Women and the implantable cardioverter defibrillator: A lifespan perspective on key psychosocial issues

Walker, Robert; Campbell, Karen; Sears, Samuel F.; Glenn, Beth A.; Sotile, B A Rebecca; Curtis, Anne B.; Conti, Jamie B.

doi:10.1002/clc.4960271019

Cited by 54 publications

(56 citation statements)

References 25 publications

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“…Recipients of ICDs who are female or young (< 50 years of age) are more likely to develop anxiety, depression, or other distress symptoms. 16,18 Patients who experience a greater number of shock discharges, whether cumulatively across time or within short periods of "ICD Storm," (≥ three shocks in 24 h) are also more likely to experience such symptoms that lower quality of life. 17,19,20,21 As ICD recipients have a more optimistic disposition and higher positive expectations for undergoing ICD therapy, their quality of life is either maintained or improves.…”

Section: Patient Factors In Implantable Cardioverter Defibrillator Rementioning

confidence: 99%

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

Stutts

Cross

Conti

et al. 2007

Clinical Cardiology

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SummaryBackground: The implantable cardioverter defibrillator (ICD) is the most effective treatment available for terminating potentially life-threatening ventricular tachycardia and ventricular fibrillation and reducing the risk of mortality. Despite its established health benefits, ICD therapy is accompanied by a unique array of patient and psychological factors meriting ample research attention. The purpose of this paper is to examine research trends and results regarding patient factors in cardiac and ICD research and to discuss key areas for future research.Hypothesis: An increase in articles associated with patient factors in cardiac and ICD research will be shown over time.Methods: The Medical Subject Heading (MeSH) system in PubMed was used to index articles under a range of psychosocial headings for both cardiovascular disease and ICDs to quantify the frequency of articles published across time, the journals most frequently utilized, the most productive institutions, and the most common areas of inquiry.Results: A significant positive relationship was revealed between patient factors in cardiac research (r = 0.96, p < 0.01)

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Section: Patient Factors In Implantable Cardioverter Defibrillator Rementioning

confidence: 99%

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

Stutts

Cross

Conti

et al. 2007

Clinical Cardiology

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“…These include being concerned that an ICD shock might harm the fetus, a higher risk of receiving an ICD shock with labor and delivery, and worry that sinus tachycardia commonly associated with pregnancy may cause inadvertent ICD shocks. 189 In a brief report of the effects of cardiac resynchronization therapy on sexual functioning 6 months after implantation (n=31), 190 cardiac resynchronization therapy was associated with a significant reduction in ED and a significant increase in libido, as well as being significantly related to a reduction in New York Heart Association class.…”

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confidence: 99%

Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners

Steinke¹,

Jaarsma²,

Barnason³

et al. 2013

Circulation

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“…83 Indeed, concerns about the impact of the device on appearance have been suggested as the primary reason for women to opt for submammary device placement. 84 However, the findings of our study suggest that the impact of the ICD on body image is a concern for both male and female patients. A study of ICD patients from Sweden and Denmark found that approximately 60% of patients reported receiving information on potential detriments of the device to psychosocial/sexual functioning.…”

Section: Implications For the Development Of Decision-support Toolsmentioning

confidence: 52%

A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care

Standing

Exley

Flynn

et al. 2016

Health Serv Deliv Res

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Background Implantable cardioverter defibrillators (ICDs) are recommended for patients at high risk of sudden cardiac death or for survivors of cardiac arrest. All ICDs combine a shock function with a pacing function to treat fast and slow heart rhythms, respectively. The pacing function may be very sophisticated and can provide so-called cardiac resynchronisation therapy for the treatment of heart failure using a pacemaker (cardiac resynchronisation therapy with pacemaker) or combined with an ICD [cardiac resynchronisation therapy with defibrillator (CRT-D)]. Decision-making about these devices involves considering the benefit (averting sudden cardiac death), possible risks (inappropriate shocks and psychological problems) and the potential need for deactivation towards the end of life. Objectives To explore patients’/relatives’ and clinicians’ views/experiences of decision-making about ICD and CRT-D implantation and deactivation, to establish how and when ICD risks, benefits and consequences are communicated to patients, to identify individual and organisational facilitators and barriers to discussions about implantation and deactivation and to determine information and decision-support needs for shared decision-making (SDM). Data sources Observations of clinical encounters, in-depth interviews and interactive group workshops with clinicians, patients and their relatives. Methods Observations of consultations with patients being considered for ICD or CRT-D implantation were undertaken to become familiar with the clinical environment and to optimise the sampling strategy. In-depth interviews were conducted with patients, relatives and clinicians to gain detailed insights into their views and experiences. Data collection and analysis occurred concurrently. Interactive workshops with clinicians and patients/relatives were used to validate our findings and to explore how these could be used to support better SDM. Results We conducted 38 observations of clinical encounters, 80 interviews (44 patients/relatives, seven bereaved relatives and 29 clinicians) and two workshops with 11 clinicians and 11 patients/relatives. Patients had variable knowledge about their conditions, the risk of sudden cardiac death and the clinical rationale for ICDs, which sometimes resulted in confusion about the potential benefits. Clinicians used various metaphors, verbal descriptors and numerical risk methods, including variable disclosure of the potential negative impact of ICDs on body image and the risk of psychological problems, to convey information to patients/relatives. Patients/relatives wanted more information about, and more involvement in, deactivation decisions, and expressed a preference that these decisions be addressed at the time of implantation. There was no consensus among clinicians about the initiation or timing of such discussions, or who should take responsibility for them. Introducing deactivation discussions prior to implantation was thus contentious; however, trigger points for deactivation discussions embedded within the pathway were suggested to ensure timely discussions. Limitations Only two patients who were prospectively considering deactivation and seven bereaved relatives were recruited. The study also lacks the perspectives of primary care clinicians. Conclusions There is discordance between patients and clinicians on information requirements, in particular the potential consequences of implantation on psychological well-being and quality of life in the short and long term (deactivation). There were no agreed points across the care pathway at which to discuss deactivation. Codesigned information tools that present balanced information on the benefits, risks and consequences, and SDM skills training for patients/relative and clinicians, would support better SDM about ICDs. Future work Multifaceted SDM interventions that focus on skills development for SDM combined with decision-support tools are warranted, and there is a potential central role for heart failure nurses and physiologists in supporting and preparing patients/relatives for such discussions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Women and the implantable cardioverter defibrillator: A lifespan perspective on key psychosocial issues

Cited by 54 publications

References 25 publications

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners

A qualitative study of decision-making about the implantation of cardioverter defibrillators and deactivation during end-of-life care

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