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Isella C, Gasparini A, Lucca G, Ielmini M, Caselli I, Poloni N, Dajelli Ermolli C, Caravati F, Castiglioni B, De Ponti R, Callegari C. Resilience, Cardiological Outcome, and Their Correlations With Anxious-Depressive Symptoms and Quality of Life in Patients With an Implantable Cardioverter Defibrillator. Front Psychiatry 2021; 12:763726. [PMID: 34899424 PMCID: PMC8653768 DOI: 10.3389/fpsyt.2021.763726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Resilience is proven as a protective factor against the development of psychiatric disorders, and it has gained clinical relevance in the development and progression of cardiovascular pathology. The authors performed a longitudinal study on patients with implantable cardioverter defibrillator (ICD) with the primary aim to highlight the possible existence of a correlation between individual resilience capacity, depressive and anxiety symptoms, and quality of life in terms of outcomes. The secondary aim was to analyze the differences between patients with major cardiac events in the follow-up and patients without cardiac events with respect to the previous variables. Materials and Methods: A total of 80 patients enrolled in the Cardiology Unit were evaluated at T0 and during the follow-up through the following scales: the 14-item Resilience Scale (RS-14), the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life-Brief Version (WHOQOL-Bref). Results: A significant linear correlation between resilience and all the areas of quality of life at T0, T1, and T2 emerged. A negative correlation between resilience and anxiety and depressive symptoms emerged, as well as between depression and anxiety and quality of life. Patients with cardiac events during the follow up have shown a worse quality of life and the onset of anxiety-depressive symptoms over time, without changes to the resilience scores. Patients without cardiac events showed an increasing trend in resilience scores. Discussion: Given the speed and simplicity of use of the RS-14 scale, it seems promising to further investigate the real clinical usefulness of this instrument in the cardiology field.
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Affiliation(s)
- Celeste Isella
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Alessandra Gasparini
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Giulia Lucca
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Marta Ielmini
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Ivano Caselli
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Nicola Poloni
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
| | - Carlo Dajelli Ermolli
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Battistina Castiglioni
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Roberto De Ponti
- Department of Heart and Vessels, Ospedale di Circolo, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Section of Psychiatry, University of Insubria, Varese, Italy
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HajKheder S, Haase-Fielitz A, Butter C. [Cardiac implantable electronic devices and health-related quality of life]. Herzschrittmacherther Elektrophysiol 2019; 30:160-167. [PMID: 30969354 DOI: 10.1007/s00399-019-0619-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Patients, scientists and healthcare providers are increasingly interested in identifying interventions that not only reduce mortality but also improve symptoms, function and health-related quality of life. Health-related quality of life is a strong, independent predictor of mortality, cardiovascular events, hospitalization and treatment costs in patients with cardiac diseases. Remote monitoring of pacemakers has a positive effect on health-related quality of life and functional capacity and is equivalent to monitoring these patients in hospitals. Implantation of an implantable cardioverter defibrillator has a major impact on mental health, with the majority of patients experiencing the fear of ICD shocks as particularly detrimental to the quality of life. Variables, such as age, gender and duration of implantation should be considered in the assessment and planning of strategies for improving the quality of life of patients with electronic implantable cardiac devices.
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Affiliation(s)
- Salma HajKheder
- Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Ladeburger Str. 17, 16321, Bernau bei Berlin, Deutschland
| | - Anja Haase-Fielitz
- Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Ladeburger Str. 17, 16321, Bernau bei Berlin, Deutschland.
| | - Christian Butter
- Abteilung für Kardiologie, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Hochschulklinikum der Medizinischen Hochschule Brandenburg (MHB) Theodor Fontane, Ladeburger Str. 17, 16321, Bernau bei Berlin, Deutschland
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Allam LE, Nabih MAE, El-Missiry MA. The psychological impact of permanent cardiac pacemakers on pediatric patients and their parents: A case control study. Indian Heart J 2018; 70:872-878. [PMID: 30580859 PMCID: PMC6306355 DOI: 10.1016/j.ihj.2018.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 01/05/2018] [Accepted: 02/28/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND This study assessed anxiety and depression in children with permanent pacemakers (PPM) and quality of life of their parents. METHODS Ninety children (63.3% males and 36.6% females) and their parents were included in the study and were divided into three groups. The control group (Group 1) included 30 normal healthy children (57% males and 43% females), the PPM group (Group 2) included 30 age-matched children (70% males and 30% females) with PPM and structurally normal heart, while the Group 3 included 30 children (63% males and 37% females) with PPM and congenital heart disease (PPM+CHD). Psychological assessment of children and their parents was carried out using an interview-based questionnaires. RESULTS Psychiatric disorders were more prevalent in PPM+CHD group including depression (P=0.04), anxiety (P=0.02) and lower parents' QoL (P=0.01). The PPM group had higher depression and lower parents' QoL than the control group. Family income was independent factor for depression (r2=-6.3, with P<0.05). Sex of the child and CCU admission were independent factors for anxiety (r2=-9.5, P<0.05 & r2=10.5, P=0.001) in PPM group. CONCLUSION Children with pacemakers have higher psychiatric disorders and their parents have lower QoL.
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Affiliation(s)
- Lamyaa Elsayed Allam
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Marwa Adel El-Missiry
- Department of Neuro-psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Frydensberg VS, Skovbakke SJ, Pedersen SS, Kok RN. Body image concerns in patients with an implantable cardioverter defibrillator: A scoping review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1235-1260. [DOI: 10.1111/pace.13421] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/14/2018] [Accepted: 06/10/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | - Søren J. Skovbakke
- Department of Psychology; University of Southern Denmark; Odense Denmark
| | - Susanne S. Pedersen
- Department of Cardiology; Odense University Hospital; Odense Denmark
- Department of Psychology; University of Southern Denmark; Odense Denmark
| | - Robin N. Kok
- Department of Psychology; University of Southern Denmark; Odense Denmark
- Centre for Innovative Medical Technology; Odense University Hospital; Odense Denmark
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Albarran JW, Tagney J, James J. Partners of ICD Patients—An Exploratory Study of Their Experiences. Eur J Cardiovasc Nurs 2016; 3:201-10. [PMID: 15350229 DOI: 10.1016/j.ejcnurse.2004.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2004] [Revised: 06/21/2004] [Accepted: 06/22/2004] [Indexed: 11/21/2022]
Abstract
BACKGROUND The experiences of partners who care for and support the needs of a loved one with an implantable cardiac defibrillator (ICD) remain largely unknown within Europe. AIMS This study explored the nature of partner's experiences from the pre-ICD implantation phase up until a maximum of 20 months at home. METHODS Eight partners cohabiting with a recipient of an ICD were interviewed using a semistructured schedule. All interviews were transcribed and content analysed for emerging categories and themes. FINDINGS Four themes representing 11 categories conceptualised the partners' experiences, these included: Acknowledging the patient's need for the device, reactions to the device, safeguarding the patient, and returning to normality. CONCLUSION This qualitative study suggests that partners of ICD recipients progress through various difficult and adaptive stages when learning how best to support the patient. A point is reached when most are able to assume control and normalise their lives. This transformation is slow; however, to improve this process and empower partners, nurses should provide relevant information and include them in decisions affecting the patient. Further research into the unique needs of partners, which includes international perspectives, would be significant in developing practice and theory in this area.
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Affiliation(s)
- John W Albarran
- Faculty of Health and Social Care, Critical Care Nursing, University of the West of England, Glenside Campus, Blackberry Hill, Bristol, BS16 1DD, UK.
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Dougherty CM, Fairbanks AM, Eaton LH, Morrison ML, Kim MS, Thompson EA. Comparison of patient and partner quality of life and health outcomes in the first year after an implantable cardioverter defibrillator (ICD). J Behav Med 2015; 39:94-106. [PMID: 26345262 DOI: 10.1007/s10865-015-9671-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/13/2015] [Indexed: 02/04/2023]
Abstract
Recovery following an implantable cardioverter defibrillator (ICD) impacts both the patient and partner, often in divergent ways. Patients may have had a cardiac arrest or cardiac arrhythmias, whereas partners may have to perform CPR and manage the ongoing challenges of heart disease therapy. Currently, support for post-ICD care focuses primarily on restoring patient functioning with few interventions available to partners who serve as primary support. This descriptive study examined and compared patterns of change for both patients and partners during the first year post-ICD implantation. For this longitudinal study, the sample included 42 of 55 (76.4 %) patient-partner dyads who participated in the 'usual care' group of a larger intervention RCT with patients following ICD implant for secondary prevention of cardiac arrest. Measures taken at across five time points (at hospital discharge and at 1, 3, 6 and 12 months follow up) tracked physical function (SF-12 PCS, symptoms); psychological adjustment (SF-12 MCS; State-Trait Anxiety Inventory; CES-D); relationship impact (Family Functioning, DOII; Mutuality and Interpersonal Sensitivity, MIS); and healthcare utilization (ED visits, outpatient visits, hospitalizations). Repeated measures analysis of variance was used to characterize and compare outcome trends for patients and partners across the first 12 months of recovery. Patients were 66.5 ± 11.3 (mean + SD) years old, predominately Caucasian male (91 %), with Charlson co-morbidities of 4.4 ± 2.4. Partners were 62.5 ± 11.1 years old, predominantly female (91 %) with Charlson co-morbidities of 2.9 ± 3.0. Patient versus partner differences were observed in the pattern of physical health (F = 10.8, p < 0.0001); patient physical health improved while partner health showed few changes. For partners compared to patients, anxiety, depression, and illness demands on family functioning tended to be higher. Patient mutuality was stable, while partner mutuality increased steadily (F = 2.5, p = 0.05). Patient sensitivity was highest at discharge and declined; partner sensitivity increased (F = 10.2, p < 0.0001) across the 12-month recovery. Outpatient visits for patients versus partners differed (F = 5.0, p = 0.008) due most likely to the number of required patient ICD visits. Total hospitalizations and ED visits were higher for patients versus partners, but not significantly. The findings highlight the potential reciprocal influences of patient and partner responses to the ICD experience on health outcomes. Warranted are new, sound and feasible strategies to counterbalance partner needs while simultaneously optimizing patient recovery outcomes.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, 1959 NE Pacific Street, HSB T615A, Box 357266, Seattle, WA, 98195-7266, USA.
| | | | - Linda H Eaton
- University of Washington School of Nursing, Seattle, WA, USA
| | | | - Mi Sun Kim
- University of Washington School of Nursing, Seattle, WA, USA
| | - Elaine A Thompson
- Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
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Development and testing of an intervention to improve outcomes for partners following receipt of an implantable cardioverter defibrillator in the patient. ANS Adv Nurs Sci 2012; 35:359-77. [PMID: 23107992 DOI: 10.1097/ans.0b013e318271d2e8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this article is to describe 3 foundational studies and how their results were used to formulate, design, and test a novel partner intervention for implementation in the immediate post-ICD (implantable cardioverter defibrillator) period after returning home. Nursing's expanding role into chronic illness management in the creation of evidence-based practice is highlighted. A randomized clinical trial comparing 2 intervention programs is being conducted with patients who receive an ICD for the first time and their intimate partners. Primary outcomes are physical functioning, psychological adjustment, relationship impact, and health care utilization.
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Ginzburg D, Tavenaux M, Sperzel J, Boukacem A, Hamm C, Jordan J. [An outpatient education program for patients and partners after implantation of implantable cardioverter defibrillators (ICD)]. Herzschrittmacherther Elektrophysiol 2011; 22:157-165. [PMID: 21822648 DOI: 10.1007/s00399-011-0146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The implantation of an implantable cardioverter defibrillator (ICD) is commonly followed by a physical and psychological process of adaptation to the new situation. Psychological support is often not provided and patients are left alone with questions and their needs. Because of the emerging sense of support group programs have proven to be apt for clearing up questions and addressing personal concerns. In the present study a psychoeducational program is presented and evaluated in detail. MATERIAL AND METHODS A total of 308 patients with ICDs as well as their partners participated in a 2 day psychoeducational program. Of the patients 100 as well as their partners were asked to complete questionnaires concerning anxiety and depression (HADS) as well as their satisfaction with the program. The program consists of five modules: a warm up and getting to know each other; medical and technical information concerning the ICD, psychoeducation concerning the topics anxiety and avoidance, relaxation and an experience report of a patient who has had an ICD for many years. RESULTS The evaluation results of 72 participants are present. All patients would definitively recommend participation in the program to other patients with an ICD without restrictions. The satisfaction with the five different modules of the intervention was very high. The depression as well as the anxious symptomatology in the HADS decreased significantly in the 1 year follow-up but did not exceed the cut-off point of 8. The anxiety and depression symptoms of the partners decreased significantly and exceeded the cut-off point of 8 in the follow-up.
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Affiliation(s)
- D Ginzburg
- Abteilung für Psychokardiologie, Herz- Thorax- und Rheumazentrum, Kerckhoff Klinik, Ludwigstr. 41, 61231, Bad Nauheim, Deutschland.
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VAN DEN BROEK KRISTAC, HABIBOVIĆ MIRELA, PEDERSEN SUSANNES. Emotional Distress in Partners of Patients with an Implantable Cardioverter Defibrillator: A Systematic Review and Recommendations for Future Research. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1442-50. [DOI: 10.1111/j.1540-8159.2010.02885.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dougherty CM, Thompson EA. Intimate partner physical and mental health after sudden cardiac arrest and receipt of an implantable cardioverter defibrillator. Res Nurs Health 2009; 32:432-42. [PMID: 19434648 DOI: 10.1002/nur.20330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to describe the physical and mental health of the intimate partners of persons receiving an implantable cardioverter defibrillator (ICD). A prospective longitudinal repeated measures design was used, with data collected at hospital discharge, and at 1, 3, 6, and 12 months after implantation. Intimate partners' physical health, symptoms, and depression significantly declined over the first year. Although anxiety was significantly reduced over time, it remained elevated in partners after 1 year. The impact of implantation of the ICD on the intimate relationship and care demands was most dramatic at hospital discharge. Health care use was low throughout the year. Intimate partners could benefit from an intervention that would assist in their psychological adjustment and provide strategies for dealing with caregiving demands at home.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Box 357266, Seattle, WA, USA
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Sears SF, Todaro JF, Lewis TS, Sotile W, Conti JB. Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review. Clin Cardiol 2009; 22:481-9. [PMID: 10410293 PMCID: PMC6656039 DOI: 10.1002/clc.4960220709] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life-threatening ventricular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well understood. HYPOTHESIS The purposes of this paper are (1) to review the available literature documenting the psychosocial impact of the ICD on patients, (2) to hypothesize possible mechanisms for this psychosocial impact, and (3) to suggest clinical risk profiles and indications for psychological consultation. METHODS Electronic and library searches (e.g., MEDLINE, PsychLit) were used to gather studies examining the psychosocial impact of the ICD. Only studies investigating psychosocial outcomes (e.g., psychological distress, quality of life, social and role functioning), either prospectively or cross-sectionally, were admitted into the review. No literature reviews or secondary sources were included. RESULTS AND CONCLUSIONS Current research suggests that ICD-specific fears and symptoms of anxiety (e.g., excessive worry, physiological arousal) are the most common psychological symptoms experienced by ICD recipients, with approximately 13-38% of recipients experiencing diagnosable levels of anxiety. Depressive symptoms are reported at rates that are generally consistent with other cardiac populations. Although the incidence of psychological disorders appears to be similar to that found in general cardiac populations, specific ICD-related concerns such as fear of shock, fear of device malfunction, fear of death, and fear of embarrassment have been identified. Selected psychological theories such as classical conditioning, learned helplessness, and a cognitive appraisal model help to explain the occurrence of psychological symptoms post implantation. Psychosocial adjustment risk profiles indicate that young ICD recipients and those with high discharge rates may experience the most adjustment difficulties.
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Affiliation(s)
- S F Sears
- University of Florida, Department of Clinical and Health Psychology, Gainesville 32610, USA
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Abstract
BACKGROUND AND OBJECTIVE The quality of life (QOL) of patients with ventricular dysrhythmias is well studied, but less is known about the QOL of their partners. This study describes the QOL of partners of patients with serious ventricular dysrhythmias enrolled in the Antiarrhythmics Versus Implantable Defibrillators trial. SUBJECTS AND METHODS A convenience sample of 124 partners of patients randomized to antiarrhythmic drugs (n = 59) or an implantable cardioverter defibrillator (n = 65) in the Antiarrhythmics versus Implantable Defibrillators trial was obtained. The Short Form-36 and Quality of Life Index were assessed at baseline (postrandomization) and at 3-, 6-, and 12-month follow-up. RESULTS AND CONCLUSIONS The mean age of the partners was 62 years. Most were white and female. Their mean Short Form-36 scores were comparable to a normative age group. Partner and participant mean Short Form-36 and Quality of Life Index scores correlated modestly (range 0.25-0.36). The physical summary scores of partners using the Short Form-36 declined over time, whereas their mental summary scores remained stable. Partner concerns related to death, dysrhythmia recurrence, and the impact of dysrhythmias on enjoyment of life lessened from baseline to 12 months. Concern about implantable cardioverter defibrillator function remained stable over time. Although the sample size of this study was relatively small and limited by missing data for some assessments, it is the largest prospective study of QOL in partners of patients with serious dysrhythmias. The results offer a foundation for future research of the partners of patients with serious dysrhythmias in terms of identifying their needs, offering support, and maximizing QOL.
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Abstract
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.
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Affiliation(s)
- Ann Sossong
- School of Nursing, University of Maine, Orono, ME 04469, USA.
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Bilge AK, Ozben B, Demircan S, Cinar M, Yilmaz E, Adalet K. Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 29:619-26. [PMID: 16784428 DOI: 10.1111/j.1540-8159.2006.00409.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are life-saving devices in treatment of life-threatening arrhythmia. We evaluate the emotional status of Turkish patients with ICD and try to explain factors that affect emotional status of the patients. METHODS Ninety-one patients with previously implanted ICD were included in the study. Follow-up periods, presence of ICD shock, shock frequency, time of the recent shock, age, and gender were noted. Depression and anxiety scores were evaluated according to Hospital Anxiety and Depression (HAD) chart. RESULTS Mean anxiety and depression scores were found as 9.1 +/- 5.3 and 7.2 +/- 5.1, respectively. According to HAD charts, 42 patients (46%) had anxiety and 37 patients (41%) had depression. Depression scores indicated significant difference between subgroups divided on the basis of follow-up periods (P = 0.026) and on the basis of time of recent shock (P = 0.028). There was significant difference in anxiety scores (P = 0.016) between patients with ICD shocks and patients with no shocks. When the patients were divided into subgroups according to shock frequency, both depression (P = 0.024) and anxiety (P = 0.016) scores presented significant difference. In female patients, depression and anxiety scores were found significantly higher compared to male patients (P = 0.046 and P = 0.016, respectively). In multivariate analysis, gender and shock frequency were found as predictors for anxiety scores (P = 0.019 and P = 0.044, respectively). However same analysis revealed no predictive factor for depression score. CONCLUSION Our study indicates presence of depression and anxiety in nearly half of the patients with ICD. Consultation with psychiatry should be a part of the treatment for patients with ICD, especially for those who constitute high-risk groups.
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Affiliation(s)
- Ahmet Kaya Bilge
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Suyama-Chishaki A, Miyazono M, Tsuchihashi-Makaya M, Chishaki H, Inoue S, Mukai Y, Takemoto M, Kaji R, Koike G, Maruyama T, Sunagawa K, Arimura T, Kubo C. Quality of Life and Psychological Factors in Patients with Implantable Cardioverter Defibrillator. J Arrhythm 2007. [DOI: 10.1016/s1880-4276(07)80031-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ladwig KH, Deisenhofer I, Simon H, Schmitt C, Baumert JJ. Characteristics associated with low treatment satisfaction in patients with implanted cardioverter defibrillators: results from the LICAD study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 28:506-13. [PMID: 15955182 DOI: 10.1111/j.1540-8159.2005.09509.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The evaluation of low treatment satisfaction (LTS) with an implanted cardioverter defibrillator (ICD) remains a neglected area of clinical research. However, a trustful attitude toward an ICD is crucial. Within the scope of ICD health technology assessment, we searched for predictors of LTS. Of 195 ICD patients enrolled (mean 59.8 years, standard deviation 12.6), 163 (83.6%) were men and 26 (16.4%) were women. We measured anxiety, helplessness, and depression with standardized instruments and LTS with 11 dichotomous items concerning a mistrustful attitude, a negative body image, and low appraisal. A total of 47 (24.1%) patients were considered as LTS patients. Multivariate logistic regression was used for assessment of LTS. Adjusted for age and survey, LTS was significantly more prevalent in depressed, anxious, and phobic patients. Multivariate logistic regression including medical and psychological covariates revealed the experience of > or =5 shocks with an odds ratio (OR) of 10.17 (95% CI 3.57-29.00, P < or = 0.001), being employed with an OR of 8.07 (95% CI 2.39-27.19, P < or = 0.001), and feelings of helplessness (OR 4.61, 95% CI 1.79-11.90, P < or = 0.002) as the most important predictors for LTS. Women had a slightly not significant effect on LTS. Age, educational status, and depression were not significant. LTS patients required more support for living with the ICD (P < or = 0.001). Thus, LTS serves as surrogate measure for deteriorated psychic health. Clinicians should be advised to identify LTS patients and to consider psychotherapeutic counseling for them.
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Affiliation(s)
- Karl-Heinz Ladwig
- Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Med. Psychologie des Klinikums rechts der Isar der Technischen Universität München, Langerstrasse 3, 81675 Munich, Germany.
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Steinke EE, Gill-Hopple K, Valdez D, Wooster M. Sexual concerns and educational needs after an implantable cardioverter defibrillator. Heart Lung 2005; 34:299-308. [PMID: 16157184 DOI: 10.1016/j.hrtlng.2005.03.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2004] [Revised: 02/28/2005] [Accepted: 03/04/2005] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Elaine E Steinke
- Wichita State University, School of Nursing, Wichita, Kansas 67260, USA
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18
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Steinke EE. INTIMACY NEEDS AND CHRONIC ILLNESS: Strategies for Sexual Counseling and Self-Management. J Gerontol Nurs 2005; 31:40-50. [PMID: 15916202 DOI: 10.3928/0098-9134-20050501-08] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Elaine E Steinke
- School of Nursing, Wichita State University, Kansas 67260-0041, USA
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Kamphuis HCM, Verhoeven NWJM, Leeuw R, Derksen R, Hauer RNW, Winnubst JAM. ICD: a qualitative study of patient experience the first year after implantation. J Clin Nurs 2004; 13:1008-16. [PMID: 15533107 DOI: 10.1111/j.1365-2702.2004.01021.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The experiences of how patients live with an implantable cardioverter defibrillator are still poorly understood. Only a few qualitative studies have investigated this phenomenon. This paper was undertaken as part of a larger project to evaluate quality of life and psychological well-being in those survivors of cardiac arrest who have received an implantable cardioverter defibrillator. AIMS AND OBJECTIVES The aim of this qualitative study was to explore how implantable cardioverter defibrillator recipients perceive their lives during the first year after implantation of the device. METHODS A sample of 21 patients who received an implantable cardioverter defibrillator was interviewed during three consecutive periods: one, six and 12 months postdischarge from the hospital. The semi-structured interviews were based on insights gained from a literature review. The transcripts were subjected to content analysis. RESULTS Analysis of the data revealed seven major categories: physical deterioration, cognitive changes, perceived social support, dependency, contact with the doctor, confrontation with mortality and uncertainty surrounding having a shock. Anxiety, uncertainty, disappointment, frustration, unexpected barriers, acceptance of and dependency on the implantable cardioverter defibrillator played a major role in the lives of implantable cardioverter defibrillator recipients. Well-being improved throughout the year. During the first months after discharge from the hospital the focus was on regaining physical health. During the early postimplantation period both the implantable cardioverter defibrillator recipient and family members had adapted to the situation. Reflection on the impact and consequences of the cardiac arrest was reported more often in the late postimplantation period. CONCLUSIONS Content analysis is a resourceful approach giving answers to questions that have hardly been addressed within the domain of cardiology. Implantable cardioverter defibrillator recipients face a complex first year, especially the first 6 months. Cognitive deterioration and confrontation with mortality are problems that need to be researched further. RELEVANCE TO CLINICAL PRACTICE Caregivers are able to explain to future patients what they can expect in the first year after implantation. Caregivers may become more receptive to physical, psychological and social limitations and to emotional and social problems that occur in implantable cardioverter defibrillator recipients, enabling them to act upon them.
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Affiliation(s)
- Helen C M Kamphuis
- Research Group Psychology of Health and Illness, and Heart Lung Institute, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Davis LL, Vitale KA, Irmiere CA, Hackney TA, Belew KM, Chikowski AMR, Sullivan CA, Hellkamp AS, Schron EB, Lamas GA. Body image changes associated with dual-chamber pacemaker insertion in women. Heart Lung 2004; 33:273-80. [PMID: 15454905 DOI: 10.1016/j.hrtlng.2004.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The study's purpose was to examine body image changes in subjects participating in a long-term multicenter pacemaker trial. METHODS At study closeout, 383 adults, all of whom had received a dual-chamber pacemaker, completed questionnaires evaluating what effect their pacemaker or pacemaker site and scar had on them or their spouses or significant others. RESULTS Most reported that their pacemaker did not change the way they or their spouses or significant others felt about their body (73.2% and 93.5%, respectively). Most (87.1%) denied feeling differently because of the pacemaker site and scar. Most were not concerned how their clothes fit or about wearing a swimsuit (92.0% and 90.7%, respectively). Women were more concerned about how the pacemaker site and scar made them feel about their body (P =.001), clothes fitting (P =.002), and wearing a swimsuit (P =.004). Men were more concerned with how their spouses or significant others perceived them postimplantation (P =.021). CONCLUSIONS Most subjects did not express undue concern about changes in body image.
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Affiliation(s)
- Leslie L Davis
- University of North Carolina, Chapel Hill, NC 27599, USA
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21
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Dougherty CM, Pyper GP, Frasz HA. Description of a nursing intervention program after an implantable cardioverter defibrillator. Heart Lung 2004; 33:183-90. [PMID: 15136779 DOI: 10.1016/j.hrtlng.2004.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although implantable cardioverter defibrillator (ICD) therapy has been found to be effective in preventing and treating life-threatening arrhythmias, adjusting to the ICD and resuming a normal lifestyle are often difficult. There are few intervention trials reported in the literature to aid in adjustment after receiving a primary ICD. OBJECTIVE This article describes the content and structure of a nursing intervention program designed to improve physical functioning and psychologic adjustment after ICD implantation. The nursing intervention program was based on social cognitive theory and the data from a previous investigation covering 7 areas of concern after ICD implantation. CONCLUSION Hospital-based education programs begin the process of recovery after ICD implantation, but they must be supplemented with further interventions to return the patient to baseline physical and psychologic functioning. This is a beginning effort in deriving and testing evidence-based intervention programs for patients with an ICD.
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Affiliation(s)
- Cynthia M Dougherty
- Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing, Seattle 98195-7266, USA
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22
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Edelman S, Lemon J, Kidman A. Psychological therapies for recipients of implantable cardioverter defibrillators. Heart Lung 2003; 32:234-40. [PMID: 12891163 DOI: 10.1016/s0147-9563(03)00037-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Implantable Cardioverter Defibrillators (ICDs) are an increasingly common therapy for the treatment of ventricular arrhythmias. Whereas most ICD recipients adjust well to living with the implant, a substantial minority suffer anxiety, depression, and anger that appears to be related to the ICD. A large number of studies have reported on the incidence of psychopathology and common psychosocial problems among patients with ICDs, however very few psychological interventions with this cohort have been reported. In an extensive literature search we identified only a handful of studies that described outcomes of psychological interventions, and most of these were in pilot form. Only one randomized controlled study with a homogenous sample of ICD patients has been reported to date. Given the unique situation of patients with ICDs and the particular vulnerability of those who experience frequent shocks, the evaluation of interventions that may improve psychological adjustment within this group would appear a worthwhile endeavor.
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Affiliation(s)
- Sarah Edelman
- Health Psychology Unit, University of Technology, Sydney, Australia
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23
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Steinke EE. Sexual concerns of patients and partners after an implantable cardioverter defibrillator. Dimens Crit Care Nurs 2003; 22:89-96. [PMID: 12649620 DOI: 10.1097/00003465-200303000-00007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Fitchet A, Doherty PJ, Bundy C, Bell W, Fitzpatrick AP, Garratt CJ. Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial. Heart 2003; 89:155-60. [PMID: 12527665 PMCID: PMC1767543 DOI: 10.1136/heart.89.2.155] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate the effects of a 12 week comprehensive cardiac rehabilitation (CCR) programme on patients who have undergone implantation of an implantable cardioverter-defibrillator (ICD). DESIGN Sixteen patients with ICDs (14 (88%) male, mean (SD) age 58 (10) years, range 34-74 years) were randomised to either attend an individually tailored CCR programme or receive usual care. They then changed to the alternative regimen for a further 12 weeks. Exercise capacity was assessed using a treadmill exercise test at baseline, after usual care, after CCR and 12 weeks after CCR to assess maintenance effects. Hospital anxiety and depression (HAD) scores were recorded at each stage. RESULTS Exercise times (min:s; mean (SD)) increased by 16% from a baseline mean of 9:55 (2:33) to 11:11 (2:17) following attendance at CCR (95% confidence interval (CI) 0:34 to 1:58; p = 0.001). This improvement was maintained 12 weeks after attendance at CCR, at 11:20 (2:17) (p = 1.00). HAD scores for anxiety and depression decreased during CCR from a baseline of 13.4 (3.6) to 8.1 (3.6), 95% CI 3.5 to 7.0 (p < 0.001) and 9.9 (3.4) to 6.7 (2.9), 95% CI 1.9 to 4.4 (p = 0.002), respectively. These improvements were maintained at 12 weeks after CCR. No ventricular arrhythmias or ICD discharges occurred during the exercise components of the CCR. The total number of ventricular arrhythmias and ICD discharges was similar 12 weeks before, during, and 12 weeks after CCR. CONCLUSIONS CCR appears to be safe for patients with ICDs. It can improve exercising ability and lower the levels of psychological distress. A larger multicentre study is recommended to confirm these findings.
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Affiliation(s)
- A Fitchet
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK.
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25
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Irvine J, Dorian P, Baker B, O'Brien BJ, Roberts R, Gent M, Newman D, Connolly SJ. Quality of life in the Canadian Implantable Defibrillator Study (CIDS). Am Heart J 2002; 144:282-9. [PMID: 12177646 DOI: 10.1067/mhj.2002.124049] [Citation(s) in RCA: 227] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The primary aim of this study was to compare quality-of-life outcome between patients randomized to implantable cardioverter defibrillator (ICD) therapy and patients randomized to amiodarone treatment in the Canadian Implantable Defibrillator Study (CIDS). A secondary aim was to evaluate the effects on quality-of-life outcomes of receiving shocks from the device. METHODS Quality of life was assessed in 317 English-speaking participants by use of the Rand Corporation's 38-item Mental Health Inventory (MHI) and the Nottingham Health Profile (NHP). Assessments were done in the hospital at baseline and with mailed questionnaires after 2, 6, and 12 months of follow-up. Sixty-two percent of patients completed the follow-up assessments at 6 and 12 months. RESULTS Repeated measures analysis of variance revealed significant time by treatment group interaction effect on total MHI and the psychological distress and psychological well-being sub-scales, and on 5 of the 7 NHP scales (energy, physical mobility, emotional reactions, sleep disturbance, and lifestyle impairment) (P <.05). Emotional and physical health scores were shown to improve significantly in the ICD group and were either unchanged (emotional health) or deteriorated (energy and physical mobility) in the amiodarone-treated group by means of post-hoc comparisons. Quality of life did not improve in the subgroup of patients in the ICD-treated group who received > or =5 shocks from their device. CONCLUSION Quality of life is better with ICD therapy than with amiodarone therapy. The beneficial quality-of-life effects from an ICD are not evident in patients who receive numerous shocks from their device.
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Affiliation(s)
- Jane Irvine
- Department of Psychology, York University, University of Toronto, Ontario, Canada.
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26
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Carlsson E, Olsson SB, Hertervig E. The role of the nurse in enhancing quality of life in patients with an implantable cardioverter-defibrillator: the Swedish experience. PROGRESS IN CARDIOVASCULAR NURSING 2002; 17:18-25. [PMID: 11872977 DOI: 10.1111/j.0889-7204.2002.00613.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During the last 10-15 years, the implantable cardioverter-defibrillator (ICD) has become an important mode of treatment for patients suffering from grave ventricular arrhythmias, but ICD implantation involves psychosocial adjustments for both patients and relatives. The aim of this pilot study was to design a plan of education and to follow a selected group of patients with interviews, observations, and a questionnaire. The goals included seeing how well they accepted their situation after the operation when they had ongoing support of the nurse, in comparison to a control group who received conventional patient education by the physician. The patients were randomly allocated into two groups. Twenty patients were recruited, 10 in the study group and 10 in the control group, between February, 1997 and April, 1998. There were 16 men (average age, 63) and four women (average age, 57). The Nottingham Health Profile was used to measure health-related quality of life. Sleep disturbances were the greatest problem in both the study group and the control group before ICD implantation. In the study group, there was a significant improvement (p<0.05) after ICD implantation in four patients. The study also revealed a difference between men and women, with women having more sleep disturbances before ICD implantation than men (p<0.05). In both groups, there was a lack of energy and emotional reactions, both before and after ICD implantation. Few considered family life a problem before or after the study. In the control group, the patients missed the lack of contact with health care personnel more than in the study group. There was also a greater need for group meetings after the hospital stay. By means of the questionnaire, interviews, and observations, it became evident that there was a great need for information, and a plan of patient education in addition to follow-up by the nurse was felt to be very important.
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Affiliation(s)
- Eva Carlsson
- Department of Cardiology, Lund University Hospital, Lund, Sweden
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27
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Eckert M, Jones T. How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families? Int J Nurs Pract 2002; 8:152-7. [PMID: 12000634 DOI: 10.1046/j.1440-172x.2002.00357.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Marion Eckert
- Evaluations, Joanna Briggs Institute for Evidence Based Nursing and Midwifery, Royal Adelaide Hospital, South Australia, Australia.
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28
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Marx A, Bollmann A, Dunbar SB, Jenkins LS, Hawthorne M. Psychological reactions among family members of patients with implantable defibrillators. Int J Psychiatry Med 2002; 31:375-87. [PMID: 11949736 DOI: 10.2190/5rfm-c4ug-vvbl-3kv6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe psychological reactions among family members of patients receiving an implantable cardioverter/defibrillator (ICD) during the first 9 months after implantation. METHODS Eighty-two family members (age 56+/-12 years, 74 percent female, 79 percent married, 88 percent Caucasian) of ICD patients completed questionnaires regarding their mood (Profile of Mood State), cognitive illness appraisals (Meaning of Illness Questionnaire) and coping strategies (Jalowiec Coping Scale) prior to ICD implantation, and as well as 1 and 9 months postoperatively. RESULTS Total mood disturbance score (TMD), threat appraisal, and emotion- and problem-focused coping were highest prior to ICD implantation, and decreased during the first postoperative month showing stable values thereafter. There was no change in challenge appraisal. Multiple regression analysis found that the use of psychotropic drugs (anxiolytics, sedatives; Beta = .25), emotion-focused coping (Beta = .37), and challenge appraisal (Beta =-.21) at 1 month accounted for 26 percent of variance in TMD at 9 mon ths. CONCLUSION A spouse's ICD implantation is a major stressful event for family members leading to a diminished mood state prior ICD implantation. Reduction in emotion-focused coping and the use of challenge appraisal may improve mood state in family members of ICD patients during early follow-up.
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Affiliation(s)
- A Marx
- University Hospital Magdeburg, Germany
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29
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Abstract
Sudden cardiac death (SCD) remains a significant problem despite an overall reduction in other cardiac related deaths in recent years. Research supports the use of the implantable cardioverter defibrillator (ICD) as an effective means of treating dangerous ventricular tachydysrhythmias to prevent SCD. The issue that demands increasing attention is the psychologic experience of ICD recipients. Although the ICD is clearly a technological success, there is evidence that recipients experience strong physical and emotional reactions to the device. Such quality of life issues are worthy of a multidisciplinary effort directed at facilitating patient acceptance and adaptation to technology that although potentially life-saving, may also be unpredictable and anxiety provoking.
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Affiliation(s)
- Megan M White
- Lutheran General Hospital, Park Ridge, Illinois, USA
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30
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Pelletier D, Gallagher R, Mitten-Lewis S, McKinley S, Squire J. Australian implantable cardiac defibrillator recipients: quality-of-life issues. Int J Nurs Pract 2002; 8:68-74. [PMID: 11993579 DOI: 10.1046/j.1440-172x.2002.00345.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Implantable cardioverter defibrillators (ICDs) have become a well-established therapy for people experiencing potentially lethal dysrhythmias. Australian recipients' quality of life and adjustment to the device over time, device-related complications, shock and associated sensations, and potential sequelae have not been widely explored. This paper reports a longitudinal prospective study of Australian ICD recipients (n = 74) to determine their responses to the device, health-related quality of life over time and shock experiences. A questionnaire designed for the study and the Medical Outcomes Trust Quality of Life Instrument, the SF36, were completed by recipients prior to and at 3 and 12 months post insertion. Results show that quality of life decreased for general health and social function between 3 and 12 months. Nearly half (49%) of the recipients received shocks within 12 months and the majority (92%) of these experienced sequelae that could make driving hazardous. Half of the population (49%) were driving at 3 months and 69% by 12 months, including 67% of those who had been shocked. Twenty-seven percent were hospitalized with device-related complications. Driving, the shock experience and rehospitalization, the shock experience and driving behaviour are significant issues for those with the implanted device. While it is a limitation of the study that partners and carers were not included, these findings will also be of interest to them.
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Affiliation(s)
- Dianne Pelletier
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia.
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31
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Hundertmark JD. Iatrogenic anxiety disorder related to failure of implantable defibrillator. Gen Hosp Psychiatry 2001; 23:166-7. [PMID: 11447986 DOI: 10.1016/s0163-8343(01)00132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Duru F, Büchi S, Klaghofer R, Mattmann H, Sensky T, Buddeberg C, Candinas R. How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life? Heart 2001; 85:375-9. [PMID: 11250956 PMCID: PMC1729685 DOI: 10.1136/heart.85.4.375] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess differences in psychosocial adaptation, quality of life, and incidence of affective disorders between patients with pacemakers and those with implantable cardioverter-defibrillators (ICDs). DESIGN Patients aged 40-70 years who underwent a first pectoral implantation of a pacemaker or an ICD system were studied. All subjects were asked to complete the hospital anxiety and depression scale (HAD), the short form general health survey (SF-36), and a specially designed device related questionnaire. Data analysis was performed for three patient groups: pacemaker (n = 76), ICD patients who received therapeutic shocks (n = 45), and ICD patients who did not receive shocks (n = 31). RESULTS There were no differences between the three patient groups in HAD scores or in any of the SF-36 subscales or summary ratings. Probable depressive disorder (depression score > 10) was observed in 5.2%, 6.5%, and 6.6%, and probable anxiety disorder (anxiety score > 10) in 13.1%, 9.7%, 13.3% of the pacemaker, non-shocked ICD, and shocked ICD patients, respectively. There were no sex differences. However, patients in the shocked ICD group were more likely than those in the other groups to report limitations in their leisure activities, to perceive their device as a "life extender," and to admit anxiety about battery depletion and technical problems. Forty per cent of shocked ICD patients would be interested in joining a support group. CONCLUSIONS Despite having distinctly different medical histories and treatments, patients with pacemakers and ICDs responded similarly to validated tools of health status assessment. ICD patients who had received shocks perceived their device as prolonging their life and had greater anxiety about technical problems. Their endorsement of the potential benefits of a support group warrants further investigation.
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Affiliation(s)
- F Duru
- Arrhythmia Unit, Division of Cardiology, Department of Internal Medicine, University Hospital, Rämistr 100, 8091 Zurich, Switzerland.
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33
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Dunbar SB, Kimble LP, Jenkins LS, Hawthorne M, Dudley W, Slemmons M, Langberg JJ. Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation. Depress Anxiety 2000; 9:163-8. [PMID: 10431681 DOI: 10.1002/(sici)1520-6394(1999)9:4<163::aid-da3>3.0.co;2-b] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Life stresses and negative emotions, such as anxiety and depression, are associated with adverse cardiac events, including arrhythmia. Patients undergoing implantation of an automatic internal cardioverter defibrillator provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device. OBJECTIVES The purpose of this study was to examine the association of emotional status after internal cardioverter defibrillator (ICD) implantation and subsequent arrhythmia events. METHODS An analysis of data obtained in a prospective longitudinal study of responses to the ICD measured mood disturbance (Profile of Mood States; POMS) before implant and at 1, 3, 6, and 9 months postoperatively. Subjects included 144 men and 32 women with a mean age of 60 +/- 13 years and a mean left ventricular ejection fraction (LVEF) of 33 +/- 12%. Arrhythmia events were measured by self-report of shocks and by ICD device interrogation to obtain the number and type (defibrillation, cardioversion, and antitachycardia pacing) of therapies delivered by the ICD. For each time point, POMS scores of subjects who had arrhythmia events were compared with those who did not. For subjects who had ICD shocks, pre-event and post-event POMS scores were also compared. Multiple logistic regression was used at each time point to determine if clinical, demographic and psychological data could predict arrhythmia events. RESULTS Patients with arrhythmia events had higher POMS scores throughout the 9 months of follow-up. Higher level of mood disturbance (specifically anxiety, fatigue, and confusion) at 1 and 3 months were independent predictors of subsequent arrhythmia events at 3 and 6 months after controlling for LVEF, the presence of coronary artery disease, pre-implant arrhythmia history, and the use of amiodarone and beta-blocking agents. There were no differences in POMS scores before and after ICD shocks, reinforcing the notion that negative emotions were a cause, rather than a consequence, of arrhythmia events. CONCLUSIONS Mood disturbances, such as anxiety, may increase the risk for arrhythmia events after ICD insertion.
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Affiliation(s)
- S B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA.
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35
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Sears SF, Todaro JF, Urizar G, Lewis TS, Sirois B, Wallace R, Sotile W, Curtis AB, Conti JB. Assessing the psychosocial impact of the ICD: a national survey of implantable cardioverter defibrillator health care providers. Pacing Clin Electrophysiol 2000; 23:939-45. [PMID: 10879376 DOI: 10.1111/j.1540-8159.2000.tb00878.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The implantable cardioverter defibrillator (ICD) provides a survival advantage over antiarrhythmic medications for patients with life-threatening ventricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care providers (e.g., physicians, nurses) can serve as a valuable source of information related to these ICD outcomes. The purpose of this study was to investigate health care provider perceptions regarding: (1) the quality-of-life and psychosocial functioning of their ICD recipients, (2) the concerns or problems reported by ICD recipients, and (3) the degree of provider comfort in managing these concerns. The final sample of health care providers (n = 261) rated ICD recipients' global quality-of-life and psychosocial functioning, and specific concerns about health care, lifestyle, special population adjustment, marital and family adjustment, and emotional well-being. With regard to quality-of-life, health care providers reported that the majority of ICD recipients were functioning better (38%) or about the same (47%) than before implantation. However, health care providers reported that 15% of recipients experienced worse quality-of-life postimplantation. Similarly, health care providers indicated that 10%-20% of ICD recipients experienced worse emotional functioning and strained family relationships. Moreover, issues related to driving, dealing with ICD shocks, and depression were the most common ICD recipient concerns. Significant differences were noted between physicians and nurses/other health care professionals on a wide range of psychosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression and anxiety). These results suggest that routine attention to ICD quality-of-life and psychosocial outcomes is indicated for health care providers who care for ICD recipients.
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Affiliation(s)
- S F Sears
- University of Florida, Department of Clinical & Health Psychology, Gainesville, USA.
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Ahmad M, Bloomstein L, Roelke M, Bernstein AD, Parsonnet V. Patients' attitudes toward implanted defibrillator shocks. Pacing Clin Electrophysiol 2000; 23:934-8. [PMID: 10879375 DOI: 10.1111/j.1540-8159.2000.tb00877.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In addition to its beneficial effect on patient survival, the implanted cardioverter defibrillator (ICD) changes a patient's life physically, socially, and psychologically. For improved patient management, it is important to understand the quality-of-life changes that accompany this mode of treatment. To this end, 119 patients were surveyed retrospectively and interviewed concurrently regarding their emotional, physical, and behavioral responses to ICD shocks and to the device itself. Most (55%) correctly estimated the total number of shocks they had received within a 10% margin. They found the shocks severe, 79% assigning a score between 3 and 5 on a scale of 1-5. Common descriptions of the shock sensation were a blow to the body or a spasm causing the entire body to jump. Most patients tolerated the shocks as lifesaving, but 23% dreaded shocks and 5% even said they would rather be without the ICD and take their chances. After a shock, 50% of patients called their physician and 42% continued their daily routine. Thirty percent went to a hospital emergency room or called a rescue service. Sixty-five percent had no preshock prodromes. Fifty-four percent were interested in the programmable option of a warning signal prior to a shock, while 31% preferred no warning. Of the 74% who were advised not to drive after implantation, 29% drove anyway. Five patients were shocked while driving with no resulting accidents. We conclude that most patients find ICD shocks moderately uncomfortable, but they tolerate them because of the lifesaving protection provided by the device.
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Affiliation(s)
- M Ahmad
- Department of Surgery, Newark Beth Israel Medical Center, New Jersey 07112, USA
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38
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Kohn CS, Petrucci RJ, Baessler C, Soto DM, Movsowitz C. The effect of psychological intervention on patients' long-term adjustment to the ICD: a prospective study. Pacing Clin Electrophysiol 2000; 23:450-6. [PMID: 10793433 DOI: 10.1111/j.1540-8159.2000.tb00826.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study prospectively examined the role of cognitive behavioral therapy (CBT) in (1) alleviating psychological and somatic distress, and (2) lowering arrhythmic events requiring shocks. Forty-nine of 61 consecutive patients were randomized into therapy (CBT, n = 25) or no therapy (NT, n = 24) and completed a battery of self-report questionnaires at baseline and at 9-month follow-up. CBT was administered at preimplant, predischarge, and at seven routine follow-up visits. Patients were 65 +/- 10 years old, 65% were men, and 92% Caucasian. Eighteen (72%) CBT patients and 18 (75%) NT patients were retained at follow-up. Compared to CBT patients, NT patients reported higher levels of depression (P = 0.046), more anxiety (P = 0.013), more psychological distress (P = 0.015), poorer overall adjustment (P = 0.009), and poorer sexual functioning (P = 0.003). Mean number of shocks did not differ between the CBT and NT groups (2.85 vs 2.30, respectively); however, more patients in the CBT group (61%) than the NT group (33%) received shocks (P = 0.070). At follow-up, a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups. In conclusion, CBT was associated with decreased depression, decreased anxiety, and increased adjustment for ICD recipients, particularly among those patients receiving shocks. CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient.
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Affiliation(s)
- C S Kohn
- MCP-Hahnemann School of Medicine, Philadelphia, Pennsylvania, USA
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Dunbar SB, Jenkins LS, Hawthorne M, Kimble LP, Dudley WN, Slemmons M, Purcell JA. Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion. Heart Lung 1999; 28:303-15. [PMID: 10486447 DOI: 10.1053/hl.1999.v28.a101052] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Adjustment to living with an implantable cardioverter defibrillator (ICD) is a dynamic process that varies among individuals. The purpose of this study was to describe patterns of recovery and to examine the relationships among demographic and clinical factors, illness appraisal and coping behaviors, and outcomes of physical and emotional function in the early recovery period of the first 3 months after initial ICD insertion. METHODS Data were collected in the acute care setting and again at 1 and 3 months after ICD insertion. Subjects were 213 patients (83% men), ages 24-85 (mean 59.6) years. Demographic and clinical variables representing personal and situational factors, illness appraisal, and coping variables were examined using hierarchical multiple-regression analyses to predict outcomes of mood disturbance and functional status. RESULTS The data revealed that symptoms, illness appraisal, and coping behaviors significantly explained additional variance in both functional status and mood disturbance above that accounted for by the less modifiable demographic and clinical variables. CONCLUSIONS Symptoms, illness appraisal, and coping behaviors were predictors of outcomes in ICD patients. These factors are modifiable aspects of the recovery process, and interventions aimed at symptom management, appraisal reframing, and coping training should be tested to improve mood and functional outcomes for ICD patients.
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Affiliation(s)
- S B Dunbar
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA 30322, USA
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Goodman M, Hess B. Could implantable cardioverter defibrillators provide a human model supporting the learned helplessness theory of depression? Gen Hosp Psychiatry 1999; 21:382-5. [PMID: 10572781 DOI: 10.1016/s0163-8343(99)00030-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Affective symptoms were examined retrospectively in 25 patients following placement of implantable cardioverter defibrillators (ICD) which can produce intermittent shocks without warning in response to cardiac ventricular arrhythmias. The number of ICD random, uncontrollable discharge shocks and pre-ICD history of psychological distress (i.e., depression and/or anxiety) were documented in all patients using a demographics questionnaire and a standardized behavioral/psychological symptoms questionnaire (i.e., Symptom Checklist-90 Revised). ICD patients were dichotomized into two groups: those without a history of psychological distress prior to ICD (n = 18) and those with a history of psychological distress prior to ICD (n = 7). In ICD patients without a prior history, results indicated that quantity of ICD discharge shocks was significantly predictive of current reported depression (r = 0.45, p = 0.03) and current reported anxiety (r = 0.51, p = 0.02). Conversely, in patients with a reported history of psychological distress, there was no significant relationship found between quantity of discharge shocks and current reported depression or anxiety. This study may provide evidence in support of a human model of learned helplessness in that it supports the notion that exposure to an unavoidable and inescapable aversive stimulus was found to be related to patients' reported depression. Further studies may wish to prospectively consider a larger sample as well as a more comprehensive assessment of premorbid psychological symptoms.
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Affiliation(s)
- M Goodman
- University of Medicine and Dentistry of New Jersy-SOM, West Orange, USA
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James J. Caring for patients with an automatic internal cardioverter defibrillator: seeking a balance between technological nursing and patient- and family-centered care — implications for practice. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s1362-3265(99)80030-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hamner M, Hunt N, Gee J, Garrell R, Monroe R. PTSD and automatic implantable cardioverter defibrillators. PSYCHOSOMATICS 1999; 40:82-5. [PMID: 9989127 DOI: 10.1016/s0033-3182(99)71277-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- M Hamner
- Department of Psychiatry, Medical University of South Carolina, Charleston, USA
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Crow SJ, Collins J, Justic M, Goetz R, Adler S. Psychopathology following cardioverter defibrillator implantation. PSYCHOSOMATICS 1998; 39:305-10. [PMID: 9691699 DOI: 10.1016/s0033-3182(98)71318-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous reports have found elevated rates of psychopathology in recipients of implantable cardioverter defibrillators (ICDs). Thirty-five consecutive ICD recipients were assessed by using the Structured Clinical Interview for DSM-III-R and a semistructured questionnaire; assessments were performed within 3 days of ICD implantation (Time 1) and again 9-18 months later (Time 2). At the initial assessment, alcohol dependence in remission was the most common diagnosis, followed by mood disorders. Two cases of depression were found at follow-up assessment, but those subjects had either a lifetime history of major depression or some depressive symptoms at Time 1. No new cases of anxiety disorders were seen at Time 2. It appears that ICD recipients have rates similar to the general population at the time of implantation, and the risk for new psychopathology is largely confined to those with a lifetime history of psychopathology.
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Affiliation(s)
- S J Crow
- Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA
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Heller SS, Ormont MA, Lidagoster L, Sciacca RR, Steinberg S. Psychosocial outcome after ICD implantation: a current perspective. Pacing Clin Electrophysiol 1998; 21:1207-15. [PMID: 9633062 DOI: 10.1111/j.1540-8159.1998.tb00179.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Depression and reduced sexual functioning have been identified as problems following ICD placement. We examined these issues, and multiple other quality-of-life measures, and their relationship to ICD and ICD discharge. Patients were 64 +/- 11 years old, 72% male, and had undergone ICD 20 +/- 14 months previously. Fifty-eight patients responded to a confidential biopsychosocial questionnaire. Positive attitudes toward the procedure increased from 52% before to 76% after implantation. Satisfaction correlated most strongly with less anger (P = 0.002, r = 0.45), less worry about ICD size (P = 0.007, r = 0.38), less sadness (P = 0.01, r = 0.37), and perceived better health (P = 0.01, r = 0.35). Of these ICD patients, 20%-58% reported measures of depression, and sexual frequency was reduced in 45%. Despite successful ICD placement, health concern increased in 62% of the respondents. Thirty-nine percent attended support groups; 96% found them very helpful. Mean number of ICD discharges described by responders was 5 +/- 11. Fifty percent of our sample reported > or = 1 shock; equal numbers had 1, 2-5, 6-10, and more than 10 shocks. Sixty-two percent of men had at least one discharge compared to 13% of women. After controlling for cardiac clinical variables, experiencing > or = 1 ICD shock was strongly associated with anxiety about family (odds ratio = 7.3), reduced new activities (odds ratio = 6.9), increased sadness (odds ratio = 6.2), and health worry (odds ratio = 5.8). Experiencing > or = 5 ICD shocks was strongly associated with increased health concern (odds ratio = 13.6), increased sadness (odds ratio = 12.5), increased fatigue (odds ratio = 6.1), current sadness (odds ratio = 5.8), and increased nervousness (odds ratio = 5.3). ICD implantation powerfully affects quality-of-life. Postimplantation health concern is paradoxically increased despite improvement in actual health. Negative emotions are associated with defibrillator discharge.
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Affiliation(s)
- S S Heller
- Psychiatric Consultation-Liaison Service, St. Luke's Roosevelt Hospital Center, New York, New York, USA
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Hegel MT, Griegel LE, Black C, Goulden L, Ozahowski T. Anxiety and depression in patients receiving implanted cardioverter-defibrillators: a longitudinal investigation. Int J Psychiatry Med 1998; 27:57-69. [PMID: 9565714 DOI: 10.2190/1g9v-eqmd-mtlq-e0bw] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The implantable cardioverter-defibrillator (ICD) has dramatically improved survival rates following sudden cardiac death episodes. However, researchers have devoted little attention to the psychosocial consequences of living with the device. The current study used a longitudinal design to evaluate the impact of adaptation to the ICD on incidence and severity of anxiety and depression. METHOD ICD recipients were administered standardized anxiety and depression questionnaires as well as questions evaluating quality of life related to the ICD in two consecutive yearly assessments. A preliminary evaluation of potentially important theoretical variables, such as the perceived predictability and controllability of shock onset was also conducted. RESULTS One-third of the study population (N = 38) had clinically significant levels of anxiety, depressed mood, and fear of symptoms of autonomic arousal. These negative affective states persisted over time, with 40 to 63 percent of subjects continuing to have ongoing difficulties over a one-year time period. Anxiety about the ICD firing was closely associated with the occurrence of depression, while avoidance of activities was associated with anxiety. "Worry" about the ICD and a belief that ICD firing can be predicted were associated with anxiety sensitivity. CONCLUSIONS Depressive and anxiety states in ICD recipients may be frequent, clinically significant, and resistant to spontaneous resolution. Early signs of anxiety and depression in ICD recipients should be evaluated. Implications for future research are discussed.
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Schuster PM, Phillips S, Dillon DL, Tomich PL. The psychosocial and physiological experiences of patients with an implantable cardioverter defibrillator. Rehabil Nurs 1998; 23:30-7. [PMID: 9460456 DOI: 10.1002/j.2048-7940.1998.tb01753.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article describes the relationships between anxiety, self-efficacy, as well as the psychosocial and physiological experiences of patients with an internal cardioverter defibrillator (ICD). Although survival rates with ICDs are impressive, patients experience psychological and physiological responses to their lifesaving devices. Thirty-nine patients completed questionnaires during outpatient clinic visits. Patients' anxiety levels were correlated with fears about ICD malfunction, fear of death, fear of being shocked, loss of control, trouble related to sleeping, inability to concentrate, overprotective family members, and depression. Patients with physical symptoms had higher anxiety levels than those without physical symptoms. There was not a significant relationship between anxiety and discomfort associated with discharge, the number of discharges, or ejection fractions. Low self-efficacy was significantly related to fears about ICD malfunction as well as patients' inability to work, engage in hobbies, and drive a car. Patients with low self-efficacy had more physical symptoms and lower ejection fractions. There were no significant relationships between self-efficacy and frequency of ICD discharge or patients' discomfort during ICD discharge.
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Affiliation(s)
- P M Schuster
- Youngstown State University, College of Health and Human Services, Department of Nursing, OH 44555, USA
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James JE. The psychological and emotional impact of living with an automatic internal cardioverter defibrillator (AICD): how can nurses help? Intensive Crit Care Nurs 1997; 13:316-23. [PMID: 9564348 DOI: 10.1016/s0964-3397(97)81048-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The introduction of the Automatic Internal Cardioverter Defibrillator (AICD) has greatly improved the mortality rates associated with sudden cardiac events (Moss et al 1996, McCarthy 1997, Trappe et al 1997). Little is known about the consequences of living with this device for patients and their families. Biomedical influences have resulted in the devices's success being measured on physical adaptation, with data on suitability, reliability, and efficiency of AICDs as a therapeutic measure. What seems to be of equal priority now is to obtain insights as to the emotional and psychological consequences of such treatment, and the effects these may have on outcomes and utilization of health-care resources. AICD patients have described many powerful emotions arising from receiving this device, which are often heightened at discharge, yet little is known of the reasons for this (James 1997a). It is essential that individuals' and their families' perceptions of their experiences are understood so that clinical staff can not only meet the technological and safety needs of this group, but also assist them to adjust to living with an AICD. Families of AICD patients report significant emotions arising from their support of AICD patients, and describe their own needs and problems. Nevertheless, the influence of, and the effects on the family are often underestimated within AICD patient care. A shift away from a purely individualistic approach towards a more family-centred approach is suggested, arguably enabling the role of family members to be recognized, supported and developed. Qualitative research in this area is needed to inform clinical nursing practice and assist in development of clinical expertise to address the important issues for patients and families. This should enable them to return to their everyday lives with appropriate support. Education of healthcare professionals in a wide variety of clinical areas is needed to ensure a sound body of knowledge, as a basis for development of a more holistic approach to care which encompasses and recognizes the feelings and emotions evoked from receiving this device.
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Affiliation(s)
- J E James
- Faculty of Health and Social Care, University of the West of England, Stapleton, Bristol, UK
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Burgess ES, Quigley JF, Moran G, Sutton FJ, Goodman M. Predictors of psychosocial adjustment in patients with implantable cardioverter defibrillators. Pacing Clin Electrophysiol 1997; 20:1790-5. [PMID: 9249833 DOI: 10.1111/j.1540-8159.1997.tb03568.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Predictors of psychological distress/adjustment were examined in 25 patients following placement of ICDs. Patients completed a demographic questionnaire and a standardized questionnaire of psychological symptoms (i.e., Symptom Checklist-90 Revised; SCL-90-R). The number of discharges categorized by the patient as inappropriate and appropriate were also ascertained. The number of ICD discharges categorized as inappropriate and diminished levels of physical activity (r = 0.53 and 0.63, P < 0.01, respectively) did significantly relate to overall psychological distress. In addition, after controlling for age and prior psychiatric and physical health status through a stepwise multiple regression analysis, the occurrence of ICD discharges categorized as inappropriate and diminished physical activity continued to significantly predict overall psychological distress (R2 = 0.41, P < 0.01). However, the number of ICD discharges categorized as appropriate did not significantly predict overall psychological distress. The results of this investigation suggest that further refinement of the ICD could reduce the risk of exposure to potential psychological distress, and an analysis of prior and anticipated patient physical activity levels should be a factor when calibrating minimum ICD discharge threshold levels.
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Affiliation(s)
- E S Burgess
- Department of Psychiatry and Behavioral Medicine, Union Memorial Hospital, Baltimore, MD, USA
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Herrmann C, von zur Mühen F, Schaumann A, Buss U, Kemper S, Wantzen C, Gonska BD. Standardized assessment of psychological well-being and quality-of-life in patients with implanted defibrillators. Pacing Clin Electrophysiol 1997; 20:95-103. [PMID: 9121977 DOI: 10.1111/j.1540-8159.1997.tb04817.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The ICD has become a standard treatment for patients with malignant arrhythmias. Despite its benefits it may cause additional discomfort to the patients. Thus, quality-of-life needs to be assessed in these patients. Previous studies have used only small samples or unstandardized measures of quality-of-life that do not allow comparisons with other patient groups. The present study used standardized questionnaires for a cross-sectional assessment of psychological well-being and quality-of-life in ICD patients and to compare them to a similar group of coronary artery disease (CAD) patients without ICD. Overall, quality-of-life did not differ between both groups, ICD patients being less anxious than the CAD group. With increasing numbers of ICD shocks, however, the percentage of psychologically distressed ICD patients rose from 10% to > 50%. Psychologically distressed patients had significantly worse scores on most of the quality-of-life subscales, showed less treatment satisfaction, and more negative attitudes. It is concluded that ICD patients have an acceptable mean quality-of-life and low mean anxiety. However, a relevant subgroup of about 15%, especially patients with frequent shocks, experience psychological distress and reduced quality-of-life and should receive special care.
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Affiliation(s)
- C Herrmann
- Department of Cardiology, University of Göttingen, Germany
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Burke LJ. Securing life through technology acceptance: the first six months after transvenous internal cardioverter defibrillator implantation. Heart Lung 1996; 25:352-66. [PMID: 8886811 DOI: 10.1016/s0147-9563(96)80077-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To understand the experience of living with a transvenous internal cardioverter defibrillator (ICD) during the first 6 months after implantation. DESIGN A grounded theory approach was used to gain an understanding of the antecedents, conditions, and consequences of the core process. SETTING Two midwestern community medical centers and patients' homes within a 250-mile radius from the medical centers. SAMPLE Ten women and 14 men between 22 and 78 years of age, who had undergone a new transvenous ICD implantation within the last week. RESULTS The core process that described the experience of living with a transvenous ICD during the first 6 months after implantation was the process of "securing life through technology acceptance." This core process was characterized by three major categories: choosing life with technology, integrating technology into life, and living life through technology. IMPLICATIONS Nursing interventions related to individualized assessment, education, and counseling are warranted to facilitate patient and family understanding and to plan for the cyclic process involved in integrating a transvenous ICD into their lives. Directions for further research are provided.
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Affiliation(s)
- L J Burke
- St. Luke's Medical Center, Milwaukee, WI 53201-2901, USA
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