Development of the implanted devices adjustment scale

The Quality of Life in Patients With Implantable Cardiac Devices: A Single-Center Cross-Sectional Study

Background Cardiovascular diseases (CVDs) and their complications are one of the most common causes of death worldwide. Implantable cardiac assistive devices (CADs) play a significant role in preventing dreadful outcomes, and the complication rate of these implanting procedures is minimal. These cardiac devices require some adaptation and could affect the patients' quality of life psychosocially and financially. This study is aimed to identify the impact of implantable cardiac assistive devices on patients' quality of life in the National Guard Hospital, Jeddah, Saudi Arabia. Methods This is an observational cross-sectional questionnaire-based study. It was conducted on patients who underwent cardiac assistive device implantation in National Guard Hospital. The patients were interviewed face-to-face and were requested to fill the Implanted Device Adjustment Scale (IDAS). Descriptive statistics were carried out. Chi-square test for independence was conducted to examine the associations between qualitative variables with the level of significance was taken as p-value <0.05. Results There was a statistically significant association between IDAS score and gender (p=0.03), monthly income (p=0.009), and type of cardiac implantation device (p=0.041). Females with an implantable cardiac defibrillator (ICD) and individuals with low socioeconomic status reported alongside divorced participants have higher IDAS scores, which correlates to worse adjustment. However, most of our patients scored 21-50 in IDAS score, which indicates a mild psychosocial effect after the cardiac assistive device implantation. Conclusion This study confirmed that most individuals adjust positively to implanted devices. It showed a significant association of gender, type of device, monthly income, and duration. Attention must be drawn to females and divorced patients in regards to psychological and emotional support.

Device nurse intervention facilitates the patients' adaptation to cardiac shock devices in the remote monitoring era

BACKGROUND

A substantial number of patients with shock devices (implantable cardioverter defibrillators [ICDs] or ICDs with resynchronization [CRTDs]) experience psychological distress.

OBJECTIVE

We investigated the device nurse telephone intervention's effect on improving the patient's adaptation to shock devices, quality of life (QOL), and anxiety in the remote monitoring era.

METHODS

The patient's adaptation to the device, health-related QOL, and anxiety were investigated by the modified Implanted Devices Adjustment-Japan score (IDAS), Short Form-36, and State-Trait Anxiety Inventory (STAI) before and 1-year after the device nurse telephone intervention, performed every 3 months. A total of 95 patients (median age 69 years and 25 females) participated. Sixty patients had ICDs and 35 CRTDs. Structural heart disease was observed in 72 patients, and idiopathic ventricular arrhythmias in the others. The mean left ventricular ejection fraction was 46% ± 15%. The median duration since the device implantation was 5.2 years.

RESULTS

The total IDAS score significantly improved from 28.42 ± 7.11 at baseline to 26.77 ± 7.68 (p = 0.0076) at 1 year. Both the state and trait anxiety significantly improved (from 38.9 ± 9.6 to 35.3 ± 9.0 [<0.0001] and 38.8 ± 10.3 to 36.2±9.8 [p = 0.0044], respectively). The prevalence of patients with a state and trait anxiety of more than 40 decreased from 44 (46%) and 38 (40%) patients before the study to 27 (28 %) and 32 (34 %) at 1 year. The SF-36 mental component summary score significantly increased (50.8 ± 8.3 at baseline to 53.1 ± 7.7 at 1 year, p = 0.0031).

CONCLUSIONS

The device nurse intervention facilitated the patient's adaptation to the shock device, increased the health-related QOL, and reduced the patient's anxiety.

Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot

Objective

To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF).

Methods

Included were 26 ToF-patients with an ICD (age 44 ± 12 years), and two control groups consisting of 28 ToF-patients without an ICD (age 40 ± 10 years) and a group of 35 ICD-patients of older age without ToF (age 72.0 ± 8 years). This last control group was chosen to represent the “older general ICD population” with acquired heart disease seen at the out-patient clinic. Psychosocial functioning encompassed daily functioning, subjective health status, quality of life, anxiety, depression, coping and social support.

Results

ToF-patients with ICD showed diminished psychosocial functioning in comparison to ToF-patients without ICD. This was reflected by diminished subjectively perceived physical functioning (p = 0.01), general health perception (p < 0.01) and a lower satisfaction with life (p = 0.02). In comparison to older ICD-patients, ToF-patients with ICD showed less satisfaction with life (p = 0.03), experienced more anxiety (p = 0.01) and showed less favourable coping styles, although physical functioning was better for ToF-patients with ICD than for older ICD-patients (p = 0.01). More inappropriate shocks were found in ToF-patients with ICD compared to the older ICD-patients.

Conclusion

In patients with ToF, ICD implantation had a major impact on psychosocial functioning which should be taken into account when considering ICD implantation in these young patients. To help improve psychosocial functioning, psychological counselling attuned to the specific needs of these patients may be useful.

Comparison of male and female psychological outcomes related to implantable cardioverter defibrillators (COMFORTID)

BACKGROUND

While randomised, controlled trials have established the efficacy of the implantable cardioverter defibrillator (ICD) for primary and secondary prevention of life threatening arrhythmias, psychosocial responses remain complex and poorly understood, especially across Europe. There appears to be a greater need to understand differences in the experience of men and women.

AIM

The aim of this prospective study was to explore differences in psychosocial adjustment over a 12 month period following ICD implantation.

METHODS

Fourteen female and thirty three male device recipients completed a series of questionnaires over a 12 month period. Instruments included a generic and an ICD specific Quality of Life (QOL) measure and the state-trait anxiety inventory.

RESULTS

Women reported higher levels of anxiety than men at discharge but over time demonstrated a significant improvement such that at 4, 8 and 12 months men were more anxious. Women reported significantly poorer emotional wellbeing at discharge, however by 12 months this was significantly improved with no difference in the perceptions held by men and women. Women consistently across the 12 months worried more than men about the impact of the device on appearance.

CONCLUSION

This study confirmed that most individuals adjust positively to the ICD during the first 12 months. Some gender differences in adjustment were evident. Further studies across Europe are warranted to establish gender specific interventions to support men and women as they adapt to life with ICD implants.

COPE-ICD: a randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population

Background

Growing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity. It has been suggested that psychological stress can increase the risk of shock and predict death. Small studies have indicated a beneficial effect arising from exercise training and psychological intervention, therefore a large-scale rehabilitation programme was set up.

Methods/Design

A mixed methods embedded experimental design was chosen to include both quantitative and qualitative measures. A randomised clinical trial is its primary component. 196 patients (power-calculated) were block randomised to either a control group or intervention group at a single centre. The intervention consists of a 1-year psycho-educational component provided by two nurses and a 12-week exercise training component provided by two physiotherapists. Our hypothesis is that the COPE-ICD programme will reduce avoidance behaviour, sexual dysfunction and increase quality of life, increase physical capability, reduce the number of treatment-demanding arrhythmias, reduce mortality and acute re-hospitalisation, reduce sickness leading to absence from work and be cost-effective. A blinded investigator will perform all physical tests and data collection.

Discussion

Most participants are men (79%) with a mean age of 58 (range 20-85). Most ICD implantations are on primary prophylactic indication (66%). 44% is NYHA II. Mean walk capacity (6MWT) is 417 m. Mean perception of General Health (SF-36) is PCS 42.6 and MCS 47.1.

A large-scale ICD rehabilitation trial including psycho-educational intervention and exercise training has been initiated and will report findings starting in 2011.

Trial Registration

ClinicalTrials.gov: NCT00569478

Nurse- and peer-led self-management programme for patients with an implantable cardioverter defibrillator; a feasibility study

Background

The prevalence of cardiovascular disease is increasing. Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, although patients often have difficulty adjusting and regaining control in daily life. In particular, patients who received an implantable cardioverter defibrillator (ICD) experience physical and psychological problems. Interventions to enhance perceived control and acceptance of the device are therefore necessary. This paper describes a small-scale study to explore the feasibility and the possible benefits of a structured nurse- and peer-led self-management programme ('Chronic Disease Self-Management Program' – CDSMP) among ICD patients.

Methods

Ten male ICD patients (mean age = 65.5 years) participated in a group programme, consisting of six sessions, led by a team consisting of a nurse specialist and a patient with cardiovascular disease. Programme feasibility was evaluated among patients and leaders by measuring performance of the intervention according to protocol, attendance and adherence of the participating ICD patients, and patients' and leaders' opinions about the programme. In addition, before and directly after attending the intervention, programme benefits (e.g. perceived control, symptoms of anxiety and depression, and quality of life) were assessed.

Results

The programme was conducted largely according to protocol. Eight patients attended at least four sessions, and adherence ranged from good to very good. On average, the patients reported to have benefited very much from the programme, which they gave an overall report mark of 8.4. The leaders considered the programme feasible as well. Furthermore, improvements were identified for general self-efficacy expectancies, symptoms of anxiety, physical functioning, social functioning, role limitations due to physical problems, and pain.

Conclusion

This study suggests that a self-management programme led by a team consisting of a nurse specialist and a patient with cardiovascular disease seems feasible according to both patients and leaders. The programme may improve general self-efficacy expectancies, symptoms of anxiety, and quality of life (physical functioning, social functioning, role limitations due to physical problems, and pain) as well. Further investigation of the programme's effectiveness among a larger sample of ICD patients or other patient groups with cardiovascular disease, is recommended.