this systematic review was to assess the prevalence of anxiety and depression or symptoms of anxiety and depression among adults with ICDs. METHODS Search of MEDLINE®, CINAHL®, PsycINFO®, EMBASE® and Cochrane® for English-language articles published through 2009 that used validated diagnostic interviews to diagnose anxiety or depression or self-report questionnaires to assess symptoms of anxiety or depression in adults with an ICD. RESULTS Forty-five studies that assessed over 5000 patients were included. Between 11% and 28% of patients had a depressive disorder and 11-26% had an anxiety disorder in 3 small studies (Ns=35-90) that used validated diagnostic interviews. Rates of elevated symptoms of anxiety (8-63%) and depression (5-41%) based on self-report questionnaires ranged widely across studies and times of assessment. Evidence was inconsistent on rates pre- versus post-implantation, rates over time, rates for primary versus secondary prevention, and for shocked versus non-shocked patients. CONCLUSION Larger studies utilizing structured interviews are needed to determine the prevalence of anxiety and depression among ICD patients and factors that may influence rates of anxiety and depressive disorders. Based on existing data, it may be appropriate to assume a 20% prevalence rate for both depressive and anxiety disorders post-ICD implant, a rate similar to that in other cardiac populations.
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Bostwick JM, Sola CL. An Updated Review of Implantable Cardioverter/Defibrillators, Induced Anxiety, and Quality of Life. Heart Fail Clin 2011; 7:101-8. [DOI: 10.1016/j.hfc.2010.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Anxiety and Depression in Implanted Cardioverter-Defibrillator Recipients and Heart Failure: A Review. Heart Fail Clin 2011; 7:59-68. [DOI: 10.1016/j.hfc.2010.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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PEDERSEN SUSANNES, VAN DEN BROEK KRISTAC, VAN DEN BERG MARTHA, THEUNS DOMINICAMJ. Shock as a Determinant of Poor Patient-Centered Outcomes in Implantable Cardioverter Defibrillator Patients: Is There More to It Than Meets the Eye? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1430-6. [DOI: 10.1111/j.1540-8159.2010.02845.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Tagney J. A literature review comparing the experiences and emergent needs of adult patients with permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs). J Clin Nurs 2010; 19:2081-9. [DOI: 10.1111/j.1365-2702.2009.03031.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Carneiro AF, Telles Mathias LAS, Rassi Júnior A, de Morais NS, Gozzani JL, de Miranda AP. Evaluation Of Preoperative Anxiety And Depression In Patients Undergoing Invasive Cardiac Procedures. Rev Bras Anestesiol 2009; 59:431-8. [DOI: 10.1590/s0034-70942009000400005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 04/08/2009] [Indexed: 11/22/2022] Open
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Cognitive and behavioral treatments for anxiety and depression in a patient with an implantable cardioverter defibrillator (ICD): a case report and clinical discussion. J Clin Psychol Med Settings 2009; 16:270-9. [PMID: 19404725 DOI: 10.1007/s10880-009-9160-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 03/17/2009] [Indexed: 10/20/2022]
Abstract
Implantable cardioverter-defibrillators (ICDs) are the treatment of choice for patients at risk for potentially life threatening arrhythmias. The associated stress of living with an implanted device and receiving ICD shock therapy has been noted to exert a psychological toll on the individual patient and family. Anxious and depressive symptomatology is frequently reported by these patients, thus creating a demand for tailored psychological interventions for this population. The current case report describes the components, delivery, and effectiveness of a targeted treatment approach for anxiety and depression in an individual with an ICD. Test results and interview data revealed significant improvements in multiple domains of cognitive, emotional, and behavioral functioning. Improvements in marital relations were also achieved. These treatment effects were maintained at follow-up and in the context of acute, medical stressors. Future clinical and research directions are also discussed.
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Kelley AS, Reid MC, Miller DH, Fins JJ, Lachs MS. Implantable cardioverter-defibrillator deactivation at the end of life: a physician survey. Am Heart J 2009; 157:702-8.e1. [PMID: 19332199 DOI: 10.1016/j.ahj.2008.12.011] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 12/10/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among older adults, implantable cardioverter-defibrillator (ICD) use is increasing. ICD shocks can occur at end of life (EOL) and cause substantial distress, warranting consideration of ICD deactivation discussions. This nationwide physician survey sought to (1) determine if physicians discuss ICD deactivation at the EOL, (2) identify predictors of those discussions, and (3) ascertain physicians' knowledge/attitudes about ICD use. METHODS We surveyed 4,876 physicians stratified by specialty (cardiologists, electrophysiologists, general internists, and geriatricians). The mailed survey presented 5 vignettes (eg, end-stage chronic obstructive pulmonary disease, advanced dementia) wherein ICD deactivation might be considered and 17 Likert-scaled items. RESULTS Five hundred fifty-eight (12%) physicians returned surveys. Respondents were largely men (77%) and white (69%). Most physicians (56%-83%) said they would initiate deactivation discussions in all 5 vignettes, whereas significantly more (82%-94%) would discuss advance directives and do not resuscitate status. In logistic regression analyses, a history of prior deactivation discussions was an independent predictor of willingness to discuss deactivation (adjusted OR range, 2.8-8.8) in 4 of the 5 vignettes. General internists and geriatricians were less likely than electrophysiologists to agree that ICD shocks are painful and to distinguish between the ICD's pacing and defibrillator functions. Finally, most physicians believed that informed consent for ICD implantation should include information about deactivation (77%) and endorsed the need for expert guidance in this area (58%). CONCLUSIONS Most physicians would discuss ICD deactivation at EOL. The strongest predictor of this was a history of prior discussions. Knowledge about ICDs varies by specialty, and most expressed a desire for more expert guidance about ICD management at EOL.
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Birnie DH, Sears SF, Green MS, Lemery R, Gollob MH, Amyotte B. No long-term psychological morbidity living with an implantable cardioverter defibrillator under advisory: the Medtronic Marquis experience. Europace 2008; 11:26-30. [DOI: 10.1093/europace/eun317] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kelley AS, Mehta SS, Reid MC. Management of patients with ICDs at the end of life (EOL): a qualitative study. Am J Hosp Palliat Care 2008; 25:440-6. [PMID: 18812618 DOI: 10.1177/1049909108320885] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Implantable cardioverter defibrillator shocks at the end of life are distressing and warrant consideration of implantable cardioverter defibrillator deactivation discussions. A nationwide survey collected physicians' comments regarding such discussions. METHODS Vignettes ascertained respondents' practices regarding implantable cardioverter defibrillator deactivation discussions. Respondents' comments were analyzed to identify themes. RESULTS About 177 respondents (32%) provided 310 comments. One third reported that initiating the discussion would depend on specific circumstances, such as do not resuscitate status (35%); 21% advocated life-prolonging therapies; 17% said the patient/family or another physician should initiate the discussion; and 9% expressed inadequate education/awareness about implantable cardioverter defibrillator functions. Geriatricians and general internists expressed inadequate knowledge most frequently (12 writers, 75% in this theme), while electrophysiologists most frequently suggested further treatments/procedures (22 writers, 58%), and another doctor (13 writers, 76%) or the patient (8 writers, 62%) should begin the discussion. CONCLUSIONS Improving the end of life care for patients with implantable cardioverter defibrillators will require additional physician education and increased commitment by subspecialists to deactivation discussions.
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Affiliation(s)
- Amy S Kelley
- Division of General Internal Medicine, University of California-Los Angeles, Los Angeles, CA 90095, USA.
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Bostwick JM, Sola CL. An updated review of implantable cardioverter/defibrillators, induced anxiety, and quality of life. Psychiatr Clin North Am 2007; 30:677-88. [PMID: 17938040 DOI: 10.1016/j.psc.2007.07.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
During the past 2 years the number of studies examining psychopathology and quality of life after ICD implantation has increased dramatically. Variables assessed have included recipient age, gender, and social support network. How recipients respond to having the device, particularly after experiencing firing, has been evaluated in light of new depression and anxiety disorder diagnoses as well as premorbid personality structure. Now the picture of what is known is, if anything, cloudier than it was 2 years ago, with little definitive and much contradictory data emerging in most of these categories. It still seems clear that in a significant minority of ICD recipients the device negatively affects quality of life, probably more so if it fires. Education about life with the device before receiving it remains paramount. Reports continue to appear of patients developing new-onset diagnosable anxiety disorders such as panic and posttraumatic stress disorder. Until recently the strongest predictors of induced psychopathology were considered to be the frequency and recency of device firing. It now seems that preimplantation psychologic variables such as degree of optimism or pessimism and an anxious personality style may confer an even greater risk than previously thought. Certainly many variables factor into the induction of psychopathology in these patients. Among these factors are age, gender, and perception of control of shocks, as well as the predictability of shocks and psychologic attributions made by the patient regarding the device. Another source of variability is this population's medical heterogeneity. Some patients receive ICDs after near-death experiences; others get them as anticipatory prophylaxis. Some have longstanding and entrenched heart disease; others were apparently healthy before sudden dangerous arrhythmias. Diagnoses as diverse as myocardial infarction in the context of advanced coronary artery disease and dilated cardiomyopathy after acute viral infection may warrant ICD placement. Moreover the course of cardiac disease after ICD placement may vary from relative stability to continuing disease progression and severe functional compromise. Unless these and other pre- and postimplantation differences are taken into account, it is almost impossible to make meaningful comparisons between studies. Ideally, future research would consist either of large-scale, randomized, prospective studies using validated structured-interview tools to supplement a literature dominated by self-report measures, unstructured assessments, and anecdotal reports, or of smaller studies designed to focus on particular diagnostic subsets. As ICDs become the standard of care for potentially life-threatening arrhythmias, the rate of implantations continues to increase. Because negative emotions have been linked to an increased incidence of arrhythmias, and untreated or unrecognized psychiatric illness can interfere with adaptation to an ICD, assessing and managing both pre-existing and induced psychiatric disorders becomes even more critical. Greater research attention should be paid to determining which patients meet criteria for anxiety disorders before and after implantation and what premorbid traits predispose to postimplantation psychopathology. The authors predict that psychiatrists will be involved increasingly in caring for this population, offering insights into treatment options that increase the likelihood of successful ICD acceptance and decrease the psychosocial costs of these devices.
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Affiliation(s)
- J Michael Bostwick
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Crössmann A, Pauli P, Dengler W, Kühlkamp V, Wiedemann G. Stability and cause of anxiety in patients with an implantable cardioverter-defibrillator: A longitudinal two-year follow-up. Heart Lung 2007; 36:87-95. [PMID: 17362789 DOI: 10.1016/j.hrtlng.2006.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 08/07/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Several investigations have found that anxiety disorders often develop in patients with an implantable cardioverter-defibrillator (ICD). This study investigated the inter--and intraindividual stability of anxiety and its relation to ICD activity in patients with an ICD. METHODS Changes in the psychopathology of 35 patients with an ICD were assessed at the beginning of the trial period and 2.5 years later. Psychometric measures of anxiety were collected. During this period, shocks and antitachycardia pacing were assessed. RESULTS Anxiety was found to be interindividually stable. We also found a slight, but statistically significant, reduction in trait anxiety and avoidance behavior over time. Patients who experienced shocks or antitachycardia pacing did not differ on psychometric or demographic variables from patients without those events. CONCLUSIONS Anxiety seems to be interindividually stable in patients with an ICD. We found no connection between anxiety and tachycardia episodes in patients with an ICD.
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Newall EG, Lever NA, Prasad S, Hornabrook C, Larsen PD. Psychological implications of ICD implantation in a New Zealand population. ACTA ACUST UNITED AC 2007; 9:20-4. [PMID: 17224417 DOI: 10.1093/europace/eul142] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Previous studies have raised concerns about high levels of anxiety and depression in implanted cardioverter-defibrillator patients, and suggested that adverse psychological outcomes have been related to delivered therapy, age, and gender. This study aimed to assess the prevalence of anxiety and depression and to analyse quality-of-life in a New Zealand patient group. METHODS AND RESULTS We questioned 46 ICD and 49 pacemaker patients regarding device and treatment satisfaction, depression, anxiety (Hospital Anxiety and Depression Scale), and quality-of-life (SF 36). The prevalence of clinical depression and anxiety in the ICD group was 7 and 13%, respectively, and did not differ from the pacemaker group. ICD patients mean anxiety and depression scores did not differ from the pacemaker group, although more ICD patients had subclinical levels of anxiety. Quality-of-life scores were normal for all ICD patients with respect to both mental and physical component scores, and not different from the pacemaker group. Anxiety, depression, and quality-of-life scores were unrelated to time from implantation, delivered therapy, age, or gender. Overall, 93% of the ICD patients thought their device was worthwhile. CONCLUSION We found a lower than expected level of anxiety and depression in ICD patients, and suggest that this may be due in part to the small team approach adopted locally in the follow-up of this patient group.
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Affiliation(s)
- E G Newall
- Department of Surgery and Anaesthesia, Wellington School of Medicine, Wellington, New Zealand
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Cuculi F, Herzig W, Kobza R, Erne P. Psychological Distress in Patients with ICD Recall. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:1261-5. [PMID: 17100681 DOI: 10.1111/j.1540-8159.2006.00523.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple clinical trials have shown that a properly functioning implantable cardioverter-defibrillator (ICD) is capable of interrupting sudden death caused by ventricular tachyarrhythmias. However, ICDs are complex medical devices, and they do not always perform as expected or they may fail completely. Exposure of ICD recipients to professional or media reports that their specific device type is potentially malfunctioning could negatively influence their psychological status. METHODS This study aimed to evaluate and quantify psychological distress in patients implanted with an ICD-recall device. Thirty patients implanted with ICD-recall devices (ICD-recall group) and 25 patients with unaffected ICD devices (ICD-control group) were interviewed using the Brief Symptom Inventory (a psychological self-report symptom scale). RESULTS Mean values of all primary psychiatric distress symptom dimensions and global indices were within the normal range for both the ICD-recall and the ICD-control group. New York Heart Association (NYHA)class was a predictor of higher distress symptoms in all categories, independently of the ICD group. NYHA II group patients tended toward higher stress levels than the NYHA I group, but only somatization was significantly different. An upward, but not significant, trend in 7 of the 12 scales was associated with symptomatic shock experience. CONCLUSION This study demonstrates that psychological distress was not significantly increased in patients recently informed about a potential malfunction of their device.
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Affiliation(s)
- Florim Cuculi
- Department of Cardiology, Kantonsspital Luzern, Switzerland
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