Living with cardiac resynchronization therapy: Challenges for people with heart failure

Abstract

The number of people with heart failure requiring implantation of a cardiac resynchronization device is increasing in Iran. Although this intervention is an effective life-saving treatment, several challenges are associated with patients' lifestyle after insertion. This study identified the challenges and coping mechanisms of Iranians with heart failure living with cardiac resynchronization therapy. A qualitative approach using conventional content analysis was adopted. Seventeen people with heart failure and three nurses were recruited between December 2014 and November 2015 from a teaching hospital and a private clinic in Rasht, Iran. Participants were interviewed using semi-structured interviews lasting 30-60 min. Five themes emerged: (i) fear of implantation, (ii) the panic of receiving a shock from the device, (iii) lack of control over life, (iv) inadequacies of the healthcare system, and (v) psychosocial coping. A heightened understanding of these challenges and coping strategies could prepare healthcare professionals to provide better routine care, education, and support to the recipients of cardiac resynchronization therapy prior to implantation, during the recovery period, and for long-term management.

Patient Work and Their Contexts: Scoping Review

“…Category 1 tasks made up a large portion of the instances of patient work tasks identified in the included studies, with the most prevalent tasks being planning [ 18 , 20 , 40 , 44 - 57 ] and proactive management of risks [ 20 , 40 - 42 , 45 - 47 , 49 , 50 , 52 , 57 - 78 ]. Tasks in category 1 are characterized by their pervasiveness and volume.…”

“…Category 4 was the only category that explicitly described how patients changed their physical environment and tools. Tasks in this category (eg, use and maintain assistive devices [ 16 , 20 , 42 , 50 , 56 , 58 , 59 , 62 , 67 , 69 , 72 , 74 , 89 , 90 , 95 , 97 , 98 ], do-it-yourself symptom management tools [ 18 , 19 , 47 , 59 , 62 , 66 , 74 , 77 , 95 ], and alter the physical environment [ 46 , 62 , 93 ]) had an immediate physical return in the form of better tools or a more comfortable physical environment, with the tools ranging from day-to-day items (eg, shoe insoles [ 97 ]) to specialized equipment (such as home oxygen tanks [ 59 ]). Patients are very aware of how this category is an investment to improve the quality of life as well as what kind of support (mainly financial) is available from health organizations.…”

“…This category included tasks where patients sought help from other people, including seek medical help [ 2 , 14 , 18 , 40 , 41 , 44 , 49 - 52 , 58 , 65 , 75 , 79 , 80 , 83 , 89 , 93 , 96 , 97 ], ask for help from family and friends [ 18 , 40 , 46 , 47 , 50 , 51 , 57 , 60 , 63 , 67 , 69 , 73 , 77 , 93 , 95 , 98 ], hire professional help [ 20 , 43 , 52 , 69 , 95 , 98 ], and consult complementary therapy [ 58 , 59 , 64 , 66 , 84 ]. This category also included unplanned interactions, such as visits to the emergency department [ 41 , 89 ].…”

“Doubtful accepting”: A grounded theory study of living with cardiac resynchronization therapy

“…Yet it can cause different problems for patients. For example, patients with CRT‐D reported problems such as panic over possible electric shock given by the device, lack of control over their own lives, lack of knowledge about the therapy, and dissatisfaction with patient education and care services (Dehghanzadeh, Dehghan Nayeri, Varaei, & Kheirkhah, ). The dysfunction of the cardiovascular implantable device or its accessories (i.e.…”

Appetite in patients with heart failure: Assessment, prevalence and related factors

“…This classification is traditionally used as the basis for medical treatment [38]. Heart failure has serious consequences on the patient's social, physical and mental wellbeing [39][40][41]. Heart failure symptoms cause burdensome physical limitations that affect the patient's ability to perform basic home routines such as cleaning and washing dishes.…”