The experience of patients with an implantable cardioverter-defibrillator: a systematic review and meta-synthesis of qualitative studies

Abstract

Background The indication for implantable cardioverter-defibrillators (ICDs) to prevent sudden death is now consolidated. However, there is no unanimous agreement on how patients experience certain aspects of their lives after an ICD implant. Various clinical studies have evaluated the impact of ICDs on patient mortality, survival, and their beneficial effects. Given the growing number of qualitative studies, a synthesis of qualitative evidence became desirable. Aims To explore and synthesize the results of qualitative studies addressing the experiences of patients with an ICD. Methods We employed a systematic review and meta-synthesis. PubMed, CINAHL, and PsycINFO were systematically searched to identify qualitative studies published between January 2005 and October 2020, which investigate the experience of patients living with an ICD. Selected studies were assessed for quality by two reviewers independently. Results A total of 24 papers were selected. Six themes emerged: fear and insecurity, the need for information, new impacts on life, living with ICD shocks, gender differences, and the role of the family. These results could help clinicians and researchers to develop new strategies and interventions to improve the quality of life in these patients. Conclusion This meta-synthesis underlines the difficulties experienced by patients with ICD implants. Despite the advanced therapeutic management programmes for this type of intervention, it is necessary to adopt and implement the current post-discharge care plans, where the family’s involvement is essential to help patients adapt to their new lifestyle.

New old life of patients after implantation of implantable cardioverter-defibrillator

“…Making the decision to have an ICD implanted is a difficult time for patients. As found by Barisone et al (2022), one of the most important motives quoted by cardiac patients when agreeing to such an intervention is the willingness to protect themselves against sudden death. Moreover, they express a sense of duty towards their family.…”

“…Considering the features of the ICD, one of the key issues is the relation between the incidence of depression and anxiety in patients and the shocks they receive. Many researchers indicate that patients experience most strongly anxiety linked to the discharge of the device (Humphreys et al, 2016a;Mańkowska-Załuska et al, 2015;Maryniak, Szumowski, Orczykowski, Przybylski & Walczak, 2009;Schulz et al, 2013), which is a sudden and unexpected phenomenon (Barisone et al, 2022). Patients are apprehensive of not only the first shock but also every subsequent shock (Humphreys et al, 2016a).…”

“…Patients are apprehensive of not only the first shock but also every subsequent shock (Humphreys et al, 2016a). This is because a discharge of the ICD generates a conviction that the heart is not functioning properly, which further heightens anxiety (Barisone et al, 2022) and reminds patients of their mortality (Humphreys et al, 2016a). The research conducted by Pedersen, Hoogwegt, Jordaens & Theuns (2013) established that shocks significantly deteriorated the functioning of patients, as manifested in their anxiety and depression.…”

Analysis of electrotherapy in patients with implantable cardioverter-defibrillator for primary prevention of sudden cardiac death according to remote monitoring data

“…Проблема необоснованных срабатываний ИКД занимает значимое место в современной аритмологии. Частые необоснованные шоки могут привести к снижению качества жизни пациентов, повышению летальности больных, они сопряжены с увеличением числа госпитализаций [1]. Причинами необоснованной электротерапии являются в основном эпизоды, связанные с ложной детекцией суправентрикулярных нарушений ритма или в результате неправильной интерпретации сигнала (детекция Т-волны, двойной сенсинг, влияние внешних электромагнитных импульсов, предсердные far-fi eld сигналы, перелом электрода).…”

Major gaps in the information provided to patients before implantation of cardioverter defibrillators: a prospective patient European evaluation

“…2 However, despite improving the prognosis of properly selected patients, this device also has its limitations and time-dependent related complications, which is a substantial concern given that implantable cardioverter-defibrillator (ICD) is usually implanted for life. 3 …”