Impact of Cardiac Devices on the Quality of Life in Pediatric Patients

Abstract

Background— Cardiac rhythm devices are increasingly used in the pediatric population, although their impact on quality of life (QOL) is poorly understood. The purpose of this study was to compare (QOL) scores among pediatric device patients, healthy controls, and congenital heart disease (CHD) patients and determine the key drivers of QOL in pediatric device patients. Methods and Results— Multicenter, cross-sectional study at 8 pediatric centers of subjects aged 8 to 18 years with either a pacemaker or defibrillator was carried out. Patient–parent pairs completed the Pediatric Quality of Life Inventory and Pediatric Cardiac Quality of Life Inventory. QOL outcomes in device patients were compared with healthy controls and patients with various forms of CHD. Structural equation modeling was used to test for differences in Pediatric Cardiac Quality of Life Inventory scores among (1) device type, (2) presence of CHD, and (3) hypothesized key drivers of QOL. One hundred seventy-three patient–parent pairs (40 defibrillators/133 pacemakers) were included. Compared with healthy controls, patients with devices and their parents reported significantly lower Pediatric Quality of Life Inventory scoring. Similarly, compared with patients with mild forms of CHD, parents and patients with devices reported significantly lower Pediatric Cardiac Quality of Life Inventory scores and were similar to patients with more severe CHD. Key drivers of patient QOL were presence of implantable cardioverter-defibrillator and CHD. For patients, self-perception was a key driver of lower QOL, whereas for parents behavioral issues were associated with lower QOL. Conclusions— Patient QOL is significantly affected by the presence of cardiac rhythm devices. Whether these effects can be mitigated through the use of psychotherapy needs to be assessed.

Psychiatric Functioning and Quality of Life in Young Patients With Cardiac Rhythm Devices

“…6 However, studies on children and adolescents with ICDs are limited. [7][8][9][10][11] DeMaso and colleagues 12 found changes in scores for anxiety, depression, family functioning, and quality of life (QoL) in pediatric patients with ICDs (20 patients). Sears and colleagues 13 examined a similar age group with ICDs and reported lower psychosocial and physical QoL scores compared with healthy children (60 patients).…”

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

“…[18][19][20][21] An increased number of shocks has also been associated with increased anxiety, depression, and psychological stress. [22][23][24] Additionally, the delivery of shocks has a detrimental effect on device battery longevity; an increased number of shocks delivered means a quicker reduction in total battery life, potentially necessitating device replacement at an earlier point in time.…”

“…16,25,27 However, most studies of ICD use in pediatric and CHD patients have found rates of IS to be between 20% and 30% in these patient populations, 10,11,13,14,[34][35][36][37][38][39][40] with some studies observing IS in up to 40% to 50% of patients and, in some instances, with inappropriate shocks being more frequent than appropriate shocks. 12,19,41,42 This is likely a result of a more active lifestyle, faster rates of sinus tachycardia, longer duration of implantation, smaller patient size, and a higher rate of device and lead complications relative to adult patients. 11,15 Inappropriate shocks are painful events that confer no benefit to patients, are associated with worsened psychosocial and clinical outcomes, and are particularly frequent in the pediatric and CHD ICD populations.…”

Diagnostic Electrophysiology Study Has Limited Value in Risk Stratification of Children and Young Adults with and without Congenital Heart Disease

“…36,37 Additionally, there is growing evidence of the decreased quality of life experienced by pediatric patients with ICD that must be considered. 38 This highlights the unique challenge of risk stratification and primary prevention strategies for pediatric patients with risk of SCD…”