Aerobic Exercise Effects on Quality of Life and Psychological Distress After an Implantable Cardioverter Defibrillator

Association Between Adherence to a 3-Month Cardiac Rehabilitation Program and Long-Term Clinical Outcomes in Japanese Patients With Cardiac Implantable Electronic Devices

PURPOSE

The objective of this study was to evaluate the association between comprehensive cardiac rehabilitation (CCR) completion and long-term clinical outcomes in patients with cardiac implantable electronic devices (CIED).

METHODS

This retrospective cohort study included 834 patients with CIED who participated in CCR, which included a cardiopulmonary exercise test or 6-min walk test. Patients with a left ventricular ejection fraction ≤40%, predicted peak oxygen uptake ≤80%, or B-type natriuretic peptide level ≥80 pg/mL were eligible. The primary outcome was all-cause mortality.

RESULTS

After excluding 241 patients with duplicate records and 69 who underwent CCR in the outpatient department, the data of 524 patients were analyzed. Mean age was 64 ± 15 yr, 389 (74%) patients were men, left ventricular ejection fraction was 31 ± 15%, and 282 (54%) patients had a history of hospitalization for worsening heart failure. Of the patients referred for CCR, 294 (56%) completed the program, and an additional 230 patients started but did not complete CCR. Over a 3.7-yr median follow-up period, all-cause mortality occurred in 156 (30%) patients. Completers had lower all-cause mortality rates than non-completers (log-rank 15.77, P < .001). After adjusting for prognostic baseline characteristics, completers had 58% lower all-cause mortality risks than non-completers (HR = 0.42; 95% CI, 0.27-0.64, P < .001).

CONCLUSIONS

Three-mo CCR program completion was associated with lower mortality risks in patients with CIED. New programs or management methods are needed to decrease mortality risks, especially for those who cannot complete CCR programs.

Psychological factors associated with exercise self-efficacy in the recipients of an implantable cardioverter defibrillator

BACKGROUND

Insufficient exercise affects the health of patients who have implantable cardioverter defibrillators (ICD). The purpose of this study was to investigate the correlations between exercise self-efficacy (ESE) and its associated psychological factors in ICD recipients.

METHODS

This cross-sectional study included individuals who had undergone ICD implantation at the cardiology department of a medical centre in Taiwan. A face-to-face survey was conducted. The survey questionnaire included questions regarding the participants' demographics, perceived health (PH), ICD shock-related anxiety (ICD-SRA), self-care self-efficacy (SSE), perceived exercise benefit (PE-benefit), perceived exercise barrier (PE-barrier), and ESE. Data were analysed using SPSS 20.0 Software. Stepwise multiple regression analyses were also performed to evaluate the predictive effects of the aforementioned factors on ESE.

RESULTS

A total of 52 ICD recipients were enrolled. ESE was negatively correlated with ICD-SRA (r = -0.511; p < 0.01) and PE-barrier (r = -0.563; p < 0.01), but positively correlated with SSE (r = 0.339; p < 0.05) and PE-benefit (r = 0.464; p < 0.01). The stepwise multiple regression analysis revealed that PE-barrier, PE-benefit, and ICD-SRA effectively predicted ESE in the participants.

CONCLUSIONS

ESE may be improved by overcoming PE-barrier, ICD-SRA and enhancing PE-benefit. Consequently, improving ESE may enhance the health benefits of exercise.

Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients

AIMS

Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time.

METHODS

Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria.

RESULTS

Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges' g = 0.39 (95%CI 0.15-0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges' g = 0.13 (95%CI 0.03-0.23)] and anxiety symptoms after 6 months [Hedges' g = 0.07 (95%CI 0-0.14)].

CONCLUSION

Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.

Review of Recent Cardiac Rehabilitation Research Related to Enrollment/Adherence, Mental Health, and Other Populations

This review overviews three topic areas observed to be highly active in the cardiac rehabilitation (CR) research literature published in 2019 and 2020. Topics summarized were enrollment or adherence in CR programs; mental health, particularly depression, stress, and anxiety of patients participating in CR programs; and patients participating in CR programs with diagnoses other than coronary artery bypass graft, myocardial infarction, or percutaneous coronary interventions.

Impact of the COVID-19 lockdown on the arrhythmic burden of patients with implantable cardioverter-defibrillators

BACKGROUND

In Italy, a nationwide full lockdown was declared between March and May 2020 to hinder the novel coronavirus disease 2019 (COVID-19) pandemic. The potential individual health effects of long-term isolation are largely unknown. The current study investigated the arrhythmic consequences of the COVID-19 lockdown in patients with defibrillators (ICDs) living in the province of Ferrara, Italy.

METHODS

Both the arrhythmias and the delivered ICD therapies as notified by the devices were prospectively collected during the lockdown period (P1) and compared to those occurred during the 10 weeks before the lockdown began (P2) and during the same period in 2019 (P3). Changes in outcome over the three study periods were evaluated for significance using McNemar's test.

RESULTS

A total of 413 patients were included in the analysis. No differences were found concerning either arrhythmias or shocks or anti-tachycardia pacing. Only the number of patients experiencing non-sustained ventricular tachycardias (NSVTs) during P1 significantly decreased as compared to P2 (p = 0.026) and P3 (p = 0.009). The subgroup analysis showed a significant decrease in NSVTs during P1 for men (vs. P2, p = 0.014; vs. P3, p = 0.040) and younger patients (vs. P2, p = 0.002; vs. P3, p = 0.040) and for ischemic etiology (vs. P2, p = 0.003). No arrhythmic deaths occurred during P1.

CONCLUSIONS

The complete nationwide lockdown, as declared by the Italian government during the first COVID-19 pandemic peak, did not impact on the incidence of arrhythmias in an urban cohort of patients with ICDs.

Comparison of depression and anxiety among pacemaker and implantable cardioverter-defibrillator recipients: A cross-sectional study

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.

Exploration and Practice of Maker Education Mode in Innovation and Entrepreneurship Education

This study was conducted with the purpose of exploring the impact of positive entrepreneurial psychological quality in innovation and entrepreneurship education, as well as the development of maker education in colleges and universities. The questionnaire survey method – The Positive Mental Characters Scale for Chinese College Students – and the SPSS 26.0 mathematical statistical analysis software were adopted to analyze and characterize the development of innovation and entrepreneurship education in colleges and universities, as well as the practice of maker education. The results show that there are differences in the factors that affect the positive entrepreneurial psychological quality of college students studying different majors in the liberal arts and sciences. Family economy has the most obvious impact on liberal arts students, sports activities have the most obvious impact on science students, has and grades have the most obvious impact on engineering students; the average score of college students’ innovation and entrepreneurship ability is around 3.0, showing that the overall innovation and creativity ability is general. Furthermore, there are differences in the development of the maker education model between the eastern and western universities. Overall, the maker faculty of eastern universities are more complete, with a larger number of professors, associate seniors, and intermediate teachers. In addition, the investigation on the positive entrepreneurial psychological quality shows a positive effect on cultivating students’ healthy entrepreneurial quality as well as promoting the development and practice of maker education.

Impact of COVID-19 Pandemic on Physical Activity in Patients With Implantable Cardioverter-Defibrillators

The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, reduced opportunities to perform physical activity. This study quantified an abrupt and statistically significant reduction by 25% of physical activity in patients with implantable defibrillators, during the forced 40-d in-home confinement.

The coronavirus disease-2019 (COVID-19) pandemic has been spreading rapidly worldwide since late January 2020. The strict lockdown strategy prompted by the Italian government, to hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) spreading, has reduced the possibility of performing either outdoor or gym physical activity (PA). This study investigated and quantified the reduction of PA in patients with automatic implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death.