Quality of Life in the Antiarrhythmics Versus Implantable Defibrillators Trial

Abstract

RN; and the AVID InvestigatorsBackground-Implantable cardioverter defibrillator (ICD) use reduces mortality in patients with serious ventricular arrhythmias compared with antiarrhythmic drug (AAD) use. However, the relative impact of these therapies on self-perceived quality of life (QoL) is unknown. Methods and Results-Three self-administered instruments were used to measure generic and disease-specific QoL in Antiarrhythmics Versus Implantable Defibrillators trial participants. Generalized linear models were used to assess the relationships between self-perceived QoL and treatment (AAD versus ICD) and adverse symptoms and ICD shocks. To minimize the impact of missing data, only patients surviving 1 year were included in the primary analyses. Baseline characteristics among QoL participants (nϭ905) and nonparticipants (nϭ111) were similar, but participants who survived 1 year (nϭ800) were healthier at baseline than nonsurvivors (nϭ105). Of the 800 patients in the primary analysis, characteristics of those randomized to AAD (nϭ384) versus ICD (nϭ416) were similar. Overall, ICD and AAD use were associated with similar alterations in QoL. The development of sporadic shocks and adverse symptoms were each associated with reduced physical functioning and mental well-being and increased concerns among ICD recipients, whereas development of adverse symptoms was associated with reduced physical functioning and increased concerns among AAD recipients. Conclusions-ICD and AAD therapy are associated with similar alterations in self-perceived QoL over 1-year follow-up.Adverse symptoms were associated with reduced self-perceived QoL in both groups, and sporadic shocks were associated with reduced QoL in ICD recipients. (Circulation. 2002;105:589-594.)

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…With the advent and then dominance of primary prevention indications, avoidable shocks assumed a relatively larger proportion of total therapy [78][79][80][81][82][83]. Gradually, publications have increased awareness of the frequency and the diverse range of adverse outcomes associated with avoidable ICD therapy, and have demonstrated that avoidable ICD shocks can be reduced by evidence-based programming of the detection rate, detection duration, antitachycardia pacing (ATP), algorithms that discriminate supraventricular tachycardia (SVT) from VT, and specific programming to minimize the sensing of noise [81][82][83][84][85][86][87][88][89][90][91][92].…”

Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

“…Similar findings were recently reported from the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial in which shock was again associated with worse physical and mental QOL. 23 The experience of shock may be confounded by the simultaneous negative appraisals of the ICD following shock. We have suggested that ICD shock may serve as a "sickness scoreboard" for patients, such that more shocks are perceived to equate to less health and initiate a cycle of negative beliefs and expectations.…”

Ventricular Arrhythmias in the Elderly

“…After one year follow-up, similar alterations in QoL were observed between both the ICD and antiarrhythmic groups; with adverse symptoms of therapy being associated with reduced QoL in both groups (mean age of 64 years). 77) An increased frequency of sporadic shocks was found to be associated with a reduced QoL in the ICD recipients. In a similar analysis of the Canadian Implantable Defibrillator Study (CIDS) in which patients (mean age 63 years) were randomized to ICD therapy or amiodarone, emotional and physical heath scores were shown to improve significantly in the ICD group but not the amiodarone randomized group.…”