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Pedersen SS, Wehberg S, Nielsen JC, Riahi S, Larroudé C, Philbert BT, Johansen JB. Patients with an implantable cardioverter defibrillator at risk of poorer psychological health during 24 months of follow-up (results from the Danish national DEFIB-WOMEN study). Gen Hosp Psychiatry 2023; 80:54-61. [PMID: 36638700 DOI: 10.1016/j.genhosppsych.2022.12.006] [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] [Received: 09/03/2022] [Revised: 12/21/2022] [Accepted: 12/26/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Identify implantable cardioverter defibrillator (ICD) patients at risk of distress (i.e., depression, anxiety, and ICD concerns) and associated risk factors. METHOD First-time ICD patients (n = 1503) from the Danish national DEFIB-WOMEN study completed questionnaires at baseline, 3, 6, 12 and 24 months. RESULTS Of patients with low scores on distress, only 4%-7.2% experienced an increase in distress during 24 months of follow-up (FU), while 30.5%-52.5% with increased levels were likely to maintain increased levels at FU. Higher education, higher age, female sex, and good physical functioning at baseline were associated with less depression, anxiety and ICD concerns at FU. Previous psychological problems, smoking, Type D personality, NYHA class III-IV - all assessed at baseline - and shocks during FU were associated with depression, anxiety and ICD concerns. CONCLUSIONS Generally, patients' psychological health improved, but patients with increased baseline scores were more likely to have increased scores at FU. We need to be vigilant if patients report elevated distress, particularly if they have depression at baseline, as depression seems more persistent. Given the impact of depression on health-related quality of life and prognosis, they should be screened and monitored closely.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Larroudé
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospital, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Sandhu U, Nguyen AT, Dornblaser J, Gray A, Paladino K, Henrikson CA, Kovacs AH, Nazer B. Patient-Reported Outcomes in a Multidisciplinary Electrophysiology-Psychology Ventricular Arrhythmia Clinic. J Am Heart Assoc 2022; 11:e025301. [PMID: 35904213 PMCID: PMC9375498 DOI: 10.1161/jaha.122.025301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Ventricular arrhythmias (VAs) and their treatment have been associated with psychological distress and diminished quality of life (QOL). We administered a battery of patient-reported outcome measures (PROMs) to patients seeing an electrophysiologist and psychologist in a multidisciplinary VA clinic for patients referred for consideration of catheter ablation for sustained VAs or implantable cardioverter-defibrillator therapies. Methods and Results In this retrospective study of the initial VA clinic visit, we analyzed PROMs of: anxiety and depression symptoms, visual analog scales for physical health status and quality of life, cardiac anxiety, implantable cardioverter-defibrillator acceptance, and implantable cardioverter-defibrillator shock anxiety. We quantitated baseline PROM score means and performed correlation analysis with clinical makers of cardiac and VA disease severity. We also performed an item-level analysis of each PROM question to quantify most frequent patient concerns. A total of 66 patients (56±15 years; 77% men) were included; 70% had prior implantable cardioverter-defibrillator shock, and 44% with prior VA ablation. Elevated symptoms of anxiety (53%) and depression (20%) were common. Younger patients had greater symptom burden of general health anxiety, cardiac anxiety, and shock anxiety, and lower device acceptance, but indices of VA burden such as number of ICD shocks and time since last ICD shock did not predict anxiety or depression. Item-level review of cardiac-specific PROMs revealed that >40% of patients expressed concern regarding resumption of physical activity, sex and employment. Conclusions Clinicians can expect elevated symptoms of depression, and cardiac and device-related anxiety among patients with VAs. Routine use of PROMs may elicit these symptoms, which were otherwise not predicted by arrhythmia burden. Review of individual PROM items can facilitate targeting specific patient concerns, which commonly involved physical activity.
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Affiliation(s)
- Uday Sandhu
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Andrew T Nguyen
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - John Dornblaser
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Andrew Gray
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Karen Paladino
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Charles A Henrikson
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
| | - Babak Nazer
- Knight Cardiovascular Institute Oregon Health & Science University Portland OR
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Sandhu U, Kovacs AH, Nazer B. Psychosocial symptoms of ventricular arrhythmias: Integrating patient-reported outcomes into clinical care. Heart Rhythm O2 2021; 2:832-839. [PMID: 34988534 PMCID: PMC8710626 DOI: 10.1016/j.hroo.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Patient-reported outcome measures (PROMs) are a valuable metric for assessing the quality of life and overall well-being in patients with ventricular arrhythmias (VAs) and/or implantable cardioverter-defibrillators (ICDs). The incorporation of PROMs into the workflow of a VA clinic not only allows for more patient-centered care but also may improve detection and treatment of clinically relevant anxiety or depression symptoms. Awareness of the factors known to correlate with adverse PROM scores may guide PROM administration and subsequent referral to mental health services. Further, change or stability in PROM scores can be used as a gauge to guide the effectiveness of cardiac and psychological treatment in certain populations that are the focus of this manuscript: patients with ICDs (with and without shocks), cardiac arrest survivors, and those with inherited arrhythmia syndromes.
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Affiliation(s)
- Uday Sandhu
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Adrienne H. Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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4
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Tripp C, Huber NL, Kuhl EA, Sears SF. Measuring ICD shock anxiety: Status update on the Florida Shock Anxiety Scale after over a decade of use. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1294-1301. [DOI: 10.1111/pace.13793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/14/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Connor Tripp
- Department of PsychologyEast Carolina University Greenville North Carolina
| | - Nichelle L. Huber
- Department of PsychologyEast Carolina University Greenville North Carolina
| | | | - Samuel F. Sears
- Department of PsychologyEast Carolina University Greenville North Carolina
- Department of Cardiovascular SciencesEast Carolina University Greenville North Carolina
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5
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Relation of multicenter automatic defibrillator implantation trial implantable cardioverter-defibrillator score with long-term cardiovascular events in patients with implantable cardioverter-defibrillator. North Clin Istanb 2019; 6:40-47. [PMID: 31180377 PMCID: PMC6526984 DOI: 10.14744/nci.2018.69335] [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: 11/24/2017] [Accepted: 02/01/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To test the hypothesis that multicenter automatic defibrillator implantation trial (MADIT) - implantable cardioverter-defibrillator (ICD) scores predict replacement requirement and appropriate shock in a mixed population including both primary and secondary prevention and long-term adverse cardiovascular events. METHODS The study has a retrospective design. Patients who were implanted with ICD in the cardiology clinic of Atatürk University Faculty of Medicine between 2000 and 2013 were included in the study. For this purpose, 1394 patients who were implanted with a device in our clinic were reviewed. Then, those who were implanted with permanent pacemaker (n=1005), cardiac resynchronization treatment (CRT) (n=45) and CRT-ICD (n=198) were excluded. RESULTS A total of 146 patients (98 males, 67.1%) with a mean age of 61.1 (±14.8) years were recruited. The median follow-up time was 21.5 months (mean 30.6±25.9 months; minimum 4 months, and maximum 120 months). The median MADIT-ICD scores in the patients were 2. MADIT-ICD scores were categorized as low in 15.1%, intermediate in 57.5%, and high score in 27.4% of patients. Accordingly, MADIT-ICD scores (1.29 [1.00-1.68], p=0.050), hemoglobin (0.86 [0.75-0.99], p=0.047), and left ventricular ejection fraction (EF) (0.97 [0.94-0.99], p=0.023) were determined as independent predictors of major adverse cardiovascular events in the long-term follow-up of ICD-implanted population. CONCLUSION In this study, we showed that there was an independent association of long-term adverse cardiovascular events with MADIT-ICD score, hemoglobin, and EF in patients implanted with ICD.
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Impact of Implantable Cardioverter-Defibrillator Interventions on All-Cause Mortality in Heart Failure Patients. Cardiol Rev 2019; 27:160-166. [PMID: 30052536 DOI: 10.1097/crd.0000000000000226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
Se presenta un estudio nomenclatural y taxonómico sobre Chrysanthemum italicum L., C. achilleae L., C. tanacetifolium Pourr., Pyrethrum cinereum Griseb., P. clusii Fisch. ex Rchb., P. clusii Tausch, P. daucifolium Pers. y P. tenuifolium Ten., táxones que pertenecen al grupo crítico de Tanacetum corymbosum. Se propone una nueva clasificación infraespecífica de Tanacetum corymbosum (L.) Sch. Bip. s. l. y se reconocen cinco subespecies sobre la base de un estudio morfológico del material tipo y otros especímenes. Se proporciona una clave de diagnóstico de los táxones estudiados. Se propone también un cambio nomenclatural, i.e. Tanacetum corymbosum subsp. daucifolium (Pers.) Iamonico comb. nov. Se designan lectotipos para los nombres Chrysanthemum cinereum (espécimen conservado en GOET), Chrysanthemum achilleae (imagen de Micheli), Chrysanthemum italicum (en LINN), Pyrethrum clusii de Rechenbach (ilustración de Clusius), Pyrethrum tenuifolium (en G) y Pyrethrum clusii de Tausch (imagen de Clusius). Se designa un neotipo para Chrysanthemum tanacetifolium (en P).
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8
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Rottmann N, Skov O, Andersen CM, Theuns DAMJ, Pedersen SS. Psychological distress in patients with an implantable cardioverter defibrillator and their partners. J Psychosom Res 2018; 113:16-21. [PMID: 30190043 DOI: 10.1016/j.jpsychores.2018.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Adjustment to life with an implantable cardioverter defibrillator (ICD) may be challenging for some patients and their partners, with disease and individual characteristics likely influencing the process. We examined whether perceived social support and clinical patient characteristics are associated with change in couples' symptoms of anxiety and depression in the first year after ICD implantation, and explored whether the associations differ between patients and partners. METHOD A cohort of consecutively implanted patients (n = 286; 21% women) and their partners completed questionnaires on social support and symptoms of anxiety and depression prior to ICD implantation and 12 months later. Information on demographic and clinical characteristics were captured from patients' medical records or purpose-designed questions. Data were analyzed using multilevel models accounting for the interdependency of scores within couples with adjustment for possible confounders. RESULTS Higher ratings of perceived social support prior to ICD implantation were associated with greater reductions in couples' symptoms of anxiety and depression, whereas having received an ICD shock was associated with less improvement. Secondary prevention indication for ICD implantation and symptomatic heart failure were associated with less improvement in anxiety symptoms. These associations applied to both patients' and partners' levels of distress. CONCLUSION The patient's heart disease affects both patients' and partners' psychological adjustment in the first year after ICD implantation. Interventions are warranted that address this issue not only in patients but also in partners. Targeting social support as a resource for both could be one avenue to pursue.
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Affiliation(s)
- Nina Rottmann
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark; The Danish Knowledge Center for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark; National Research Center for Cancer Rehabilitation, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Ole Skov
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christina Maar Andersen
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Dominic A M J Theuns
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Susanne S Pedersen
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
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9
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Baskar S, Jefferies JL, Salberg L, Khoury PR, Spar DS, Knilans TK, Czosek RJ. Patient understanding of disease and the use and outcome of implantable cardioverter defibrillators in hypertrophic cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:57-64. [PMID: 29154461 DOI: 10.1111/pace.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 11/29/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD) in young individuals. Implantable cardioverter defibrillators (ICD) are the primary therapy for sudden death prevention; however, are associated with both physical and psychological complications. We sought to determine factors associated with ICD understanding and patient satisfaction. This was a cross-sectional study, using patient/parent answered questionnaires distributed to patients enrolled in the Hypertrophic Cardiomyopathy Association. Patient characteristics and satisfaction data were obtained via questionnaire. Patients were compared based on age at diagnosis and presence of ICD. ICD patients with high satisfaction were compared to those with low satisfaction to determine factors associated with poor satisfaction. A total of 538 responses were obtained (53 ± 16 years); 46% were females. Seventy patients (13%) were diagnosed with HCM < 18 years of age and 356 (66%) had an ICD. Compared to those without an ICD, patients with ICDs were younger at age of diagnosis (P = 0.001) and time of study (P = 0.008). Patients with ICDs were more likely to have presented with syncope and have family history of ICD, SCD, or HCM-related death. Nineteen patients (5%) felt that issues surrounding their ICD outweighed its benefit. Compared to patients with a favorable satisfaction, the only significant difference was the preimplant ICD discussion (P < 0.001) and history of lead replacement (P = 0.01). In conclusion, the majority of HCM patients with ICDs are satisfied with their ICD management and feel the benefits of ICDs outweigh issues associated with ICDs. Additionally, these data highlight the importance of the preimplant patient-physician discussion around the need for ICD prior to implantation.
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Affiliation(s)
- Shankar Baskar
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John L Jefferies
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lisa Salberg
- Hypertrophic Cardiomyopathy Association, Denville, NJ, USA
| | - Philip R Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David S Spar
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Timothy K Knilans
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Richard J Czosek
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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10
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Bazoukis G, Papadatos SS, Letsas KP, Pagkalidou E, Korantzopoulos P. Impact of statin therapy on all-cause mortality and ICD interventions in heart failure patients - a systematic review. Acta Cardiol 2017; 72:547-552. [PMID: 28685653 DOI: 10.1080/00015385.2017.1310562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Implantable cardioverter defibrillators (ICDs) have a unique role for the primary and secondary prevention of sudden cardiac death (SCD). The aim of our systematic review is to present the existing data about the impact of statins on all-cause mortality and ICD interventions in heart failure (HF) patients who had an ICD implanted either for primary or for secondary prevention of SCD. METHODS AND RESULTS We searched PubMed database and the reference list of the relevant studies for retrieving studies evaluating the effect of statins on all-cause mortality and ICD interventions in HF patients. We finally included 17 relevant studies in our systematic review. Of them, nine studies included data about the impact of statins on all-cause mortality, eight studies about the impact of statins on appropriate ICD interventions and three studies about the impact of statins on inappropriate ICD interventions in HF patients. These data showed that statins seem to have a beneficial role in the reduction of all-cause mortality and ICD interventions in HF patients. CONCLUSIONS Statins seem to have a beneficial role in the reduction of all-cause mortality and ICD interventions in HF patients. However, further research about pleiotropic effects of statins is needed as well randomized control trials to elucidate the exact role of statin therapy in ICD outcomes.
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Affiliation(s)
- George Bazoukis
- Department of Internal Medicine, General Hospital of Athens “Elpis”, Athens, Greece
| | - Stamatis S. Papadatos
- Third Department of Internal Medicine, Athens School of Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Konstantinos P. Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, “Evangelismos” General Hospital of Athens, Athens, Greece
| | - Eirini Pagkalidou
- Department of Hygiene and Epidemiology, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
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Almehmadi F, Porta-Sánchez A, Ha ACT, Fischer HD, Wang X, Austin PC, Lee DS, Nanthakumar K. Mortality Implications of Appropriate Implantable Cardioverter Defibrillator Therapy in Secondary Prevention Patients: Contrasting Mortality in Primary Prevention Patients From a Prospective Population-Based Registry. J Am Heart Assoc 2017; 6:JAHA.117.006220. [PMID: 28862957 PMCID: PMC5586459 DOI: 10.1161/jaha.117.006220] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background We sought to examine the mortality impact of appropriate implantable cardioverter defibrillator (ICD) therapy between patients who received ICD for primary versus secondary prevention purposes. Methods and Results From a prospective, population‐based registry, we identified 7020 patients who underwent de novo ICD implantation between February 2007 and May 2012 in Ontario, Canada. The primary outcome was all‐cause mortality. We used multivariable Cox proportional hazard modeling to adjust for differences in baseline characteristics and analyzed the mortality impact of first appropriate ICD therapy (shock and antitachycardia pacing [ATP]) as a time‐varying covariate. There were 1929 (27.5%) patients who received ICDs for secondary prevention purposes. The median follow‐up period was 5.02 years. Compared with those with secondary prevention ICDs, patients with primary prevention ICDs had more medical comorbidities, and lower ejection fraction. Patients who experienced appropriate ICD shock or ATP had greater risk of death compared with those who did not, irrespective of implant indication. In the primary prevention group, the adjusted hazard ratios of death for appropriate shock and ATP were 2.00 (95% CI: 1.72–2.33) and 1.73 (95% CI: 1.52–1.97), respectively. In the secondary prevention group, the adjusted hazard ratios of death for appropriate ICD shock and ATP were 1.46 (95% CI: 1.20–1.77) and 1.38 (95% CI: 1.16–1.64), respectively. Conclusions Despite having a more favorable clinical profile, occurrence of appropriate ICD shock or ATP in patients with secondary prevention ICDs was associated with similar magnitudes of mortality risk as those with primary prevention ICDs. A heightened degree of care is warranted for all patients who experience appropriate ICD shock or ATP therapy.
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Affiliation(s)
| | - Andreu Porta-Sánchez
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Canada.,Department de Medicina, Universitat de Barcelona, Spain
| | - Andrew C T Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Canada
| | - Hadas D Fischer
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada .,University of Toronto, Canada
| | - Kumaraswamy Nanthakumar
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada .,University of Toronto, Canada
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12
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Prevalence and risk markers of early psychological distress after ICD implantation in the European REMOTE-CIED study cohort. Int J Cardiol 2017; 240:208-213. [DOI: 10.1016/j.ijcard.2017.03.124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
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13
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Habibović M, Denollet J, Pedersen SS. Posttraumatic stress and anxiety in patients with an implantable cardioverter defibrillator: Trajectories and vulnerability factors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:817-823. [DOI: 10.1111/pace.13090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Mirela Habibović
- Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
- Department of Cardiology; Elisabeth-TweeSteden Hospital; Tilburg The Netherlands
| | - Johan Denollet
- Department of Medical and Clinical Psychology; Tilburg University; Tilburg The Netherlands
| | - Susanne S. Pedersen
- Department of Psychology; University of Southern Denmark; Odense Denmark
- Department of Cardiology; Odense University Hospital; Odense Denmark
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Manuel A, Brunger F. Embodying a New Meaning of Being At Risk: Living With an Implantable Cardioverter Defibrillator for Arrhythmogenic Right Ventricular Cardiomyopathy. Glob Qual Nurs Res 2017; 3:2333393616674810. [PMID: 28462346 PMCID: PMC5342860 DOI: 10.1177/2333393616674810] [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: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic condition that can cause fatal arrhythmias. The implantable cardioverter defibrillation (ICD) is a primary treatment for ARVC/D. Using a grounded theory approach, this study examines the experiences of 15 individuals living with an ICD. The ability to cope with and adjust to having an ICD is influenced by the acceptance of the ICD as something needed to survive, an understanding of the ICD's function, existing support networks, and ones' ability to manage everyday challenges. Coping well requires reshaping ideas about the meaning of being at risk and understanding how the ICD fits into that changing personal risk narrative. A thorough understanding of the unique needs of individuals with ARVC/D and of the specific factors contributing to the psychosocial distress related to having an ICD (vs. having the disease itself) is needed. Nurses must be prepared to provide ongoing support and education to this population.
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Affiliation(s)
- April Manuel
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fern Brunger
- Memorial University, St. John's, Newfoundland and Labrador, Canada
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15
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Richards K, Kramer Freeman L, Sears SF. The Influence of Social Media Use, Online Information Seeking, and Acceptance on Implantable Cardioverter Defibrillator Patient Shock Anxiety. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2016. [DOI: 10.1080/15398285.2016.1201787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Mastenbroek MH, Pedersen SS, Meine M, Versteeg H. Distinct trajectories of disease-specific health status in heart failure patients undergoing cardiac resynchronization therapy. Qual Life Res 2015; 25:1451-60. [PMID: 26563250 PMCID: PMC4870284 DOI: 10.1007/s11136-015-1176-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
Abstract
Purpose It is well known that a significant proportion of heart failure patients (10–44 %) do not show improvement in symptoms or functioning from cardiac resynchronization therapy (CRT), yet no study has examined patient-reported health status trajectories after implantation. Methods A cohort of 139 patients with a CRT-defibrillator (70 % men; age 65.7 ± 10.1 years) completed the Kansas City Cardiomyopathy Questionnaire (KCCQ) prior to implantation (baseline) and at 2, 6, and 12–14 months post-implantation. Latent class analyses were used to identify trajectories and associates of disease-specific health status over time. Results All health status trajectories showed an initial small to large improvement from baseline to 2-month follow-up, whereafter most trajectories displayed a stable pattern between short- and long-term follow-up. Low educational level, NYHA class III/IV, smoking, no use of beta-blockers, use of psychotropic medication, anxiety, depression, and type D personality were found to be associated with poorer health status in unadjusted analyses. Interestingly, subgroups of patients (12–20 %) who experienced poor health status at baseline improved to stable good health status levels after implantation. Conclusions Levels of disease-specific health status vary considerably across subgroups of CRT-D patients. Classification into poorer disease-specific health status trajectories was particularly associated with patients’ psychological profile and NYHA classification. The timely identification of CRT-D patients who present with poor disease-specific health status (i.e., KCCQ score < 50) and a distressed psychological profile (i.e., anxiety, depression, and/or type D personality) is paramount, as they may benefit from cardiac rehabilitation in combination with psychological intervention.
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Affiliation(s)
- Mirjam H Mastenbroek
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.,CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands
| | - Henneke Versteeg
- Department of Cardiology, University Medical Center, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands. .,CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.
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Lane DA, Aguinaga L, Blomström-Lundqvist C, Boriani G, Dan GA, Hills MT, Hylek EM, LaHaye SA, Lip GYH, Lobban T, Mandrola J, McCabe PJ, Pedersen SS, Pisters R, Stewart S, Wood K, Potpara TS, Gorenek B, Conti JB, Keegan R, Power S, Hendriks J, Ritter P, Calkins H, Violi F, Hurwitz J. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015; 17:1747-69. [PMID: 26108807 DOI: 10.1093/europace/euv233] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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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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Mastenbroek MH, Pedersen SS, Versteeg H, Doevendans PA, Meine M. State of the art of ICD programming: Lessons learned and future directions. Neth Heart J 2014; 22:415-20. [PMID: 25074477 PMCID: PMC4188844 DOI: 10.1007/s12471-014-0582-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The lifesaving benefits of implantable cardioverter defibrillator (ICD) therapy are more and more weighted against possible harm (e.g. unnecessary device therapy, procedural complications, device malfunction etc.) which might have adverse effects on patients' perceived health status and quality of life. Hence, there has been an increasing interest in the optimisation of ICD programming to prevent inappropriate and appropriate but unnecessary device therapy. The purpose of the current report is to give an overview of research into the optimisation of ICD programming and present the design of the on-going ENHANCED-ICD study. The ENHANCED-ICD study is a prospective, safety monitoring study enrolling 60 primary and secondary prophylactic ICD patients at the University Medical Center Utrecht. Patients implanted with any type of ICD with SmartShock technology(TM), and between 18-80 years of age, were eligible to participate. In all patients a prolonged detection of 60/80 intervals was programmed. The primary objective of the study is to investigate whether enhanced programming to further reduce ICD therapies is safe. The secondary objective is to examine the impact of enhanced programming on (i) antitachycardia pacing and shocks (both appropriate and inappropriate) and (ii) quality of life and distress. The first results of the ENHANCED-ICD study are expected in 2015.
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Affiliation(s)
- M H Mastenbroek
- Cardiology, Department of Heart and Lung, University Medical Center, Heidelberglaan 100, PO Box 85500, 3584 CX, Utrecht, the Netherlands,
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Hickey KT, Sciacca RR, Biviano AB, Whang W, Dizon JM, Garan H, Chung WK. The effect of cardiac genetic testing on psychological well-being and illness perceptions. Heart Lung 2014; 43:127-32. [PMID: 24594249 DOI: 10.1016/j.hrtlng.2014.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the effects of positive cardiac genetic diagnoses, ICD discharges, and arrhythmias on measures of psychological well-being. METHODS Fifty-eight adults with prior cardiac genetic testing were enrolled. Patient well-being was determined using the SF-36 (QoL), HADS-A and HADS-D (anxiety/depression), and IPQ-R (patients' perceptions of illness). Patients with positive and negative cardiac genetic test results were compared using non-parametric statistics. RESULTS Genetic testing yielded 76% with a positive diagnosis and 29% reported an ICD shock. QoL assessments (n = 33) were within normal ranges (mean of 50) with the exceptions of general health (44.1 ± 12.2, p < 0.01) and bodily pain (55.1 ± 9.1, p < 0.01) domains, but only the bodily pain domain showed differences between those with positive and negative cardiac genetic test results. Subjects with ICD discharges had higher scores than those without shocks in consequential and emotional IPQR subscales as well as greater perceived risks of experiencing a serious cardiac event, developing additional symptoms, or limitations in daily activities. CONCLUSION Positive genetic results did not negatively impact patient well-being with the exception of the bodily pain domain of the SF-36.
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Affiliation(s)
- Kathleen T Hickey
- Columbia University School of Nursing, Columbia University Medical Center, New York, NY, USA.
| | | | - Angelo B Biviano
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - William Whang
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - Jose M Dizon
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - Hasan Garan
- Department of Cardiac Electrophysiology, Columbia University Medical Center, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics and Medicine, Columbia University Medical Center, New York, NY, USA
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Habibović M, Cuijpers P, Alings M, van der Voort P, Theuns D, Bouwels L, Herrman JP, Valk S, Pedersen S. Attrition and adherence in a WEB-Based Distress Management Program for Implantable Cardioverter defibrillator Patients (WEBCARE): randomized controlled trial. J Med Internet Res 2014; 16:e52. [PMID: 24583632 PMCID: PMC3961745 DOI: 10.2196/jmir.2809] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/11/2013] [Accepted: 12/10/2013] [Indexed: 11/26/2022] Open
Abstract
Background WEB-Based Distress Management Program for Implantable CARdioverter defibrillator Patients (WEBCARE) is a Web-based randomized controlled trial, designed to improve psychological well-being in patients with an implantable cardioverter defibrillator (ICD). As in other Web-based trials, we encountered problems with attrition and adherence. Objective In the current study, we focus on the patient characteristics, reasons, and motivation of (1) completers, (2) those who quit the intervention, and (3) those who quit the intervention and the study in the treatment arm of WEBCARE. Methods Consecutive first-time ICD patients from six Dutch referral hospitals were approached for participation. After signing consent and filling in baseline measures, patients were randomized to either the WEBCARE group or the Usual Care group. Results The treatment arm of WEBCARE contained 146 patients. Of these 146, 34 (23.3%) completed the treatment, 88 (60.3%) dropped out of treatment but completed follow-up, and 24 (16.4%) dropped out of treatment and study. Results show no systematic differences in baseline demographic, clinical, or psychological characteristics between groups. A gradual increase in dropout was observed with 83.5% (122/146) completing the first lesson, while only 23.3% (34/146) eventually completed the whole treatment. Reasons most often given by patients for dropout were technical problems with the computer, time constraints, feeling fine, and not needing additional support. Conclusions Current findings underline the importance of focusing on adherence and dropout, as this remains a significant problem in behavioral Web-based trials. Examining possibilities to address barriers indicated by patients might enhance treatment engagement and improve patient outcomes. Trial Registration Clinicaltrials.gov: NCT00895700; http://www.clinicaltrials.gov/ct2/show/NCT00895700 (Archived by WebCite at http://www.webcitation.org/6NCop6Htz).
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Affiliation(s)
- Mirela Habibović
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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Carroll SL, McGillion M, Stacey D, Healey JS, Browne G, Arthur HM, Thabane L. Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial. Trials 2013; 14:346. [PMID: 24148851 PMCID: PMC4015905 DOI: 10.1186/1745-6215-14-346] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/08/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients, identified to be at risk for but who have never experienced a potentially lethal cardiac arrhythmia, have the option of receiving an implantable cardioverter defibrillator (ICD) as prophylaxis against sudden cardiac death - a primary prevention indication. In Canada, there is no clear framework to support patients' decision-making for these devices. Decision support, using a decision aid, could moderate treatment-related uncertainty and prepare patients to make well-informed decisions. Patient decision aids provide information on treatment options, risks, and benefits, to help patients clarify their values for outcomes of treatment options. The objectives of this research are: 1) develop a decision aid, 2) evaluate the decision aid, and 3) determine the feasibility of conducting a trial. METHODS/DESIGN A development panel comprised of the core investigative team, health service researchers, decision science experts, cardiovascular healthcare practitioners, and ICD patient representatives will collaborate to provide input on the content and format of the aid. To generate probabilities to include in the aid, we will synthesize primary prevention ICD evidence. To obtain anonymous input about the facts and content, we will employ a modified Delphi process. To evaluate the draft decision aid will invite ICD patients and their families (n = 30) to rate its acceptability. After we evaluate the aid, to determine the feasibility, we will conduct a feasibility pilot randomized controlled trial (RCT) in new ICD candidates (n = 80). Participants will be randomized to receive a decision aid prior to specialist consultation versus usual care. Results from the pilot RCT will determine the feasibility of research processes; inform sample size calculation, measure decision quality (knowledge, values, decision conflict) and the influence of health related quality of life on decision-making. DISCUSSION Our study seeks to develop a decision aid, for patients offered their first ICD for prophylaxis against sudden cardiac death. This paper outlines the background and methods of a pilot randomized trial which will inform a larger multicenter trial. Ultimately, decision support prior to specialist consultation could enhance the decision-making process between patients, physicians, and families, associated with life-prolonging medical devices like the ICD. TRIAL REGISTRATION ClinicalTrials.gov: NCT01876173.
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Affiliation(s)
- Sandra L Carroll
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael McGillion
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Heart and Stroke Foundation/Michael G DeGroote Endowed Chair in Cardiovascular Nursing, Hamilton, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- University Research Chair in Knowledge Translation to Patients, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeff S Healey
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gina Browne
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Heather M Arthur
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Lehana Thabane
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Departments of Clinical Epidemiology and Biostatistics, Pediatrics and Anesthesia, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, St Joseph’s Healthcare - Hamilton, Hamilton, ON, Canada
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Morken IM, Bru E, Norekvål TM, Larsen AI, Idsoe T, Karlsen B. Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients. J Clin Nurs 2013; 23:450-60. [DOI: 10.1111/jocn.12200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Ingvild M Morken
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Department of Health Studies; University of Stavanger; Stavanger Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Stavanger Norway
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
| | - Tone M Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Alf I Larsen
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Thormod Idsoe
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
- Norwegian
Institute of Public Health; Oslo Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Stavanger Norway
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Pedersen SS, Hoogwegt MT, Jordaens L, Theuns DA. Procedure- and device-related complications and psychological morbidity in implantable cardioverter defibrillator patients. Int J Cardiol 2013; 168:606-7. [DOI: 10.1016/j.ijcard.2013.01.226] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 01/18/2013] [Indexed: 11/24/2022]
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Gupta A, Dharmarajan K, Dreyer R, Bikdeli B, Chen R, Kulkarni VT, Shi R, Shojaee A, Ranasinghe I. Most Important Outcomes Research Papers on Device Therapies for Cardiomyopathies. Circ Cardiovasc Qual Outcomes 2013. [DOI: 10.1161/circoutcomes.113.000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pedersen SS, Hoogwegt MT, Jordaens L, Theuns DA. Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12months post implantation. Int J Cardiol 2013; 166:215-20. [DOI: 10.1016/j.ijcard.2011.10.092] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/18/2011] [Accepted: 10/18/2011] [Indexed: 11/15/2022]
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Phantom shocks: innocent bystander or complication of implantable cardioverter defibrillator therapy? Neth Heart J 2013; 21:189-90. [DOI: 10.1007/s12471-013-0388-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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VAN DEN Broek KC, Heijmans N, VAN Assen MALM. Anxiety and depression in patients with an implantable cardioverter defibrillator and their partners: a longitudinal study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:362-71. [PMID: 23252886 DOI: 10.1111/pace.12055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/11/2012] [Accepted: 10/23/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the relation between emotional distress of patients with an implantable cardioverter defibrillator (ICD) and distress of their partners. This longitudinal study aimed to determine the association between patient and partner distress, and to explain distress in patients and partners using demographic, clinical, and psychological characteristics of patients and partners. METHODS In total, 343 patients (84% male, mean age = 63.2 ± 9.2 years) and partners (18% male, mean age = 60.3 ± 9.4 years) completed self-report measures on anxiety and depressive symptoms at the time of implantation and at 2, 12, and 18 months follow-up. Type D personality (DS14; nonexpression of negative emotions) was assessed at baseline. Clinical information was gathered from medical records. Multilevel modeling was applied. RESULTS The correlations between distress in patients and partners were positive (range r = 0.19-0.43; all P's < 0.001). Generally, partners experienced more anxiety and patients more depression. Patient and partner characteristics explained about half of the variance of distress of patients and partners. As expected, psychological characteristics had the strongest effect on distress. Patient anxiety was associated with patient depression and Type D, and to the corresponding distress variable of the partner (anxiety). Similar results were found for patient depression, partner anxiety, and partner depression. CONCLUSION Distress of ICD patients is associated with distress of their partners. Future studies need to investigate mechanisms of these patient-partner dynamics, such as communication and behavioral issues. It may be timely to not only focus emotional support on patients, but also on their partners.
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Affiliation(s)
- Krista C VAN DEN Broek
- Department of Medical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
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Trajectories of Perceived Emotional and Physical Distress in Patients with an Implantable Cardioverter Defibrillator. Int J Behav Med 2012; 21:149-59. [DOI: 10.1007/s12529-012-9275-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Pedersen SS, Tekle FB, Hoogwegt MT, Jordaens L, Theuns DAMJ. Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator. Circ Cardiovasc Qual Outcomes 2012; 5:373-80. [PMID: 22570357 DOI: 10.1161/circoutcomes.111.964197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using a prospective study design. METHODS AND RESULTS Consecutively implanted ICD patients (n=383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3, 6, and 12 months. Of all patients, 23.5% had a Type D personality and 13.8% received a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up. Shock during follow-up was a significant independent associate of poorer health status for 4 of 8 subscales of the SF-36 and the Mental Component Summary (all P<.05), with shocked patients scoring between 2.60 to 13.30 points lower than nonshocked patients. Type D personality was an independent associate of poor postimplantation health status for 6 of 8 of the SF-36 subscales and the Mental Component Summary, with Type D patients scoring between 2.12 to 8.02 points lower, adjusting for demographic and clinical characteristics. CONCLUSIONS ICD shock and the patient's preimplantation personality disposition were equally important associates of health status 12 months after implantation. Identification of the patient's personality profile before ICD implantation may help identify subsets of patients who may need additional care, for example, with a psychosocial component.
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Affiliation(s)
- Susanne S Pedersen
- CoRPS, Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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VERSTEEG HENNEKE, STARRENBURG ANNEMIEKE, DENOLLET JOHAN, PALEN JOBVANDER, SEARS SAMUELF, PEDERSEN SUSANNES. Monitoring Device Acceptance in Implantable Cardioverter Defibrillator Patients Using the Florida Patient Acceptance Survey. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:283-93. [DOI: 10.1111/j.1540-8159.2011.03299.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van den Broek KC, Tekle FB, Habibović M, Alings M, van der Voort PH, Denollet J. Emotional distress, positive affect, and mortality in patients with an implantable cardioverter defibrillator. Int J Cardiol 2011; 165:327-32. [PMID: 21963213 DOI: 10.1016/j.ijcard.2011.08.071] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/19/2011] [Accepted: 08/21/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about the relationship between emotional distress and mortality in patients with an implantable cardioverter defibrillator (ICD). Our aim was to examine the predictive value of general negative and positive affect, and depressive symptoms (including its components somatic symptoms and cognitive-affective symptoms) for mortality. METHODS ICD patients (N=591, 81% male, mean age=62.7 ± 10.1 years) completed the Global Mood Scale to measure the independent dimensions negative and positive mood, and the Beck Depression Inventory to measure depressive symptoms. Covariates consisted of demographic and clinical variables. RESULTS During the median follow-up of 3.2 years, 96 (16.2%) patients died. After controlling for covariates, negative affect was significantly related to all-cause mortality (HR=1.034, p=0.002), whereas positive affect was not (HR=1.007, p=0.61). Depressive symptoms were also independently associated with an increased mortality risk (HR=1.031, p=0.030) and somatic symptoms of depression in particular (HR=1.130, p=0.003), but cognitive-affective symptoms were not associated with mortality (HR=0.968, p=0.29). When entering both significant psychological predictors in a covariate-adjusted model, negative mood remained significant (HR=1.039, p=0.009), but somatic symptoms of depression did not (HR=0.988, p=0.78). Similar results were found for cardiac-related death. Of covariates, increased age, CRT, appropriate shocks were positively related to death. CONCLUSIONS Negative affect in general was related to mortality, but reduced positive affect was not. Depression, particularly its somatic symptoms, was also related to mortality, while cognitive-affective symptoms were not. Future research may further focus on the differential predictive value of emotional distress factors, as well as on mechanisms that relate emotional distress factors to mortality.
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Affiliation(s)
- Krista C van den Broek
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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Pedersen SS, Schiffer AA. The distressed (Type D) personality. A risk marker for poor health outcomes in ICD patients. Herzschrittmacherther Elektrophysiol 2011; 22:181-188. [PMID: 21710200 DOI: 10.1007/s00399-011-0139-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The distressed (Type D) personality is an emerging risk marker for poor health outcomes in patients with cardiovascular disease. Patients with this personality disposition are typified by a general propensity to experience psychological distress. The contribution focuses on the impact of Type D personality on psychological distress, quality of life, ventricular tachyarrhythmias, and mortality in implantable cardioverter-defibrillator (ICD) patients and examines the relative influence of this vulnerability factor compared to ICD shocks and markers of disease severity in relation to these outcomes.
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Affiliation(s)
- S S Pedersen
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Warandelaan 2, 90153, 5000, LE Tilburg, The Netherlands.
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Habibovic M, van den Broek KC, Theuns DAMJ, Jordaens L, Alings M, van der Voort PH, Pedersen SS. Gender disparities in anxiety and quality of life in patients with an implantable cardioverter-defibrillator. Europace 2011; 13:1723-30. [DOI: 10.1093/europace/eur252] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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van den Broek KC, Versteeg H, Erdman RAM, Pedersen SS. The distressed (Type D) personality in both patients and partners enhances the risk of emotional distress in patients with an implantable cardioverter defibrillator. J Affect Disord 2011; 130:447-53. [PMID: 21093061 DOI: 10.1016/j.jad.2010.10.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/25/2010] [Accepted: 10/25/2010] [Indexed: 11/13/2022]
Abstract
BACKGROUND A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences emotional distress. This may be related to partner factors. We examined the impact of the personality of the partner (i.e., the distressed (Type D) personality) in combination with that of the patient on anxiety and depression levels in ICD patients. METHODS Consecutively implanted ICD patients (N=281; 80.1% men; mean age=58.3±11.0) and their partners (N=281; 20.6% men; mean age=56.5±11.7) completed the Type D Scale at baseline; patients also completed the Hospital Anxiety and Depression Scale at baseline and 6 months post-implantation. RESULTS ANOVA for repeated measures, using the Type D main effects and the interaction effect, showed that the interaction time by Type D patient by Type D partner was significant (F((1,277))=7.0, p=.009) for depression as outcome, but not for anxiety (F((1,277))=3.1, p=.08). Post-hoc comparisons revealed that Type D patients with a Type D partner (n=23/281, 8.2%) experienced the highest depression levels compared to other personality combinations (all ps<.05). LIMITATIONS The group of Type D patients with a Type D partner was rather small. CONCLUSIONS ICD patients with a Type D personality report more depressive symptoms, but not anxiety, if the partner also has a Type D personality. This may be due to poor communication and lack of emotional support in the relationship. These results emphasize the importance of taking into account the psychological profile of the partner in the management and care of the ICD patient, and to direct behavioural support not only at the ICD patient but also at the partner.
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Sears SF, Hauf JD, Kirian K, Hazelton G, Conti JB. Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient. Circ Arrhythm Electrophysiol 2011; 4:242-50. [PMID: 21505176 DOI: 10.1161/circep.110.957670] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F. Sears
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jessica D. Hauf
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Kari Kirian
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Garrett Hazelton
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jamie B. Conti
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
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Brouwers C, van den Broek KC, Denollet J, Pedersen SS. Gender disparities in psychological distress and quality of life among patients with an implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:798-803. [PMID: 21438898 DOI: 10.1111/j.1540-8159.2011.03084.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A subset of patients with an implantable cardioverter defibrillator (ICD) reports psychological distress and poor quality of life (QoL). Gender is one of the factors that has been proposed to explain individual differences in these outcomes. In this viewpoint, we (1) review the evidence for gender disparities in psychological distress and QoL in ICD patients by means of a systematic review, and (2) provide recommendations for future research and clinical implications. A systematic search of the literature identified 18 studies with a sample size ≥ 100 that examined gender disparities in anxiety/depression and QoL in ICD patients (mean prevalence of women = 21%; mean age = 62 years). Our review shows that there is insufficient evidence to conclude that gender per se is a major autonomous predictor for disparities in psychological distress and QoL in ICD patients. Women had a higher prevalence of anxiety and poorer QoL in some studies, but there was no statistically significant gender effect in relation to 80% (26/32) of the outcomes reported in the 18 studies. Studies are warranted that are designed a priori and sufficiently powered to examine gender disparities in distress and QoL outcomes in order to establish the exact gender-specific effect. Due to a need to explore the complexity of this issue further, at this time, caution is warranted with respect to the clinical implications.
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Affiliation(s)
- Corline Brouwers
- Department of Medical Psychology and Neuropsychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands
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Aatre RD, Day SM. Psychological Issues in Genetic Testing for Inherited Cardiovascular Diseases. ACTA ACUST UNITED AC 2011; 4:81-90. [DOI: 10.1161/circgenetics.110.957365] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Rajani D. Aatre
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
| | - Sharlene M. Day
- From the Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI
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Johansen JB, Mortensen PT, Videbæk R, Riahi S, Møller M, Haarbo J, Pedersen SS. Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals. Europace 2010; 13:663-7. [PMID: 21148663 DOI: 10.1093/europace/euq404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS The aim of this study was to examine health-care professionals attitudes towards implantable cardioverter-defibrillator (ICD) therapy and issues discussed with patients. METHODS AND RESULTS Survey of 209 health-care professionals providing specialized treatment and care of ICD patients at the five implanting centres in Denmark. Questions pertained to gender, age, years of experience within the field, knowledge of the ongoing critical debate on ICD therapy, and personal experience with ICD treatment, and/or sudden cardiac arrest within family and/or friends. Of all participants, 185 (88.5%) completed the survey. Physicians spent less time informing patients about ICD treatment prior to implantation (mean min = 17.7 ± 11.2 vs. 28.6 ± 19.4; P < 0.001). They were more likely to discuss clinical issues but less likely to discuss psychosocial issues with patients compared with non-physicians. Physicians were less likely to believe that their personal attitude towards ICD treatment has no influence on how they deal professionally with patients (27.8 vs. 43.6%; P = 0.04). Physicians and non-physicians were equally positive towards ICD therapy as primary prophylaxis in ischaemic cardiomyopathy (87.6 vs. 82.1%; P = 0.40) but not in non-ischaemic cardiomyopathy (57.3 vs. 83.9%; P < 0.001). Physicians were more positive towards ICD therapy as secondary prophylaxis (98.9 vs. 84.2%; P = 0.001) compared with non-physicians. CONCLUSIONS Physicians focus on clinical rather than psychosocial issues when discussing ICD treatment with candidate patients. At the same time, physicians are more aware that their attitude towards ICD treatment may influence how they deal professionally with patients compared with non-physicians.
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Affiliation(s)
- Jens B Johansen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus N, Skejby, Denmark.
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PEDERSEN SUSANNES. Depression and Heart Disease: Uncracked Mystery of the Chicken and the Egg. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1451-4. [DOI: 10.1111/j.1540-8159.2010.02929.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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