Comparison of patient and partner quality of life and health outcomes in the first year after an implantable cardioverter defibrillator (ICD)

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.

Patient plus partner trial: A randomized controlled trial of 2 interventions to improve outcomes after an initial implantable cardioverter-defibrillator

“…Intimate partners also reported significantly higher levels of anxiety and depression over the first 12-months, higher than patients themselves. Following ICD implantation, partners consistently reported high caregiving demands and a corresponding lower level of satisfaction with their relationship with the patient [3,4]. Partners also note that important information and support was typically not available to them in outpatient settings.…”

Sleep disturbance in patients with an implantable cardioverter defibrillator: Prevalence, predictors and impact on health status

“… 5 , 6 In turn, this may lead to impaired QoL, adverse cardiovascular outcomes and perhaps sleep disturbances. 7 – 9 Particularly, patients with a Type D (distressed) personality (combination of high negative affectivity and high social inhibition) are prone to experience adverse health outcomes post-implantation. 10 , 11 …”

Calidad de vida relacionada con la salud, la ansiedad y depresión en personas con cardiodesfibrilador

“…En las variables sociodemográficas de este estudio se resalta la predominancia del género masculino de la muestra (81,2%), información similar a la de una investigación en paises de América del Norte, Europa y Asia con el 79% (15) . Hallazgos similares se observaron en estudios llevados a cabo en China (8) , Japón (16) , Irán (17) , Israel (18) , México (3) , Brasil (19) , Estados Unidos (20,21) , Australia (21) , España (22,23) , Alemania (24,25) , Países Bajos (26,27) , Dinamarca (28)(29)(30) y Suecia (31)(32)(33) . No obstante, en otras publicaciones, poco más del 60% de los participantes correspondían al género masculino (34)(35)(36) , mientras que en otras eran cerca del 68,4% de población masculina (17) .…”

“…En relación con la edad, la media en este estudio fue de 65 años en un rango de 36-92 años, lo cual corresponde al incremento de la población adulta a la que se le implantan cardiodesfibriladores. Estos datos concuerdan con los resultados de estudios que describieron edades medias entre los 60 a 70 años (8,15,18,(20)(21)(22)(23)(24)(25)(26)(30)(31)(32)(33) con rangos extensos entre 17 a 94 años (8,16,22,23,31,33,35) . Otros estudios en países norteamericanos, europeos y oceánicos también han encontrado edades medias inferiores a los 60 años (3,17,19,(27)(28)(29)35,36) .…”

“…No obstante, la media de calidad de vida es similar a los datos que reportan autores al utilizar la HeartQoL, donde se halló un valor de 1,66 (DE=±0,78), siendo posibles los rangos entre 0 a 3 (de peor a mejor calidad de vida) (30) ; o con la escala análoga de las versiones de EQ -5D, con medias cercanas a 65 (15,30) . Cabe resaltar que otras investigaciones han utilizado la SF12 v.2 Health Survey relacionando el bienestar con la calidad de vida (20,35) y algunos autores, refieren que en la mayoría de los pacientes la calidad de vida mejora después del procedimiento de implantación (22,34,36) , o no se altera (35) . Sin embargo, este estudio encontró que la mayoría de usuarios participantes (75,3%) identifican una evolución reciente sobre un mejor estado de salud.…”