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Borsari W, Davis L, Meiers E, Salberg L, Barbara McDonough. Living with hypertrophic cardiomyopathy: a patient's perspective. Future Cardiol 2021; 18:43-50. [PMID: 34533409 DOI: 10.2217/fca-2021-0091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a complex disease characterized by thickening of the cardiac muscle. Common symptoms include chest pain, shortness of breath, palpitations, fatigue and syncope (fainting), which are often confused for other conditions. Clinical treatment focuses on the relief of symptoms with medical therapies, which provide adequate to more variable symptomatic relief. Patients may experience more severe complications that require surgical intervention, such as implantable cardioverter-defibrillator therapy or septal myectomy. Despite the potential impact on quality of life, the humanistic burden of HCM is not well established. Here, we present four patient testimonials that highlight challenges faced by patients and clinicians in diagnosing HCM and managing symptoms. These testimonials provide valuable information on the spectrum and expression of HCM across generations. Such testimonials can better inform disease diagnosis and monitoring, maximizing quality of life and improving disease outcome.
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Affiliation(s)
- Wendy Borsari
- Medical consultant, HCM patient, Plymouth, MA 02360, USA.,Patient author
| | - Lindsay Davis
- Former Miss Ohio/heart health advocate, HCM patient, New York, NY 10019, USA.,Patient author
| | - Eric Meiers
- HCM patient, Arlington, VA 22206, USA.,Patient author
| | - Lisa Salberg
- Hypertrophic Cardiomyopathy Association, HCM patient, Denville, NJ 07834, USA.,Patient author
| | - Barbara McDonough
- Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
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2
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Pike A, Dobbin-Williams K, Swab M. Experiences of adults living with an implantable cardioverter defibrillator for cardiovascular disease: a systematic review of qualitative evidence. JBI Evid Synth 2021; 18:2231-2301. [PMID: 32813405 DOI: 10.11124/jbisrir-d-19-00239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The objective of this review was to synthesize the best available qualitative evidence on the everyday life experiences of adults living with an implantable cardioverter defibrillator for cardiovascular disease. INTRODUCTION Cardiovascular disease is a rising concern worldwide. The efficacy of the implantable cardioverter defibrillator as a successful treatment for cardiovascular disease has been well documented. Research suggests that living with an implantable cardioverter defibrillator is complex and can cause substantial psychosocial distress that can manifest itself at various intervals over time. The first step to developing evidence-based recommendations related to the management of implantable cardioverter defibrillator-related distress is a critical appraisal and synthesis of relevant literature to gain a more comprehensive understanding of this phenomenon. INCLUSION CRITERIA The participants of interest were adults 18 years or older who had an implantable cardioverter defibrillator for the management of cardiovascular disease (e.g. ischemic heart disease, angina, cardiomyopathy, myocardial infarction, congenital defect, arrhythmias, heart failure). The phenomenon of interest was the everyday life experience of adults living with an implantable cardioverter defibrillator. The review considered all qualitative research related to the phenomenon of interest. METHODS Key databases searched were PubMed, CINAHL, PsycINFO, Embase, International Bibliography of the Social Sciences, Sociological Abstracts, OpenGrey, MedNar, ProQuest Dissertations and Theses Global, Google, and Google Scholar. Published and unpublished papers and articles from 1990 to July 2018 were included in the search. The JBI approach to critical appraisal, study selection, data extraction, and synthesis for qualitative research was used throughout the review. RESULTS Twenty-seven papers were included in the review that yielded 143 findings and 13 categories. The methodological quality of the 27 included studies was moderate to strong. Based on ConQual scores, confidence in the synthesized findings was moderate. From this, three synthesized findings were extracted: i) living under the shadow of uncertainty, ii) orchestrating a new normal, and iii) crafting a positive vision for the future. CONCLUSIONS Evidence suggests that while implantable cardioverter defibrillator recipients do experience psychosocial distress, they gradually positively embrace the device as part of their everyday norm. Recommendations for practice and education point to the further development of best practice guidelines for implantable cardioverter defibrillator management, continuing education programs for health care providers, and strategies to support implantable cardioverter defibrillator recipients and their families to cope with the device. Research that examines onset, level, and duration of implantable cardioverter defibrillator psychosocial distress is needed to target specific interventions reflective of this population's needs. While findings suggest the experiences of women living with an implantable cardioverter defibrillator are similar to men, the low number of women in included studies limits the strength of this conclusion.
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Affiliation(s)
- April Pike
- Memorial University of Newfoundland, Faculty of Nursing, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Karen Dobbin-Williams
- Memorial University of Newfoundland, Faculty of Nursing, St. John's, NL, Canada.,Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada
| | - Michelle Swab
- Memorial University Faculty of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A JBI Affiliated Group, St. John's, NL, Canada.,Memorial University of Newfoundland, Health Sciences Library, St. John's, NL, Canada
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3
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Wising J, Mattsson G, Rambaree K, Willmer M, Wallhagen M, Magnusson P. 'Life with a device': the octogenarians' experiences with an implantable cardioverter-defibrillator-a qualitative study. Eur J Cardiovasc Nurs 2021; 21:161-168. [PMID: 33928354 DOI: 10.1093/eurjcn/zvab033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/23/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022]
Abstract
AIMS Implantable cardioverter-defibrillator (ICD) treatment has expanded due to its effectiveness. However, there are concerns about complications, and use in the most elderly has been questioned. There is scarce data on qualitative aspects regarding experiences of living with an ICD among patients above the age of 80 years. The aim of this study was to explore octogenarians' experience, knowledge, and attitude of living with an ICD. METHOD AND RESULTS We used semi-structured interviews to collect data from 20 patients, aged 80-89 years (90% men). The data were then structured and analysed through deductive thematic analysis network approach using the ATLAS.ti v.8.4 software. The framework of the analysis was based on the Successful Aging Theory. Three main themes emerged regarding the patients' experiences: Life goes on; Their Health, The Janus-Faced Device; Their attitudes, and Mind the gap; Their knowledge. None of the octogenarians regretted receiving their ICD, instead, they presented with feelings such as gratitude towards the device. However, a lack of knowledge about the devices was expressed, which can be a risk for potential complications, in turn causing suffering and unnecessary concerns. CONCLUSION Overall, the ICD did not pose a threat towards successful ageing. It was mainly considered a life-saving device. However, the lack of knowledge might hinder informed choices close to death and contribute to ethical dilemmas when deactivation of the ICD is a reasonable option.
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Affiliation(s)
- Jenny Wising
- Centre for Research and Development, Region Gävleborg, Uppsala University, Lasarettsvägen 1, Gävle SE-80187, Sweden
| | - Gustav Mattsson
- Centre for Research and Development, Region Gävleborg, Uppsala University, Lasarettsvägen 1, Gävle SE-80187, Sweden
| | - Komalsingh Rambaree
- Department of Social Work and Criminology, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden
| | - Mikaela Willmer
- Department of Caring Sciences, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden
| | - Marita Wallhagen
- Department of Building Engineering, Energy Systems and Sustainability Science, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden
| | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg, Uppsala University, Lasarettsvägen 1, Gävle SE-80187, Sweden.,Department of Caring Sciences, University of Gävle, Kungsbäcksvägen 47, Gävle SE-80176, Sweden.,Department of Medicine, Solna, Cardiology Research Unit, Karolinska Institutet, Karolinska University Hospital D1:04, Stockholm SE-171 76, Sweden
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Magnusson P, Mörner S. Current Knowledge of Hypertrophic Cardiomyopathy Among Health Care Providers in Sweden. Cureus 2020; 12:e12220. [PMID: 33500852 PMCID: PMC7819499 DOI: 10.7759/cureus.12220] [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] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Hypertrophic cardiomyopathy (HCM) is a common disorder with various manifestations, including sudden cardiac death. Patients with suspected or confirmed HCM may be encountered throughout the healthcare system, especially in internal medicine and cardiology. Thus, thorough knowledge of HCM is essential among healthcare providers. Methods A web-based questionnaire was developed to assess the cross-sectional evaluation of HCM knowledge. It covered aspects such as epidemiology and diagnosis, treatment, lifestyle, risk stratification of sudden cardiac death, and implantable cardioverter-defibrillator knowledge. Results In total, 123 subjects completed the survey. The mean age was 38.5 ±10.7 years and two-thirds (n=82) were females; 43.1% were physicians (non-specialist 24.4%, cardiologists 8.9%, specialist, other than cardiology 9.8%); and the remaining were nurses (nurses within cardiology 37.4%, nurses outside cardiology 19.5%). Almost all subjects had heard about the disease (95.9%) and the vast majority (77.2%) had taken part in the management of a patient with HCM. The total mean score was 15.9 ±3.9 credits and the 25th, 50th, and 75th percentiles were 14, 15, and 18 credits, respectively. The predefined arbitrary pass score of ≥60% was reached by 61.8%, and 20.3% were considered to pass with distinction. Physicians scored higher than nurses (70.7 ±17.0% vs 58.1 ±11.8; p<0.001). Within each professional category, there was a similar score with regard to gender. Conclusions There is a considerable lack of knowledge of HCM among healthcare professionals working within the field of internal medicine/cardiology. This insufficient knowledge may contribute to less implementation of evidence-based medicine and current guidelines, although further studies are needed to confirm this.
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Affiliation(s)
- Peter Magnusson
- Center of Research and Development, Uppsala University/ Region Gävleborg, Gävle, SWE
- Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, SWE
| | - Stellan Mörner
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, SWE
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Grubic N, Puskas J, Phelan D, Fournier A, Martin LJ, Johri AM. Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young. Curr Cardiol Rep 2020; 22:168. [PMID: 33040200 PMCID: PMC7547819 DOI: 10.1007/s11886-020-01419-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events. RECENT FINDINGS Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing prevention, survivorship, and the downstream communal effects of a young death is required. Support systems and intervention could assist in the management of the associated psychosocial burden, yet there is a lack of clinical guidelines to direct this form of care. There is an important need for multidisciplinary collaboration across subspecialties to provide support to grieving individuals and manage patient well-being throughout the screening process for SCD. This collaborative approach requires the integration of cardiovascular and psychological expertise where relevant.
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Affiliation(s)
- Nicholas Grubic
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
- Department of Medicine, Queen’s University, Kingston, Canada
| | - Jake Puskas
- Department of Medicine, Queen’s University, Kingston, Canada
| | - Dermot Phelan
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC USA
| | - Anne Fournier
- Department of Pediatrics, University of Montréal, Montréal, Canada
| | - Luc J. Martin
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada
| | - Amer M. Johri
- Department of Medicine, Queen’s University, Kingston, Canada
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Magnusson P, Wimo A. Health economic evaluation of implantable cardioverter defibrillators in hypertrophic cardiomyopathy in adults. Int J Cardiol 2020; 311:46-51. [DOI: 10.1016/j.ijcard.2020.02.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/08/2020] [Accepted: 02/19/2020] [Indexed: 12/21/2022]
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Varghese S, Geller JC, Ohlow MA. Decision regret in implantable cardioverter-defibrillator recipients : A cross-sectional analysis on patients that regret their decision after ICD implantation. Herzschrittmacherther Elektrophysiol 2020; 31:77-83. [PMID: 32078717 DOI: 10.1007/s00399-020-00675-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are designed to deliver therapy in the event of malignant ventricular arrhythmias. Despite their benefits, some ICD recipients regret their decision on device implantation. OBJECTIVES The aim of this study was to evaluate the incidence, predictors, and consequences of recipients that regretted their decision after implantation. METHODS A questionnaire-based cross-sectional survey of consecutive ICD recipients examined during a routine outpatient follow-up visit was conducted. Their level of depression and anxiety was assessed with the hospital anxiety and depression scale (HADS). Quality of life (QOL) was assessed using the Minnesota living with heart failure questionnaire. RESULTS Of 434 ICD recipients invited to the study, 423 (97.5%) agreed and completed the survey, 349 (83%) had a primary prevention indication, and 339 (80%) ischemic cardiomyopathy. A total of 41 recipients (9.7%) regretted their decision to undergo ICD implantation. These patients were: (1) younger (63 versus 69 years), (2) more frequently in New York Heart Association (NYHA) ≥2 functional class (63% versus 22%), (3) had higher education levels (more than high-school: 76% versus 60%), (4) felt that preoperative information was lacking (22% versus 4%), (5) had more complications in the perioperative period (15% versus 3%), (6) felt less safe after ICD implantation (54% versus 5%), and (7) considered more frequently ICD deactivation during near end-of-life situations (54% versus 29%). Mean QOL and HADS scores were significantly worse in these patients (36 versus 30 and 12 versus 8.8 points, respectively; p < 0.01 for all). CONCLUSION Almost 10% of ICD recipients regretted their decision after implantation. Predictors included younger age, higher education levels, complicated perioperative period, and lack of preoperative information.
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Affiliation(s)
- Swaroop Varghese
- Division of Cardiology, Ameosklinikum Halberstadt, Halberstadt, Germany
| | - J Christoph Geller
- Division of Invasive and Interventional Electrophysiology, Zentralklinik, Bad Berka, Germany
| | - Marc-Alexander Ohlow
- Division of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99438, Bad Berka, Germany.
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Forman J, Baumbusch J, Jackson H, Lindenberg J, Shook A, Bashir J. Exploring the patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator. Eur J Cardiovasc Nurs 2018; 17:698-706. [DOI: 10.1177/1474515118777419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The implantable cardioverter defibrillator provides effective treatment for the prevention of sudden cardiac arrest but significant risks associated with transvenous implantation persist. The subcutaneous implantable cardioverter defibrillator has proven to be an alternative and innovative treatment option for select patients to mitigate these risks. Obtaining the patients’ perspectives can provide clinicians with essential information to guide implant selection, procedural decision-making, and support patient management. Conventional implantable cardioverter defibrillator patients have reported shock-related anxiety, fear, insufficient education, and challenges adapting to physical and psychological changes. Little evidence exists to determine whether differences between the subcutaneous implantable cardioverter defibrillator and conventional implantable cardioverter defibrillator allow for the transferability of our current knowledge to the care and management of this population. Aims: The purpose of this study was to explore patients’ experiences of living with a subcutaneous implantable cardioverter defibrillator including the decision-making process, implant, and follow-up care processes. Methods: Using an exploratory qualitative approach, semi-structured interviews were conducted by telephone with 15 participants who underwent subcutaneous implantable cardioverter defibrillator implant. Results: Analysis revealed five main themes: (a) influences on decision-making; (b) unmet education needs; (c) physical impact; (d) psychological impact; and (e) recommendations. Conclusion: As a new technology, little knowledge of the subcutaneous implantable cardioverter defibrillator exists outside of the tertiary implanting sites, therefore developing new strategies to increase learning and dissemination is essential. Although similarities exist in our findings to those of conventional implantable cardioverter defibrillators, there are significant differences in the decision-making process and physical impact which require individualized care planning and development of strategies to provide a patient-centered approach to care.
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Mestres CA, Bartel T, Sorgente A, Müller S, Gruner C, Dearani J, Quintana E. Hypertrophic obstructive cardiomyopathy: what, when, why, for whom? Eur J Cardiothorac Surg 2018; 53:700-707. [PMID: 29438530 DOI: 10.1093/ejcts/ezy020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/30/2017] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and is associated with symptoms of heart failure and increased risk of sudden cardiac death. The most common condition is obstruction of the left ventricular outflow tract. Surgical septal myectomy and alcohol septal ablation are the 2 accepted modes of septal reduction therapy and are indicated when there are advanced symptoms and a peak left ventricular outflow gradient ≥50 mmHg. Advantages of alcohol septal ablation are limited groin approach, reduction of obstruction of the left ventricular outflow tract and functional improvement, but there are higher chances for intracardiac device implantation and residual obstruction. Septal myectomy offers very low mortality, absolute and immediate resolution of obstruction of the left ventricular outflow tract and survival comparative to a matched general population with almost negligible residual obstruction. It is recommended that patients with obstructive hypertrophic cardiomyopathy should be treated at experienced centres.
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Affiliation(s)
- Carlos A Mestres
- Department of Cardiovascular Surgery, Herzzentrum University Hospital Zürich, Zürich, Switzerland.,Department of Cardiothoracic and Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Thomas Bartel
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Antonio Sorgente
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Silvana Müller
- Department of Internal Medicine, Cardiology, Tirol Kliniken, University of Innsbruck, Innsbruck, Austria
| | - Christiane Gruner
- Department of Cardiology, Herzzentrum University Hospital Zürich, Zürich, Switzerland
| | - Joseph Dearani
- Department of Cardiovascular Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
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