In Rhythm : the Impact of an ICD on Quality of Life

Abstract

The main purpose of this study was to investigate quality of life in patients' who had survived a cardiac arrest and were treated with an implantable Cardioverter Defibrillator (ICD). Two groups were compared, those that had received an ICD with those that were treated otherwise. This thesis comprises several studies on cardiac arrest survivors and especially those that received an ICD therapy. In chapter 1 we described quality of life and the determinants of quality of life. The study design is also described in this chapter. The sample consisted of 168 consecutive patients who were admitted to the hospital after OHCA. The patients completed a questionnaire at baseline, and at one, six and 12 months. The questionnaire contained items on quality of life (Rand-36 and HPPQ), depressive symptomatology (CES-D), anxiety (State Trait Anxiety Inventory), coping (Utrecht Coping List), social support ( Social Support List Interactions), social activities (subscale EORTC), sexuality (subscale EORTC), satisfaction with patient education (patient education questionnaire), continuity of care (CCCpQ) and utilization of care (RC-UD survey). In Chapter 2 the results are presented on the relationship between continuity of care and quality of life. We found no significant association between patient education, continuity of care and quality of life in either group. We, however, did find an association between patient satisfaction with received care and quality of life. Chapter 3 reports on a 12 month quality of life assessment of cardiac arrest survivors treated with or without an implantable cardioverter defibrillator. No differences were found between the ICD group and control group regarding quality of life and well-being. A significant improvement in physical and social functioning, and mental health were found in the first six months. The prevalence of anxiety and probable depression was high irrespective of the treatment received: anxiety and depressive symptoms did not change significantly between 1 and 12 months after discharge. Chapter 4 details the factors that predict quality of life and depression in ICD recipients. Mental health, appraisal support, feelings of displeasure and physical functioning measured at baseline (before treatment) were significant predictors of quality of life in ICD recipients at 12 months. In Chapter 5 we assessed quality of life, depression and anxiety in ICD recipients who did and did not experience an ICD shock delivery. Significant differences were found within the groups over time regarding physical role limitations (p < 0.051). Those who experienced shocks throughout the year (group 1) felt more limited in their daily activities due to physical or mental problems. We concluded that overall quality of life and psychological well-being did not change in ICD recipients, irrespective of whether they experienced defibrillatory shocks. Chapter 6 describes the content of the qualitative study. Seven major categories were derived from the analysis: anxiety, uncertainty, disappointment, frustration, unexpected barriers, acceptance of and dependency on the ICD played a major role in the lives of ICD recipients. This study leads us to believe that survival of cardiac arrest has a greater impact on quality of life than the type of therapy received after the event.