Implantable Cardioverter Defibrillators and Quality of Life<subtitle>Results From the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation Study</subtitle>

Abstract

Background: The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study demonstrated that implantable cardioverter defibrillators (ICDs) significantly reduce the risk of sudden cardiac death in patients with nonischemic cardiomyopathy and an ejection fraction of 35% or less, with no statistically significant decrease in overall mortality. The impact of ICD placement and shock on health-related quality of life (HRQL) in this population is unknown. Methods: The 12-Item Medical Outcomes Short-Form Health Survey and the Minnesota Living with Heart Failure Questionnaire were administered to 458 patients with nonischemic cardiomyopathy, an ejection fraction of 35% or less, and either nonsustained ventricular tachycardia or 10 or more premature ventricular depolarizations per hour atbaseline,1monthafterrandomization,andevery3months thereafter throughout the trial. The subjects were randomized to an ICD or standard medical therapy. Outcomes were compared using hierarchical linear regression. Results: Overall, there were no significant differences in HRQL throughout the trial between patients randomized to an ICD or standard medical therapy. However, in patients with 1 or more ICD shocks, HRQL declined 0.5±0.2 (mean±SD) points per shock on the emotional scale of the Minnesota Living with Heart Failure Questionnaire (P=.04) and 1.0±0.5 points per shock on the mental component score of the 12-Item Medical Outcomes Short-Form Health Survey (P =.04). Conclusions: Overall, HRQL was not affected by ICD implantation in patients in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study. Implantable cardioverter defibrillator shock was associated with a reduction in some measures of HRQL, but the effects were unlikely to result in a clinically observable alteration until 5 or more shocks were experienced.

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

“…25,41,42 Two studies demonstrated no changes in psychological states after ICD shock therapy, whereas several studies found that Ͼ5 shocks was the threshold to impact the ICD recipient's psychological states of anxiety and depression. 35,[43][44][45][46] The studies suggest that ICD patients are able to endure 1 to 5 shocks without clinically meaningful differences in QOL, but significant changes in QOL were evidenced when Ն5 shocks were experienced. More recently, the SCD-HeFT trial provided data examining the acute effects of shock on QOL subscales.…”

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

“…Although there is mixed evidence on the effect of single ICD shocks, 5,6 the literature consistently supports the negative impact of Ͼ5 shocks on quality of life and emotional distress. 7,8 ICD shock has been a focus of research interest because it is a unique experience for the ICD patient and can be perceived as a traumatic event. In addition, the existence of concomitant heart disease, angina, congestive heart failure, or previous sudden death may create sensitivity to traumatic stress that warrants improved understanding by attending electrophysiologists.…”

Anxiety in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Implantable Cardioverter Defibrillators

“…7 The experience of receiving 1 or more ICD shocks further negatively affects quality of life. 7,8 Inappropriate shocks (ie, for sinus or supraventricular tachycardia or T-wave oversensing) can elicit similar psychological responses to appropriate shocks for life-threatening ventricular arrhythmias. This is a particularly important consideration for young patients because 1 in 4 may be expected to receive at least 1 inappropriate shock.…”