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Sanders KH, Chousou PA, Carver K, Pugh PJ, Degens H, Azzawi M. Benefits of support groups for patients living with implantable cardioverter defibrillators: a mixed-methods systematic review and meta-analysis. Open Heart 2022; 9:openhrt-2022-002021. [PMID: 36252993 PMCID: PMC9577922 DOI: 10.1136/openhrt-2022-002021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patients with implantable cardioverter defibrillators (ICD) experience anxiety, depression and reduced quality of life (QoL). OBJECTIVES This mixed-methods systematic review evaluates whether ICD support groups have a beneficial effect on mental well-being. METHODS Literature searches were carried out in MEDLINE, Embase, CINAHL, PsycINFO and Web of Science. Eligible studies investigated patient-led support groups for ICD patients aged 18 years or older, using any quantitative or qualitative design. The Mixed-Methods Assessment Tool was used to assess quality. Meta-analysis of measures of mental well-being was conducted. Thematic synthesis was used to generate analytic themes from the qualitative data. The data were integrated and presented using the Pillar Integration Process. RESULTS Ten studies were included in this review. All studies bar one were non-randomised or had a qualitative design and patients had self-selected to attend a support group. Five contributed to the quantitative data synthesis and seven to the qualitative synthesis. Meta-analysis of anxiety and QoL measures showed no significant impact of support groups on mental well-being, but qualitative data showed that patients perceived benefit from attendance through sharing experiences and acceptance of life with an ICD. DISCUSSION ICD support group attendance improved the patients' perceived well-being. Attendees value the opportunity to share their experiences which helps to accept their new life with an ICD. Future research could consider outcomes such as patient acceptance and the role of healthcare professionals at support groups.
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Affiliation(s)
- Katie H Sanders
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
| | - Panagiota Anna Chousou
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kathryn Carver
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Peter J Pugh
- Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK,Lithuanian Sports University, Kaunas, Lithuania
| | - May Azzawi
- Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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Schulz SM, Ritter O, Zniva R, Nordbeck P, Wacker C, Jack M, Groschup G, Deneke T, Puppe F, Ertl G, Angermann C, Störk S, Pauli P. Efficacy of a web-based intervention for improving psychosocial well-being in patients with implantable cardioverter-defibrillators: the randomized controlled ICD-FORUM trial. Eur Heart J 2021; 41:1203-1211. [PMID: 30957867 PMCID: PMC9597328 DOI: 10.1093/eurheartj/ehz134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/28/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
Aims Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. Methods and results This multicentre, randomized controlled trial (RCT) enrolled 118 ICD patients with increased anxiety or depression [≥6 points on either subscale of the Hospital Anxiety and Depression Scale (HADS)] or reduced QoL [≤16 points on the Satisfaction with Life Scale (SWLS)] from seven German sites (mean age 58.8 ± 11.3 years, 22% women). The primary outcome was a composite assessing change in heart-focused fear, depression, and mental QoL 6 weeks after randomization to WBI or UC, stratified for age, gender, and indication for ICD placement. Web-based intervention consisted of 6 weeks’ access to a structured interactive web-based programme (group format) including self-help interventions based on cognitive behaviour therapy, a virtual self-help group, and on-demand support from a trained psychologist. Linear mixed-effects models analyses showed that the primary outcome was similar between groups (η
p
2 = 0.001). Web-based intervention was superior to UC in change from pre-intervention to 6 weeks (overprotective support; P = 0.004, η
p
2 = 0.036), pre-intervention to 1 year (depression, P = 0.004, η
p
2 = 0.032; self-management, P = 0.03, η
p
2 = 0.015; overprotective support; P = 0.02, η
p
2 = 0.031), and 6 weeks to 1 year (depression, P = 0.02, η
p
2 = 0.026; anxiety, P = 0.03, η
p
2 = 0.022; mobilization of social support, P = 0.047, η
p
2 = 0.018). Conclusion Although the primary outcome was neutral, this is the first RCT showing that WBI can improve psychosocial well-being in ICD patients. ![]()
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Affiliation(s)
- Stefan M Schulz
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, BY, 97070 Würzburg, Germany.,Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Wallstraße 3, RP, 55122 Mainz, Germany
| | - Oliver Ritter
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Cardiologoephrology and Pulmology, Brandenburg Medical School, University Hospital Brandenburg, Hochstraße 29, BB, 14770 Brandenburg an der Havel, Germany
| | - Richard Zniva
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, BY, 97080 Würzburg, Germany
| | - Christian Wacker
- Division of Cardiology, Department of Medicine, ANregiomed-Hospital Rothenburg ob der Tauber, Ansbacher Straße 131, BY, 91541 Rothenburg ob der Tauber, Germany
| | - Mary Jack
- Hospital Bad Wörishofen, Tannenbaum 2, BY, 86825 Bad Wörishofen, Germany
| | - Guido Groschup
- Division of Rhythmology, Department of Medicine I, City Hospital Aschaffenburg, Am Hasenkopf 1, BY, 63739 Aschaffenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Centre GmbH, Schlossplatz 1, BY, 97616 Bad Neustadt a. d. Saale, Germany
| | - Frank Puppe
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Chair of Computer Science VI, University of Würzburg, Am Hubland, BY, 97074 Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Christiane Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, BY, 97080 Würzburg, Germany
| | - Paul Pauli
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, BY, 97070 Würzburg, Germany
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Yardımcı T, Mert H. Web-Based Intervention to Improve Implantable Cardioverter Defibrillator Patients’ Shock-Related Anxiety and Quality of Life: A Randomized Controlled Trial. Clin Nurs Res 2017; 28:150-164. [DOI: 10.1177/1054773817741427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In spite of its effectiveness, implantable cardioverter defibrillator (ICD) patients face psychological problems such as shock-related anxiety due to device shocks. The aim of this study was to evaluate whether a web-based intervention program for ICD patients would reduce shock-related anxiety and improve quality of life compared with usual care. This was a randomized controlled trial study including a total of 76 patients. Data were collected using Turkish versions of the Florida Shock Anxiety Scale and Short Form Health Survey (SF-36) at 0 (baseline), 3, and 6 months. Following intervention, there was a significant decrease in shock anxiety levels of patients and a statistically significant increase in social functioning, role-physical, mental health, vitality, and bodily pain subdimensions of SF-36. While no statistically significant difference was found between groups in terms of summary scores of SF-36, our results suggest that web-based interventions can be useful for ICD patients.
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Affiliation(s)
| | - Hatice Mert
- Dokuz Eylül University Faculty of Nursing, Izmir, Turkey
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Abstract
Implantable cardioverter-defibrillators (ICD) are increasingly used for the prevention of potentially lethal cardiac arrhythmias due to their confirmed superior medical efficiency. Nevertheless, ICD-patients often suffer from psychosocial problems, e.g., anxiety and depression. These issues are rarely addressed in routine medical follow-up care. Due to the limited mobility of many ICD-patients, Internet-based care may be ideal for delivering psychosocial care to patients in their homes. Our pilot study and case studies illustrate prospects and challenges of this approach. We developed icd-forum.de, a 6-week internet-based prevention program that provides a platform for information, a virtual self-help group, and a professionally moderated chat room in order to help decrease anxiety and to improve quality of life. A critical evaluation in the context of other published studies on the subject allows recommendations for the implementation of future internet-based psychosocial programs for ICD-patients to be deduced. It is the authors' opinion that such programs offer advantages specifically for heart failure patients and they recommend their broader use. Prior to this, conclusive evaluation studies are needed.
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Affiliation(s)
- S M Schulz
- Lehrstuhl für Psychologie I, Universität Würzburg, Marcusstr. 9-11, 97070, Würzburg, Deutschland.
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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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