Living with life-saving technology - coping strategies in implantable cardioverter defibrillators recipients

Global Prevalence of Anxiety in Adult Cardiology Outpatients: A Systematic Review and Meta-analysis

Anxiety and anxiety disorders are associated with adverse cardiovascular outcomes, and reduced quality of life. Despite this, no comprehensive study on the global prevalence of anxiety symptoms and disorders among adult cardiology outpatients exists. This systematic review and meta-analysis aims to provide cardiologists with a precise estimate of the prevalence of anxiety in their outpatient clinics. PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched from database inception to January 23, 2023. Data characteristics were extracted independently by 2 investigators. Ninety-three studies, n = 36,687 participants across 31 countries, were included. Global prevalence of anxiety symptoms/disorders was 28.9% (95%CI 25.7-32.4; 8927/36, 687; I2 = 97.33; n = 93). The highest rates were found in patients presenting with hypertension, 43.6%. Subgroup analyses revealed higher prevalence estimates when using self-report screening compared to gold-standard diagnostic interview. When using diagnostic interview, the highest rates were reported in outpatients with undifferentiated chest pain/palpitations, 19·0%. Panic disorder was the most frequent diagnosis 15.3%, and rates were significantly higher in patients with undifferentiated chest pain/palpitations compared to ischemic heart disease. Higher rates of anxiety were found in studies of outpatients from developing countries, and female outpatients tended to have higher rates compared to males. Anxiety occurred frequently among cardiology outpatients and at a higher rate than estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective identification and management strategies be developed to support cardiologists in identifying and treating these conditions in their clinics.

The Quality of Life in Patients With Implantable Cardiac Devices: A Single-Center Cross-Sectional Study

Background Cardiovascular diseases (CVDs) and their complications are one of the most common causes of death worldwide. Implantable cardiac assistive devices (CADs) play a significant role in preventing dreadful outcomes, and the complication rate of these implanting procedures is minimal. These cardiac devices require some adaptation and could affect the patients' quality of life psychosocially and financially. This study is aimed to identify the impact of implantable cardiac assistive devices on patients' quality of life in the National Guard Hospital, Jeddah, Saudi Arabia. Methods This is an observational cross-sectional questionnaire-based study. It was conducted on patients who underwent cardiac assistive device implantation in National Guard Hospital. The patients were interviewed face-to-face and were requested to fill the Implanted Device Adjustment Scale (IDAS). Descriptive statistics were carried out. Chi-square test for independence was conducted to examine the associations between qualitative variables with the level of significance was taken as p-value <0.05. Results There was a statistically significant association between IDAS score and gender (p=0.03), monthly income (p=0.009), and type of cardiac implantation device (p=0.041). Females with an implantable cardiac defibrillator (ICD) and individuals with low socioeconomic status reported alongside divorced participants have higher IDAS scores, which correlates to worse adjustment. However, most of our patients scored 21-50 in IDAS score, which indicates a mild psychosocial effect after the cardiac assistive device implantation. Conclusion This study confirmed that most individuals adjust positively to implanted devices. It showed a significant association of gender, type of device, monthly income, and duration. Attention must be drawn to females and divorced patients in regards to psychological and emotional support.

Implementation, feasibility, and acceptability of quality of life therapy to improve positive emotions among patients with implantable cardioverter defibrillators

Implantable cardioverter defibrillators (ICDs) save lives, but often induce significant psychological distress among patients. Positive psychological constructs are associated with improved outcomes among cardiac patients. In this NHLBI-funded randomized controlled trial, one aim was to evaluate the feasibility and acceptability of a positive psychology intervention (Quality of Life Therapy; QOLT, n = 11), compared to a Heart Healthy Education (HHE) control (n = 10), among ICD patients. A majority of participants across groups attended all 12 sessions (71%) and completed homework assignments (80%). Agreement on participant engagement and interventionist protocol adherence were high, with no differences between groups (ps > 0.20). A greater proportion of QOLT participants rated their sessions was "very" helpful compared to HHE participants (63% vs. 10%, p = 0.19). These initial data support the feasibility and acceptability of QOLT. A larger-scale trial using positive psychology interventions among ICD patients is indicated to determine potential mechanisms underlying the relationship between positive psychological constructs and cardiovascular health.

Living at the boundary between life and death: A qualitative study of how patients' lives are impacted by the implantable cardioverter defibrillator

AIMS

To examine the effect on patients' lives of implantable cardioverter defibrillator implantation and their experiences of worry about death.

DESIGN

A descriptive phenomenological design.

METHODS

Participants with implantable cardioverter defibrillators were recruited through purposive sampling with maximum variation in Antalya, Turkey. Data collection included individual semi-structured interviews conducted between September 2018 - May 2019. Interviews were audio recorded, transcribed verbatim, and analysed by Giorgi's descriptive phenomenology method.

RESULTS

Twenty-six individuals with implantable cardioverter defibrillators participated in the study. Analysis of the data resulted in three themes and 10 subthemes. The first theme was the physical impact of the device on the body with the subthemes changes in physical functioning and like part of the body; the second theme was social impact in daily life and adaptation to restrictions with the subthemes necessary for life, restrictive behaviours of day-to-day life and Seeking social support and the third theme was the emotional impact of the experience of shock and worry about death with the subthemes inevitable truth, living at the boundary, every shock is like you are going to die, advancing on an uncertain path, and trust in life insurance.

CONCLUSION

It was found in this study that the implantation of implantable cardioverter defibrillators affected patients physically, socially, and emotionally in many ways. It is thought that this study will raise the awareness of health professionals and will support a holistic approach, increasing the quality of care.

IMPACT

Although the implantation of the cardioverter defibrillator is greatly effective in protecting against sudden cardiac death, for patients it brings with it many physical, social, and emotional problems. This study can contribute to health professionals planning individual education in coping with changes, an increase in group-based counselling to support the sharing of experience, social networks, and monitoring programs to improve care.

"Those Plates That Save Me": Experiences of Italian Patients With Implantable Cardioverter Defibrillator

This study aimed to investigate and understand the experiences and feelings lived by people with an ICD. Qualitative study, semi-structured interviews were conducted with a sample of 16 patients, during the annual follow-up. A hermeneutical analysis of the interviews was carried out to identify the themes. Four main themes were classified: "My heart falls asleep," highlighting a reduced awareness of the pathology and ICD installation; "But what is this thing. . .?" underlining the lack of information and fears related to the device and its functioning; "I cannot hug the microwave" which describes the changes brought about by the surgery; "And with this one I am alright for the rest of my life", involving hopes and life expectations. This study highlighted the patients' need for major support from health professionals while processing their new life conditions.

Optimism as predictor of patient-reported outcomes in patients with an implantable cardioverter defibrillator (data from the WEBCARE study)

OBJECTIVE

The implantable cardioverter defibrillator (ICD) is the treatment of choice for prevention of sudden cardiac death. However, a subgroup of ICD patients experiences psychological adjustment problems post implant. To date, positive psychological constructs (e.g. optimism) have been understudied in this population. Hence, we examined the association between optimism and anxiety, depression, and health status at 12-months post implant.

METHODS

Patients (N=171) enrolled in the WEB-based distress management study for ICD patients were included in the analyses. Optimism and pessimism (LOT), and Type D personality (DS14) were administered at baseline, while anxiety (GAD-7), depression (PHQ-9), and health status (SF-12) were assessed at 12-months.

RESULTS

The mean age was 59.6±10.06 with 81% being male. After controlling for demographic, personality, and clinical variables, baseline optimism was associated with lower anxiety (β=-0.210; p=0.011) and depression (β=-0.222; p=0.005), and better physical (β=0.227; p=0.004) and mental health status (β=0.350; p=0.000) at follow-up. Optimism was also associated with change in mental health status (β=0.195; p=0.007) but not with change in anxiety, depression, and physical health status at follow-up.

CONCLUSIONS

Our findings indicate that optimism is associated with less distress and possibly helps safeguard mental health in ICD patients. Increase optimism might be the way forward to reduce long-term distress and impaired health status.

TRIAL REGISTRATION

http://www.ClinicalTrials.gov. Identifier: NCT00895700.

Living with hypertrophic cardiomyopathy and an implantable defibrillator

BACKGROUND

ICDs efficiently terminate life-threatening arrhythmias, but complications occur during long-term follow-up. Patients' own perspective is largely unknown. The aim of the study was to describe experiences of hypertrophic cardiomyopathy (HCM) patients with implantable defibrillators (ICDs).

METHODS

We analyzed 26 Swedish patient interviews using hermeneutics and latent content analysis.

RESULTS

Patients (aged 27-76 years) were limited by HCM especially if it deteriorates into heart failure. The ICD implies safety, gratitude, and is accepted as a part of the body even when inappropriate ICD shocks are encountered. Nobody regretted the implant. Both the disease and the ICD affected professional life and leisure time activities, especially at younger ages. Family support was usually strong, but sometimes resulted in overprotection, whereas health care focused on medical issues. Despite limitations, patients adapted, accepted, and managed challenges.

CONCLUSION

HCM patients with ICDs reported good spirit and hope even though they had to adapt and accept limitations over time.

Perceptions and experiences of patients living with implantable cardioverter defibrillators: a systematic review and meta-synthesis

Background

Sudden cardiac deaths have become a growing major public health concern that affects the world. Despite the various etiologies, life-threatening cardiac arrhythmias attribute the main cause of sudden cardiac deaths. Therefore in certain groups of high-risk patients, the Implantable Cardioverter Defibrillator (ICD) has been recommended as either a secondary or primary prophylactic method of prevention.

Objective

To summarise the perceptions of ICD recipients and provide an overview of their experiences with regards to the quality of life, coping strategies, and learning needs.

Methods

A systematic search was conducted using CINAHL, MEDLINE, PsycINFO, Scopus, Cochrane Library, and Web of Science. Primary research articles published from January 2005 to January 2016 that met the inclusion criteria were selected and assessed for methodological quality.

Results

Thirty-nine articles consisting of 16 qualitative studies, 22 quantitative studies, and 1 mixed methods study were included for the meta-synthesis. Findings extracted from these studies were grouped into eight subthemes with ‘living the ICD experience: a constant process of redefining oneself’ emerging as an over-arching theme.

Conclusion

This review provides insight into the perspectives and experiences of ICD recipients. Current evidence highlights the need for healthcare professionals to improve future care standards and develop a patient-centric holistic program that meets the specific needs of ICD recipients. Moreover, future studies are required to address the research gaps identified and also explore the perceptions of patients living with ICD in the Asian context.

The Challenges of Living With an Implantable Cardioverter Defibrillator: A Qualitative Study

BACKGROUND

Dysrhythmia is one of the most common causes of sudden cardiac death worldwide. An implantable cardioverter defibrillator is the most effective method of treatment for dysrhythmias causing cardiac arrest. However, living with an implantable cardioverter defibrillator is associated with challenges such as fear, anxiety, and depression.

OBJECTIVES

The purpose of this study was to identify the challenges of living with an implantable cardioverter defibrillator.

PATIENTS AND METHODS

In this qualitative study, an interpretive phenomenological approach was used, with thirteen participants (seven men and six women) between the ages of 21 and 70 years old (mean = 58.15, SD = 14.4). The duration of having an implantable cardioverter defibrillator was 1 - 120 months (mean = 23.15, SD = 33.31). Maximum variation sampling was used to purposefully select the participants from the governmental Imam Khomeini hospital in Tehran, Iran, between May and October of 2013. Semi-structured interviews were conducted for 30 to 45 minutes, and Van Manen's six-step method was used in this study.

RESULTS

The challenges of living with an implantable cardioverter defibrillator include: living with fear, concerns about the future, concerns about device malfunction, fearing death during the shock, pain due to the shock, loss of control, the cost of the device, and the lifestyle limitations.

CONCLUSIONS

Patients who live with implantable cardioverter defibrillators face many concerns and challenges. Therefore, the role of nurses in teaching patients before and after implementation is very important.

Perceptions of an implantable cardioverter-defibrillator: A qualitative study of families with a history of sudden life-threatening cardiac events and recommendations to improve care

OBJECTIVE

To identify major concerns associated with implantable cardioverter-defibrillators (ICDs) and to provide recommendations to adult and pediatric physicians involved in the care of patients with ICDs.

BACKGROUND

Cardiac ion channelopathies are a well-recognized cause of sudden cardiac death in infants, children, adolescents, and young adults. ICDs are effective in preventing sudden death from fatal arrhythmias in patients with known cardiac channelopathies. There is a paucity of research on the effect of ICDs on quality of life in patients with cardiac channelopathy diagnoses, especially young patients.

METHODS

A qualitative study interviewing patients and families affected by inherited arrhythmias was conducted. Fifty participants with personal or family histories of cardiac events or sudden death were interviewed individually or in focus groups by clinical psychologists. All interviews were transcribed verbatim and then analyzed and coded based on current qualitative research theory to identify themes related to the research question. Twenty-four participants discussed ICDs in their interviews.

RESULTS

Participants reported concerns about ICDs, and these concerns were categorized into six themes: (1) comprehension and physician-patient communication; (2) anxiety; (3) restrictions and fallacies; (4) complications; (5) utility; and (6) alternative therapy. Participants noted communication breakdowns between providers and their colleagues, and between providers and their patients. Participants and their families experienced many different forms of anxiety, including worry about the aesthetics of the ICDs and fears of being shocked. Multiple restrictions, fallacies, and complications were also cited.

CONCLUSION

Interview themes were used to formulate recommendations for counseling and educating patients with ICDs.

A psychometric evaluation of the four-item version of the Control Attitudes Scale for patients with cardiac disease and their partners

BACKGROUND

The four-item Control Attitudes Scale (CAS) was developed to measure control perceived by patients with cardiac disease and their family members, but extensive psychometric evaluation has not been performed.

OBJECTIVE

The aim was to translate, culturally adapt and psychometrically evaluate the CAS in a Swedish sample of implantable cardioverter defibrillator (ICD) recipients, heart failure (HF) patients and their partners.

METHODS

A sample (n=391) of ICD recipients, HF patients and partners were used. Descriptive statistics, item-total and inter-item correlations, exploratory factor analysis, ordinal regression modelling and Cronbach's alpha were used to validate the CAS.

RESULTS

The findings from the factor analyses revealed that the CAS is a multidimensional scale including two factors, Control and Helplessness. The internal consistency was satisfactory for all scales (α=0.74-0.85), except the family version total scale (α=0.62). No differential item functioning was detected which implies that the CAS can be used to make invariant comparisons between groups of different age and sex.

CONCLUSIONS

The psychometric properties, together with the simple and short format of the CAS, make it to a useful tool for measuring perceived control among patients with cardiac diseases and their family members. When using the CAS, subscale scores should be preferred.