Quality of life in patients with implantable cardioverter–defibrillator: systematic review of randomized controlled trials

Silva, Katia Regina da; Costa, Roberto; Rodrigues, Clarissa Garcia; Schasechter, Andi; Nobre, Moacyr Roberto Cucê; Passman, Rod; Mark, Daniel B.

doi:10.1177/1474515117739619

Cited by 32 publications

(34 citation statements)

References 35 publications

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“…Similarly, according to Engelmann and Pehrson there seems to be a possible enhancement of QoL in patients with atrial fibrillation after having undergone an invasive treatment, for example, ablation. 27 However, findings regarding QoL and implantation of a ICD are conflicting, 28 as some studies show an increase in QoL 9, 29 while others indicate a decrease in QoL post-implantation. 30,31 Tomzik et al concluded that it is unknown whether QoL relates to ICD therapy or not.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes at hospital discharge among patients with arrhythmia: Results from the national DenHeart survey

Thrysoee

Thorup

Rasmussen

et al. 2019

European Journal of Cardiovascular Nursing

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Background: Patient-reported outcomes are important predictors of mortality, cardiovascular events and hospitalisation in patients with cardiac diseases, but differences in patient-reported outcomes between groups of patients with arrhythmia have not yet been investigated. Aims: To describe and compare patient-reported outcomes at discharge among patients with different types of cardiac arrhythmia and to examine the associations between demographic characteristics, inhospital factors and patient-reported outcomes. Methods: Data were derived from the national DenHeart study including patient-reported outcomes from the following questionnaires: the hospital anxiety and depression scale (HADS), HeartQoL, short form 12 (SF-12), current health status (EQ-5D), brief illness perception questionnaire (B-IPQ) and the Edmonton symptom assessment scale (ESAS). Clinical and demographic data were obtained from national registers. Multiple linear and logistic regression models were used to investigate the associations between the potential risk factors and the patient-reported outcomes. Results: A total of 4251 patients diagnosed with arrhythmia completed the questionnaire. Across the arrhythmia subgroups, some differences were observed. In general, patient-reported outcome scores were worst among patients with ‘ventricular arrhythmia’ (e.g. highest depression scores and highest prevalence of feeling unsafe at discharge). Regression analysis revealed that longer hospital stay, female gender, being unmarried and having a short education were significantly associated with poor health for almost all arrhythmia subgroups. Conclusion: Differences exist in self-reported health, quality of life and symptom burden across arrhythmia groups with patients with ventricular arrhythmia reporting poorer patient-reported outcomes. Longer hospital stay, female gender, being unmarried and having a low level of education were significantly associated with worse outcomes among the total population.

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Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes at hospital discharge among patients with arrhythmia: Results from the national DenHeart survey

Thrysoee

Thorup

Rasmussen

et al. 2019

European Journal of Cardiovascular Nursing

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“…Having a cardiac device is associated with more frequent out-patient visits, reinterventions and possibly anxiety, as the device is an always present reminder of the heart disease, but studies so far have yielded contradictory findings regarding quality of life [25,26]. Here we show that there is no difference between patients with or without cardiac devices in self-reported health-related quality of life.…”

Section: Quality Of Lifementioning

confidence: 51%

Implantable cardiac devices in adult patients with repaired tetralogy of Fallot

Sandström

Rinnström

Kesek

et al. 2020

Scandinavian Cardiovascular Journal

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Objectives: Implantable cardiac devices are common in patients with tetralogy of Fallot (ToF) (18.3-21.3%) according to previous reports from large centres. We conducted this study to investigate the prevalence and incidence of cardiac devices in a less selected population of patients with ToF and assess factors other than arrhythmia associated with having a device. Design: 530 adult (18 years) patients with repaired ToF were identified in the national registry of congenital heart disease (SWEDCON) and matched with data from the Swedish pacemaker registry. Patients with implantable cardiac devices were compared with patients without devices. Results: Seventy-five patients (14.2%) had a device; 51 (9.6%) had a pacemaker and 24 (4.5%) had an implantable cardioverter defibrillator. The incidence in adult age (18 years) was 5.9/1000 patient years. Estimated device free survival was 97.5% at twenty, 87.2% at forty and 63.5% at sixty years of age. Compared with previous studies, the prevalence of devices was lower, especially for ICD. In multivariate logistic regression, cardiovascular medication (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.8-6.8), impaired left ventricular function, (OR 2.6, 95%CI 1.3-5.0) and age (OR 1.02, 95%CI 1.002-1.05) were associated with having a device. Conclusion: The prevalence of devices in our population, representing a multicenter register cohort, was lower than previously reported, especially regarding ICD. This can be due to differences in treatment traditions with regard to ICD in this population, but it may also be that previous studies have reported selected patients with more severe disease.

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“…Quality of life studies were conducted in the primary prevention clinical trials. The body of data indicates there is no clear evidence of a reduction in quality of life associated with ICD placement . Nonetheless, a subset of patients who experience an ICD shock develop post‐traumatic stress disorder, which in turn is associated with significant adverse outcomes inclusive of premature death .…”

Section: Additional Considerationsmentioning

confidence: 99%

Decision‐making regarding primary prevention implantable cardioverter‐defibrillators among older adults

Hess

Matlock

Al‐Khatib

2019

Clinical Cardiology

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Most implantable cardioverter defibrillators (ICDs) are implanted for the purpose of primary prevention of sudden cardiac death among older patients with heart failure with reduced ejection fraction. Shared decision‐making prior to device implantation is guideline‐recommended and payer‐mandated. This article summarizes patient and provider attitudes toward device placement, device efficacy and effectiveness, potential periprocedural complications, long‐term events such as shocks, quality of life, costs, and shared decision‐making principles and recommendations. Most patients eligible for an ICD anticipate more than 10 years of survival. Physicians are less likely to offer an ICD to patients ≥80 years of age given a perceived lack of benefit. There is a dearth of data from randomized clinical trials addressing device efficacy among older patients; there is a need for more research in this area. However, currently available data support the use of ICDs irrespective of age provided life expectancy exceeds 1 year. Advanced age is independently associated with complications at the time of device placement but not the risk of device infection. The risk of inappropriate shock may be comparable or lower than that of younger patients. While quality of life is generally not adversely impacted by an ICD, a subset of patients experience post‐traumatic stress disorder. ICDs are cost‐effective from societal and health care sector perspectives; however, out‐of‐pocket costs vary according to insurance type and level. Shared decision‐making encounters may be incremental and iterative in nature. Providers are encouraged to partner with their patients, providing them counsel tailored to their values, preferences, and clinical presentation inclusive of age.

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Quality of life in patients with implantable cardioverter–defibrillator: systematic review of randomized controlled trials

Abstract: There was no evidence of impaired QoL in patients with an ICD. However, ICD patients must be educated of all possible risks and benefits, including transitory declines in QoL after ICD shocks.

Cited by 32 publications

References 35 publications

Patient-reported outcomes at hospital discharge among patients with arrhythmia: Results from the national DenHeart survey

Patient-reported outcomes at hospital discharge among patients with arrhythmia: Results from the national DenHeart survey

Implantable cardiac devices in adult patients with repaired tetralogy of Fallot

Decision‐making regarding primary prevention implantable cardioverter‐defibrillators among older adults

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