Elsevier

Australian Critical Care

Volume 32, Issue 5, September 2019, Pages 383-390
Australian Critical Care

Research paper
Perceived control and quality of life among recipients of implantable cardioverter defibrillator

https://doi.org/10.1016/j.aucc.2018.08.005Get rights and content

Abstract

Background

Perceived control is strongly associated with health-related quality of life (HRQOL) among patients with chronic conditions, and it is possible to increase perceived control with appropriate intervention. Little is known about the relationship between perceived control and HRQOL in implantable cardioverter defibrillator (ICD) recipients.

Objectives

To determine the relationship of perceived control with quality of life in ICD recipients and to determine predictors of perceived control in this population.

Methods

A total of 263 ICD recipients (63% male, age 61 ± 14 years) completed the Control Attitude Scale-Revised to measure perceived control and completed self-reported measures on potential correlates of perceived control (i.e., depressive symptoms, anxiety, social support, and ICD concerns). The EuroQol-5D was used to measure HRQOL. Regression analysis was used to determine predictors of perceived control and its relationship to HRQOL, controlling for covariates.

Results

Lower perceived control (β = 0.30, p < .01), and higher levels of depression (β = −0.30, p < .01) and anxiety (β = −0.18, p < .05) predicted lower levels of HRQOL. Higher anxiety (β = −0.17, p < .05), higher depression (β = −0.23, p < .05), lower social support (β = 0.26, p < .01), and higher ICD-related concerns (β = −0.16, p < .05) independently predicted lower perceived control.

Conclusions

Interventions targeting patients' ICD concerns and psychosocial factors before, and continuing after, ICD insertion are needed to improve ICD recipients' perceived control and, in turn, their HRQOL.

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.

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