Collaborative care for the wearable cardioverter defibrillator patient: Getting the patient and medical team “vested and active”

Abstract

Patients with a reduced ejection fraction of 35% or less and a history of myocardial infarction (MI) are at increased risk of sudden cardiac death (SCD). These patients have a class I indication for an implantable cardioverter‐defibrillator after allowing time for medical therapy optimization and potential cardiac recovery. The rates of SCD are highest in this “gap” period early after a cardiac event, and the wearable cardioverter‐defibrillator (WCD) is an intervention that can be used to protect against SCD during this time period. There has been a clinical trial that randomized patients with a reduced ejection fraction at the time of MI to a WCD versus control. Results of the trial showed no statistically significant difference in the primary endpoint of SCD. There are many intricacies to the interpretation of the trial, including the importance of patient adherence to WCD therapy, which is affected by the patient experience and psychological factors. Patients with a new cardiomyopathy are affected by a mix of psychological factors, including the feeling of safety and protection from a WCD contrasted by the WCD providing a reminder of awareness and fear of ventricular arrhythmias and SCD. Beyond the capabilities of a WCD to defibrillate a life‐threatening ventricular arrhythmia, the device can also provide activity and heart failure diagnostics monitoring. Patients need to be engaged in shared decision‐making conversations about a WCD, so that patients can make a decision based on their own values construct, ultimately increasing adherence among the patients that want a WCD.

Experience with a Wearable Cardioverter-defibrillator in 436 Patients

“…In our opinion, the role of the WCD may evolve more toward that of a long term monitoring system and reminder for compliance with a comprehensive HF program. 23 Similarly, a fol lowup study of the VEST trial showed that patients with better compliance benefit more from WCD use. 24 There fore, perhaps WT compliance translates to improved medical and behavioral compliance.…”

Evaluation of a Standardized Training and Adherence Surveillance Programme to Overcome Quality-of-Life Impairments and Enhance Compliance in Patients Treated with Wearable Cardioverter Defibrillator

“… 6 Because of the constant risk of cardiac arrhythmias, compliance is the fundamental requirement for effectiveness of a wearable cardioverter-defibrillator. 18 One retrospective analysis from our center addressed the impact of WCD therapy on daily patient life and displayed a remarkable reduction of QoL during the trial period, 20 which might cause poor therapy adherence. Therefore, we conducted a standardized WCD training and adherence surveillance programme to optimize patient compliance and evaluate the effect on daily wear time and QoL and compared the results with the above-mentioned retrospective cohort from our center.…”

“…Due to the fact that WCD therapy is only effective if the vest is worn, compliance is the key to therapy success and clinicians should focus significant attention on achieving compliance. 18 Although QoL displays a potential risk factor for reduced adherence during WCD treatment, only limited data is available. Previous trials have described premature treatment discontinuation due to comfort issues.…”

“…Due to the fact that WCD therapy is only effective if the vest is worn, compliance is the key to therapy success and clinicians should focus significant attention on achieving compliance. 18 …”

Wearable Cardioverter–Defibrillator-Measured Step Count for the Surveillance of Physical Fitness during Cardiac Rehabilitation

“…A more recent feature of the WCD is the assessment of physical activity and heart rate. It has a built-in three-dimensional accelerometer with the capacity of measuring step count and patient activity, and measures and stores the heart rate in 5 min intervals [18].…”