Research paperPerceived control and quality of life among recipients of implantable cardioverter defibrillator
Introduction
The implantable cardioverter defibrillator (ICD) is standard treatment for life-threatening ventricular arrhythmias and prevention of sudden cardiac death.1 Although the ICD has reduced mortality,[2], [3], [4] patients' psychological responses and adaptation to the ICD implant are not simple. Patients' lives change after ICD implantation,[5], [6] and ICD recipients often are overwhelmed and live with fears related to the unpredictability of ICD shocks and the possibility of device failure.[7], [8]
Feelings of fear and uncertainty can reduce confidence and lead to decreased engagement in social and leisure activities.[9], [10] These changes in lifestyle can lead to anxiety and depressive symptoms, feelings of powerlessness, and loss of control.[7], [11] About one-quarter of ICD recipients experience symptoms of anxiety and/or depression that result in decreased health-related quality of life (HRQOL).[6], [12], [13] Psychological distress and impaired HRQOL are associated with adverse outcomes, such as increased rates of sustained lethal arrhythmias and higher risk of sudden cardiac death.[14], [15], [16], [17], [18] To develop strategies to improve patients' HRQOL, it is paramount to identify factors underlying and influencing HRQOL in ICD recipients.
Perceived control—the belief that one is able to cope with negative events and exert control over one's life and health, and achieve positive outcomes—is essential for successful adaptation to stressful events and improvement in HRQOL among patients with chronic cardiac diseases.[19], [20], [21] A positive relationship between perceived control and HRQOL was found in heart failure (HF) patients and among female heart transplant recipients.22 However, predictors of perceived control and its relationship with HRQOL have not been studied in ICD recipients. Therefore, the aims of this study were to (1) determine whether perceived control is an independent predictor of HRQOL in ICD recipients and (2) identify predictors of perceived control in ICD recipients.
Section snippets
Design
This cross-sectional study involved ICD recipients recruited from the United States and Australia. Before conducting the study, the appropriate institutional review board approvals were obtained from the two largest universities and two tertiary hospitals in Kentucky, United States, (13-0993; 13.0666) and two hospital sites and one university in Melbourne, Australia, (HREC/15/Alfred31; Eastern Health SERP 42-2015; 2015-162R). Data were collected between July 2015 and July 2016.
Participants
Participants were
Sample characteristics
The study sample consisted of 263 ICD recipients (190 participants from the US and 73 participants from Australia; Table 1). The mean age of participants was 61 ± 14 years. Most of the participants were men and were either married or living with someone. The majority of participants (85%) self-identified as a Caucasian. More than a third of the study sample had a history of receiving an ICD shock. Using the reported scores of HADS (≥8), 25% of the participants in this study had symptoms of
Discussion
The main finding of our study was that perceived control predicted overall HRQOL and greater prevalence of self-reported problems in every dimension of HRQOL (i.e. mobility, self-care, usual activity, pain, and symptoms of anxiety and/or depression). The addition of perceived control explained 7% more variance in HRQOL than a model containing only demographic, clinical, and psychological covariates. These findings imply the importance of targeting perceived control and psychological variables
Summary and conclusion
Lower level of perceived control and higher HADS score (indicating symptoms of depression and/or anxiety) among ICD recipients were strongly associated with worse HRQOL, controlling for demographic, clinical, and other psychological factors. Perceived control was predicted by higher level of depressive symptoms, anxiety, ICD concerns; and lower level of social support. These results suggest that reducing psychosocial distress may be instrumental in improving perceived control and thereby
Future studies
The results of small pilot studies have shown that CBT had positive effects on levels of anxiety and depression in ICD recipients.[82], [83] Large-scale interventions focusing on CBT and psychoeducational programs that target psychosocial factors before and after ICD implantation are needed to identify its impact on symptoms of anxiety, depression, and HRQOL. These studies should include larger sample size and longer follow-up times.
In this study, lower levels of perceived control were strongly
Limitations
There are limitations to note. (1) More than 70% of our participants were men; making comparisons of predictors of HRQOL and perceived control based on gender differences is difficult. (2) Our sample participants were mainly Caucasian, which limits generalisability of the findings to minority population. (3) We used a cross-sectional design. Therefore, we were unable to assess any cause and effect relationship between perceived control and HRQOL. (4) The study variables including HRQOL,
Clinical implications
Education is a critical strategy in empowering ICD recipients. Psychoeducational programs should be integrated as a major component of treatment to improve perceived control and, in turn, HRQOL in ICD recipients.
Funding
The authors disclosed receipt of the following financial support for this work. In the United States, the study was funded by the University of Louisville Internal Research Grant and the University of Kentucky Research Professor Award. In Australia, this study received funding from the Australian Catholic University.
References (83)
- et al.
Clinical trials update: sudden cardiac death prevention by implantable device therapy
Crit Care Nurs Clin
(2005) - et al.
Analysis of mortality events in the multicenter automatic defibrillator implantation trial (madit-ii)
J Am Coll Cardiol
(2004) - et al.
Avoidance behaviors in patients with implantable cardioverter defibrillators
Heart Lung
(2004) - et al.
Costs and quality-of-life effects of implantable cardioverter-defibrillators
Am J Cardiol
(2006) - et al.
Anxiety and depression in implanted cardioverter-defibrillator recipients and heart failure: a review
Heart Fail Clin
(2011) Emotional stress and sudden death--the role of cathecholaminergic polymorphic ventricular tachycardia
Eur J Intern Med
(2009)Anger management may save your life new insights into emotional precipitants of ventricular arrhythmias
J Am Coll Cardiol
(2009)- et al.
Perceived control reduces emotional stress in patients with heart failure
J Heart Lung Transplant
(2003) - et al.
Psychosocial recovery from a cardiac event: the influence of perceived control
Heart Lung : J Crit Care
(1995) - et al.
Quality of life in patients with heart failure: ask the patients
Heart Lung
(2009)
Functional status and perceived control influence quality of life in female heart transplant recipients
J Heart Lung Transplant
The validity of the hospital anxiety and depression scale. An updated literature review
J Psychosom Res
The hospital anxiety and depression scale: a diagnostic meta-analysis of case-finding ability
J Psychosom Res
Concerns about the implantable cardioverter defibrillator: a determinant of anxiety and depressive symptoms independent of experienced shocks
Am Heart J
The prevalence of anxiety and depression in adults with implantable cardioverter defibrillators: a systematic review
J Psychosom Res
Quality of life in implanted cardioverter defibrillator recipients: the impact of a device shock
Heart Lung
A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients
Gen Hosp Psychiatr
Socioeconomic status, perceived control, diurnal cortisol, and physical symptoms: a moderated mediation model
Psychoneuroendocrinology
Perceived control in relation to socioeconomic and behavioral resources for health
Soc Sci Med
Life after a ventricular arrhythmia
Am Heart J
Sudden cardiac death in heart failure trial I. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure
N Engl J Med
Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter automatic defibrillator implantation trial investigators
N Engl J Med
How does an implantable cardioverter defibrillator (icd) affect the lives of patients and their families?
Int J Nurs Pract
Psychosocial outcome after icd implantation: a current perspective
Pacing Clin Electrophysiol
Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review
Clin Cardiol
Recipients' of implanted cardioverter-defibrillators actual and perceived adaptation: a review of the literature
J Am Acad Nurse Pract
Standardized assessment of psychological well-being and quality-of-life in patients with implanted defibrillators
Pacing Clin Electrophysiol
Quality of life and psychological functioning of icd patients
Heart
Association of mood disturbance and arrhythmia events in patients after cardioverter defibrillator implantation
Depress Anxiety
Triggering of ventricular ectopic beats by emotional, physical, and meteorologic stress: role of age, sex, medications, and chronic risk factors
Croat Med J
Emotional and physical precipitants of ventricular arrhythmia
Circulation
Euroqol--a new facility for the measurement of health-related quality of life
Health Pol
A review of health utilities using the eq-5d in studies of cardiovascular disease
Health Qual Life Outcome
Validity and responsiveness of the euroqol as a measure of health-related quality of life in people enrolled in an aids clinical trial
Qual Life Res
Validity and reliability of the eq-5d for cancer patients in korea
Support Care Canc
Comparing the performance of the standard eq-5d 3l with the new version eq-5d 5l in patients with chronic hepatic diseases
Qual Life Res
Quality of life profile and psychometric properties of the eq-5d-5l in hiv/aids patients
Health Qual Life Outcome
The control attitudes scale-revised: psychometric evaluation in three groups of patients with cardiac illness
Nurs Res
Social support, type a behavior, and coronary artery disease
Psychosom Med
Psychometric characteristics of the multidimensional scale of perceived social support
J Pers Assess
Psychometric properties of the multidimensional scale of perceived social support in urban adolescents
Am J Community Psychol
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