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Rakhshan M, Khoshnood Z, Ansari L, Aslani A. Body Image and Adjustment among Patients with Heart Rhythm Management Devices following Cardiac Rehabilitation Program: A Randomized, Controlled Clinical Trial. Clin Med Res 2022; 20:1-8. [PMID: 34996819 PMCID: PMC9390850 DOI: 10.3121/cmr.2021.1530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/27/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Heart rhythm management devices save patients' lives. However, they may cause problems with the patient's perspective of their body image. Therefore, given the significance of the heart function and cardiac rehabilitation, this study was conducted to investigate and compare the effect of the cardiac rehabilitation program on adjustment and body image among patients who use heart rhythm management devices.Methods: This two-group clinical trial was conducted with 100 patients who used various heart rhythm management devices. The patients were randomly assigned into either the control group or intervention group (50 patients in each group) via four triad blocks. The intervention was 16 sessions of the cardiac rehabilitation program and 4 telephone follow-ups over twelve weeks. Data was gathered before the intervention and both eight and twelve weeks after the intervention using the psychosocial adjustment to illness scale and the body image and relationships scale.Findings: The majority of the patients were male and in the age range of 40-60 years. Before the intervention, no statistically significant differences were reported between the groups in terms of adjustment control = 68.13 ± 9.1, intervention = 67.13 ± 4.6) and body image (control = 93.14 ± 8.5, intervention = 91.16 ± 8.4) (P>0.5). However, in the intervention group, with each of three devices (pacemaker, ICD, CRT), significant improvements were observed in all aspects of adjustment (16.7 ± 9.3, 25.3 ± 9.5, 20.6 ± 10.3) and body image (45.50 ± 9.80, 55.10 ± 8.80, 42.90 ± 6.10) over time respectively (P<0.001).Conclusion: The effectiveness of the cardiac rehabilitation program in improving the body image was reported in this study. Therefore, the cardiac rehabilitation program can have a vital role in improving body image and adjustment among patients who use various cardiac rhythm management devices.
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Affiliation(s)
- Mahnaz Rakhshan
- Associate professor, Community Based Psychiatric Care Research Center. School of nursing and midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zeinab Khoshnood
- Student research committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ansari
- Student research committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Aslani
- Associate Professor, School of Medicine, Shiraz University of Medical Sciences. Shiraz, Iran
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Januszkiewicz Ł, Barra S, Providencia R, Conte G, de Asmundis C, Chun JKR, Farkowski MM, Guerra JM, Marijon E, Boveda S. Long-term quality of life and acceptance of implantable cardioverter-defibrillator therapy: results of the European Heart Rhythm Association survey. Europace 2022; 24:860-867. [PMID: 35167672 DOI: 10.1093/europace/euac011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Implantable cardioverter-defibrillator (ICD) may impact patients’ life significantly. The aim of this survey was to analyse the impact of the ICD on quality of life (QoL) metrics from the patient’s perspective. ‘Living with an ICD’ was a prospective, multicentre study with an online questionnaire submitted to the European Heart Rhythm Association (EHRA) Research Network centres as well as patient associations from 10 European countries; it was filled-in directly and personally by the patients that were invited to participate, with a minimal interaction or influence from the healthcare professionals. Overall, the questionnaire was completed by 1809 patients (624 women, 34.5%). Patients in their 60s and 70s and from Western Europe were the most represented. The median time from first ICD implantation was 5 years (IQR 2–10). Device-related complications were reported by 505 patients (22.4%), including one or more inappropriate shocks (n = 209, 11.6%). Almost half the respondents reported improved QoL, with a more favourable impact for those receiving cardiac resynchronization therapy-defibrillator (CRT-D), and only a 10th experienced a significant decrease in QoL. The occurrence of complications remained a major predictor of deteriorated QoL (odds ratio 2.1, 95% confidence interval 1.4–3.0, P < 0.001). In conclusion, most patients have a globally positive view and acceptance of ICD therapy, reporting preserved to improved QoL after device implantation. Complications, namely inappropriate shocks, affect the expectation of living a normal life post-implant and are associated with a significant decrease in QoL. Our findings also highlight the importance of a detailed informed consent process and the involvement of the patient in the decision-making process.
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Affiliation(s)
| | - Sérgio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
| | - Rui Providencia
- Barts Heart Centre, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- Institute of Health Informatics Research, University College of London, London, UK
| | - Giulio Conte
- Cardiology Department, Fondazione CardiocentroTicino, Lugano, Switzerland
- Universita` della Svizzera Italiana Lugano, Lugano, Switzerland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Warsaw, Poland
| | - Michał M Farkowski
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | | | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
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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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Sert M, Turan Kavradim S, Canli Özer Z. Living at the boundary between life and death: A qualitative study of how patients' lives are impacted by the implantable cardioverter defibrillator. J Adv Nurs 2020; 77:934-947. [PMID: 33222292 DOI: 10.1111/jan.14650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/04/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
AIMS To examine the effect on patients' lives of implantable cardioverter defibrillator implantation and their experiences of worry about death. DESIGN A descriptive phenomenological design. METHODS Participants with implantable cardioverter defibrillators were recruited through purposive sampling with maximum variation in Antalya, Turkey. Data collection included individual semi-structured interviews conducted between September 2018 - May 2019. Interviews were audio recorded, transcribed verbatim, and analysed by Giorgi's descriptive phenomenology method. RESULTS Twenty-six individuals with implantable cardioverter defibrillators participated in the study. Analysis of the data resulted in three themes and 10 subthemes. The first theme was the physical impact of the device on the body with the subthemes changes in physical functioning and like part of the body; the second theme was social impact in daily life and adaptation to restrictions with the subthemes necessary for life, restrictive behaviours of day-to-day life and Seeking social support and the third theme was the emotional impact of the experience of shock and worry about death with the subthemes inevitable truth, living at the boundary, every shock is like you are going to die, advancing on an uncertain path, and trust in life insurance. CONCLUSION It was found in this study that the implantation of implantable cardioverter defibrillators affected patients physically, socially, and emotionally in many ways. It is thought that this study will raise the awareness of health professionals and will support a holistic approach, increasing the quality of care. IMPACT Although the implantation of the cardioverter defibrillator is greatly effective in protecting against sudden cardiac death, for patients it brings with it many physical, social, and emotional problems. This study can contribute to health professionals planning individual education in coping with changes, an increase in group-based counselling to support the sharing of experience, social networks, and monitoring programs to improve care.
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Affiliation(s)
- Mediha Sert
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Selma Turan Kavradim
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | - Zeynep Canli Özer
- Department of Internal Medicine Nursing, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Garrino L, Borraccino A, Peraudo E, Bobbio M, Dimonte V. “Hosting” an implantable cardioverter defibrillator: A phenomenological inquiry. Res Nurs Health 2017; 41:57-68. [DOI: 10.1002/nur.21842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 10/27/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Lorenza Garrino
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
| | | | - Marco Bobbio
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatrics; University of Torino; Torino Italy
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