Experiences of adults living with an implantable cardioverter defibrillator for cardiovascular disease: a systematic review of qualitative evidence

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 Published and unpublished papers and articles from 1990 to July 2018 were included in the search.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.

Living at the boundary between life and death: A qualitative study of how patients' lives are impacted by the implantable cardioverter defibrillator

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.

Perceptions and experiences of patients living with implantable cardioverter defibrillators: a systematic review and meta-synthesis

Background

Sudden cardiac deaths have become a growing major public health concern that affects the world. Despite the various etiologies, life-threatening cardiac arrhythmias attribute the main cause of sudden cardiac deaths. Therefore in certain groups of high-risk patients, the Implantable Cardioverter Defibrillator (ICD) has been recommended as either a secondary or primary prophylactic method of prevention.

Objective

To summarise the perceptions of ICD recipients and provide an overview of their experiences with regards to the quality of life, coping strategies, and learning needs.

Methods

A systematic search was conducted using CINAHL, MEDLINE, PsycINFO, Scopus, Cochrane Library, and Web of Science. Primary research articles published from January 2005 to January 2016 that met the inclusion criteria were selected and assessed for methodological quality.

Results

Thirty-nine articles consisting of 16 qualitative studies, 22 quantitative studies, and 1 mixed methods study were included for the meta-synthesis. Findings extracted from these studies were grouped into eight subthemes with ‘living the ICD experience: a constant process of redefining oneself’ emerging as an over-arching theme.

Conclusion

This review provides insight into the perspectives and experiences of ICD recipients. Current evidence highlights the need for healthcare professionals to improve future care standards and develop a patient-centric holistic program that meets the specific needs of ICD recipients. Moreover, future studies are required to address the research gaps identified and also explore the perceptions of patients living with ICD in the Asian context.

Iranian Patients' Experiences of the Internal Cardioverter Defibrillator Device Shocks: a Qualitative Study

Introduction: Implantable Cardioverter Defibrillator (ICD) is a valuable treatment for the patients at risk of sudden cardiac death. In this method, after diagnosis of pathological cardiac rhythms, shock is automatically applied to normalize the rhythms. Shock is discharged when the patients are conscious, but the patients’ experiences of shock have remained unknown. Thus, this study aimed to identify and describe the patients’ experiences of shocks received from ICD.

Methods: The present qualitative study was conducted through thematic analysis and semi-structured interviews on 9 patients mean age 41.55 (1.57) with ICD from November 2013 to July 2014. Data analysis was also performed simultaneously using constant comparative analysis.

Results: In this study, two main themes, namely "with a parachute for life" and "Faced with nuisance", were obtained representing the patients’ experiences regarding ICD shock. With a parachute for life included subthemes, such as "Rebirth", "Comforter and healing", and "Life assurance". In addition, "Faced with nuisance" consisted of 2 subthemes of "Discomfort in moments of shock" and "Displeasure after shock".

Conclusion: This study provided a basis for evaluation of patients nursing after discharge. By identification of the patients’ experiences regarding shock, the present study can help the professional health staff to efficiently play their roles and provide patients with holistic care. It can also be effective in designing behavioral and cognitive interventional programs to change the patients’ attitude and promote their adaptation with their conditions.