Caring for patients with third-generation implantable cardioverter defibrillators: from decision to implant to patient's return home

Living With an Implantable Cardioverter Defibrillator

BACKGROUND AND PURPOSE

Life-threatening cardiac dysrhythmias that cause sudden cardiac death claim more than a thousand lives a day. Many sudden cardiac death survivors and those at high risk receive an implantable cardioverter defibrillator (ICD). Despite the large number of people living with an ICD, little is known about their ICD knowledge and the impact of this knowledge on their uncertainty and quality of life (QOL). The purpose of this study was to determine if ICD knowledge and uncertainty predict QOL in individuals living with an ICD.

METHODS

A purposive sample of 90 ICD recipients was recruited from a large rural Northeastern cardiac clinic. A descriptive correlational design was used. Multiple regression analysis was used to assess relationships among ICD knowledge, uncertainty, and QOL. Confounding variables of age, education, left ventricular ejection fraction, and number of years postimplantation were controlled in the analyses.

RESULTS AND CONCLUSIONS

Statistically significant relationships were found between uncertainty and QOL, but ICD knowledge was not significantly related to uncertainty or QOL. Younger recipients reported a lower QOL. Education, ejection fraction, number of ICD shocks since implantation, and number of months since implantation were unrelated to ICD knowledge, uncertainty, or QOL in these ICD recipients. It is important to evaluate ICD recipients' understanding of the information they receive and to determine what ICD knowledge, uncertainty, and QOL means from the patient's perspective to assist them in the transitional process of learning to live with an ICD.

Sexual concerns and educational needs after an implantable cardioverter defibrillator

BACKGROUND

Patients with an implantable cardioverter defibrillator (ICD) describe anxiety, fears, and other psychosocial issues, although sexual concerns are not well understood.

PURPOSE

The purpose of this descriptive study was to explore the experiences of patients and partners with return to sexual activity post-ICD implantation.

PARTICIPANTS

Subjects were 12 patients with an ICD (10 men, 2 women) and 4 partners (1 man, 3 women). Most patients with an ICD and partners were age 55 years or older, with a mean age of 62 years for patients and 47 years for partners.

METHODS

A semistructured interview was used to explore the meaning and influence of the ICD on the sexual relationship. Interviews were recorded, transcribed verbatim, and analyzed using a qualitative descriptive approach.

RESULTS

Themes identified were (1) anxiety and apprehension, with subthemes of partner overprotectiveness and fear of ICD discharge with sexual activity; (2) varying interest and pattern of sexual activity; (3) powerfulness of ICD discharge; and (4) a need for information and sexual counseling.

IMPLICATIONS

Additional research is needed to further understand the experience of ICD discharge with sexual activity and to develop educational strategies.

Psychosocial Issues of Patients With Implantable Cardioverter Defibrillators

Use of implantable cardioverter defibrillators has become standard therapy for patients at high risk for life-threatening ventricular arrhythmias. Although acceptance of the device is generally high among patients and their families, quality of life and psychosocial issues associated with use of the defibrillators deserve greater attention to improve outcomes. Psychosocial issues, their ramifications, and theory-and evidence-based approaches to improving outcomes are described.

INTIMACY NEEDS AND CHRONIC ILLNESS: Strategies for Sexual Counseling and Self-Management

Individuals experiencing a chronic illness have many needs and concerns. One area frequently overlooked is that of intimacy. Those experiencing cardiovascular illnesses have concerns about the strain of sexual activity on their heart. Individuals with lung diseases may perceive that sexual activity is no longer possible because of breathing difficulties. Accurate information and strategies for self-management are needed to address the intimacy needs and concerns of these individuals. The purpose of this article is to identify intimacy needs and strategies for sexual counseling for individuals with cardiovascular illnesses such as myocardial infarction, heart failure, implantable defibrillators, hypertension, and for chronic lung problems.

Postoperative Pulmonary Dysfunction in Adults After Cardiac Surgery With Cardiopulmonary Bypass: Clinical Significance and Implications for Practice

Postoperative pulmonary complications are the most frequent and significant contributor to morbidity, mortality, and costs associated with hospitalization. Interestingly, despite the prevalence of these complications in cardiac surgical patients, recognition, diagnosis, and management of this problem vary widely. In addition, little information is available on the continuum between routine postoperative pulmonary dysfunction and postoperative pulmonary complications. The course of events from pulmonary dysfunction associated with surgery to discharge from the hospital in cardiac patients is largely unexplored. In the absence of evidence-based practice guidelines for the care of cardiac surgical patients with postoperative pulmonary dysfunction, an understanding of the pathophysiological basis of the development of postoperative pulmonary complications is fundamental to enable clinicians to assess the value of current management interventions. Previous research on postoperative pulmonary dysfunction in adults undergoing cardiac surgery is reviewed, with an emphasis on the pathogenesis of this problem, implications for clinical nursing practice, and possibilities for future research.

Sexual concerns of patients and partners after an implantable cardioverter defibrillator

Sexual concerns of patients after an implantable cardioverter defibrillator (ICD) exist, but are not well understood. This study explored sexual concerns and educational needs of those living with an ICD and their partners. Study results suggest a need for written patient education tools specific to sexual issues for patients and partners, and educational resources for health professionals. Addressing the fears and concerns related to sexual function of ICD patients and partners is an essential aspect of rehabilitation and recovery.

How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families?

This study aimed to identify the lived experience of patients with implantable cardioverter defibrillators (ICD) and their families. The methodology used was interpretative phenomenology. Unstructured interviews were conducted with three family members and three ICD recipients. Using a methodological approach outlined by van Manen, the participants transcribed texts were analysed looking for similar concepts and ideas that developed into themes that explicated the meaning of this phenomena. The themes that emerged were: dependence, which encompassed their perceptions about the life-saving device; the memory of their first defibrillation experience; lifestyle changes, which incorporated modification techniques; lack of control, which highlighted feelings such as fear, anxiety and powerlessness; mind game, which illustrated psychological challenges; and the issue of security, demonstrating how 'being there' and not 'being there' impacted on their everyday lives. The long-term outcomes of living with an ICD are important considerations for all health-care providers. This research highlights the everyday activities of recipients, the lifestyle changes they have made, the emotional significance of the device and the psychological coping strategies that the participants have adopted. The findings of this research will allow health-care professionals to be better prepared to provide education and support for ICD recipients and their families in regards to issues related to insertion of the device during the postinsertion recovery period and for long-term management after hospital discharge.