Skip to main content

Advertisement

SpringerLink
Log in

Longitudinal changes in quality of life following ICD implant and the impact of age, gender, and ICD shocks: observations from the INTRINSIC RV trial

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

ICDs can improve survival in at-risk patients but no consensus exists with respect to their impact on health-related quality of life (QOL). Moreover, the data are unclear on QOL benefits in specific patient subgroups. We sought to analyze, in the INTRINSIC RV ICD trial population, health-related QOL longitudinally following ICD implant and consider impact of age, gender, and ICD shocks on QOL by employing a global measure of health-related QOL.

Methods

One thousand five hundred thirty patients had an ICD implanted. One week after implant (n = 1461), 988 patients were randomized to DDDR with AV search hysteresis (n = 502) or VVI (n = 486) programming. QOL data, using the SF-36 short form, were obtained for the 1461 patient cohort, irrespective of randomization status, at baseline and prospectively for 1 year following ICD implant.

Results

Longitudinal mixed-effect analyses revealed significant improvements from baseline across all SF-36 subscales and component scores for the overall study cohort. Women had a substantially lower QOL at baseline, although their improvement after implant was similar to men. Patients <50 years scored consistently worse at baseline but experienced the greatest QOL improvement versus other age groups. Patients with higher NYHA class, angina, and diabetes had greater QOL improvements. There was no significant difference in QOL between patients with and without ICD shocks.

Conclusions

Our findings indicate that QOL was reportedly better post-implant and suggest that benefits associated with ICD implantation go beyond the direct treatment of arrhythmias, with benefits seen across genders and different age groups. These results further highlight that ICD implantation, in and of itself, does not reduce QOL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ICD:

Implantable cardioverter defibrillator

HF:

Heart failure

RV:

Right ventricle

AVSH:

AV search hysteresis

QOL:

Quality of life

SF-36:

Medical Outcome Study 36-item Short Form Survey Instrument

References

  1. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.

    Article  CAS  PubMed  Google Scholar 

  2. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.

    Article  PubMed  Google Scholar 

  3. Exner DV, Pinski SL, Wyse DG, Renfroe EG, Follmann D, Gold M, et al. Electrical storm presages nonsudden death: the antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation. 2001;103(16):2066–71.

    Article  CAS  PubMed  Google Scholar 

  4. Burns JL, Serber ER, Keim S, Sears SF. Measuring patient acceptance of implantable cardiac device therapy: initial psychometric investigation of the Florida Patient Acceptance Survey. J Cardiovasc Electrophysiol. 2005;16(4):384–90.

    Article  PubMed  Google Scholar 

  5. Oldridge NB. Outcome assessment in cardiac rehabilitation. Health-related quality of life and economic evaluation. J Cardpulm Rehabil. 1997;17(3):179–94.

    Article  CAS  Google Scholar 

  6. Oldridge N, Gottlieb M, Guyatt G, Jones N, Streiner D, Feeny D. Predictors of health-related quality of life with cardiac rehabilitation after acute myocardial infarction. J Cardpulm Rehabil. 1998;18(2):95–103.

    Article  CAS  Google Scholar 

  7. McEntee DJ, Badenhop DT. Quality of life comparisons: gender and population differences in cardiopulmonary rehabilitation. Heart Lung. 2000;29(5):340–7.

    Article  CAS  PubMed  Google Scholar 

  8. Sears Jr SF, Todaro JF, Lewis TS, Sotile W, Conti JB. Examining the psychosocial impact of implantable cardioverter defibrillators: a literature review. Clin Cardiol. 1999;22(7):481–9.

    Article  PubMed  Google Scholar 

  9. Steinke EE. Sexual concerns of patients and partners after an implantable cardioverter defibrillator. Dimens Crit Care Nurs. 2003;22(2):89–96.

    Article  PubMed  Google Scholar 

  10. Sears Jr SE, Conti JB. Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care. Clin Cardiol. 2003;26(3):107–11.

    Article  PubMed  Google Scholar 

  11. Serber ER, Sears SF, Sotile RO, Burns JL, Schwartzman DS, Hoyt RH, et al. Sleep quality among patients treated with implantable atrial defibrillation therapy: effect of nocturnal shock delivery and psychological distress. J Cardiovasc Electrophysiol. 2003;14(9):960–4.

    Article  PubMed  Google Scholar 

  12. Lemon J, Edelman S, Kirkness A. Avoidance behaviors in patients with implantable cardioverter defibrillators. Heart Lung. 2004;33(3):176–82.

    Article  PubMed  Google Scholar 

  13. Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, et al. Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation. 2002;105(5):589–94.

    Article  PubMed  Google Scholar 

  14. Irvine J, Dorian P, Baker B, O’Brien BJ, Roberts R, Gent M, et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS). Am Heart J. 2002;144(2):282–9.

    Article  PubMed  Google Scholar 

  15. Sears SF, Matchett M, Conti JB. Effective management of ICD patient psychosocial issues and patient critical events. J Cardiovasc Electrophysiol. 2009;20(11):1297–304.

    Article  PubMed  Google Scholar 

  16. Mark DB, Anstrom KJ, Sun JL, Clapp-Channing NE, Tsiatis AA, Davidson-Ray L, et al. Quality of life with defibrillator therapy or amiodarone in heart failure. N Engl J Med. 2008;359(10):999–1008.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Sears SF, Kirian K. Shock and patient-centered outcomes research: is an ICD shock still a critical event? Pacing Clin Electrophysiol. 2010;33(12):1437–41.

    Article  PubMed  Google Scholar 

  18. Morken IM, Isaksen K, Karlsen B, Norekval TM, Bru E, Larsen AI. Shock anxiety among implantable cardioverter defibrillator recipients with recent tachyarrhythmia. Pacing Clin Electrophysiol. 2012;35(11):1369–76.

    Article  PubMed  Google Scholar 

  19. Sears SF, Whited A, Volosin KJ. Enhancing patient care by estimation and discussion of risk for ICD shock. Pacing Clin Electrophysiol. 2015;38(1):1–7.

    Article  PubMed  Google Scholar 

  20. Olshansky B, Day JD, Moore S, Gering L, Rosenbaum M, McGuire M, et al. Is dual-chamber programming inferior to single-chamber programming in an implantable cardioverter-defibrillator? Results of the INTRINSIC RV (Inhibition of Unnecessary RV Pacing With AVSH in ICDs) study. Circulation. 2007;115(1):9–16.

    Article  PubMed  Google Scholar 

  21. Ware J. SF-36 Health Survey: manual and interpretation guide. Boston, Mass: Nimrod Press; 1993.

    Google Scholar 

  22. Samsa G, Edelman D, Rothman ML, Williams GR, Lipscomb J, Matchar D. Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II. Pharmacoeconomics. 1999;15(2):141–55.

    Article  CAS  PubMed  Google Scholar 

  23. Steinberg JS, Joshi S, Schron EB, Powell J, Hallstrom A, McBurnie M, et al. Psychosocial status predicts mortality in patients with life-threatening ventricular arrhythmias. Heart Rhythm. 2008;5(3):361–5.

    Article  PubMed  Google Scholar 

  24. Amiaz R, Asher E, Rozen G, Czerniak E, Glikson M, Weiser M. Do implantable cardioverter defibrillators contribute to new depression or anxiety symptoms? A retrospective study. Int J Psychiatry Clin Pract. 2016;20(2):101–5.

    Article  PubMed  Google Scholar 

  25. Thylen I, Dekker RL, Jaarsma T, Stromberg A, Moser DK. Characteristics associated with anxiety, depressive symptoms, and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients. J Psychosom Res. 2014;77(2):122–7.

    Article  PubMed  Google Scholar 

  26. Falcoz PE, Chocron S, Laluc F, Puyraveau M, Kaili D, Mercier M, et al. Gender analysis after elective open heart surgery: a two-years comparative study of quality of life. Ann Thorac Surg. 2006;81(5):1637–43.

    Article  PubMed  Google Scholar 

  27. Bhatia SC, Bhatia SK. Depression in women: diagnostic and treatment considerations. Am Fam Physician. 1999;60(1):225–34. 39–40.

    CAS  PubMed  Google Scholar 

  28. Pigott T. Anxiety disorders. In: Kornstein S, Clayton AH, editors. Women’s mental health: a comprehensive textbook. New York: Guilford Press; 2002.

    Google Scholar 

  29. Walker RL, Campbell KA, Sears SF, Glenn BA, Sotile R, Curtis AB, et al. Women and the implantable cardioverter defibrillator: a lifespan perspective on key psychosocial issues. Clin Cardiol. 2004;27(10):543–6.

    Article  PubMed  Google Scholar 

  30. Luderitz B, Jung W, Deister A, Marneros A, Manz M. The quality of life after the implantation of a cardioverter/defibrillator in malignant arrhythmias. Dtsch Med Wochenschr. 1993;118(9):285–9.

    Article  CAS  PubMed  Google Scholar 

  31. Dubin AM, Batsford WP, Lewis RJ, Rosenfeld LE. Quality-of-life in patients receiving implantable cardioverter defibrillators at or before age 40. Pacing Clin Electrophysiol. 1996;19(11 Pt 1):1555–9.

    Article  CAS  PubMed  Google Scholar 

  32. Sears Jr SF, Burns JL, Handberg E, Sotile WM, Conti JB. Young at heart: understanding the unique psychosocial adjustment of young implantable cardioverter defibrillator recipients. Pacing Clin Electrophysiol. 2001;24(7):1113–7.

    Article  PubMed  Google Scholar 

  33. Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, et al. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002;87(3):235–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Dougherty CM, Dewhurst T, Nichol WP, Spertus J. Comparison of three quality of life instruments in stable angina pectoris: Seattle angina questionnaire, short form health survey (SF-36), and quality of life index-cardiac version III. J Clin Epidemiol. 1998;51(7):569–75.

    Article  CAS  PubMed  Google Scholar 

  35. Wilkoff BL, Williamson BD, Stern RS, Moore SL, Lu F, Lee SW, et al. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol. 2008;52(7):541–50.

    Article  PubMed  Google Scholar 

  36. Sears SF, Whited A, Koehler J, Gunderson B. Examination of the differential impacts of antitachycardia pacing vs. shock on patient activity in the EMPIRIC study. Europace. 2015;17(3):417–23.

    Article  PubMed  Google Scholar 

  37. Tomzik J, Koltermann KC, Zabel M, Willich SN, Reinhold T. Quality of life in patients with an implantable cardioverter defibrillator: a systematic review. Front Cardiovasc Med. 2015;2:34.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Pauli P, Wiedemann G, Dengler W, Blaumann-Benninghoff G, Kuhlkamp V. Anxiety in patients with an automatic implantable cardioverter defibrillator: what differentiates them from panic patients? Psychosom Med. 1999;61(1):69–76.

    Article  CAS  PubMed  Google Scholar 

  39. Sears Jr SF, Conti JB. Quality of life and psychological functioning of ICD patients. Heart. 2002;87(5):488–93.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors thank the INTRINSIC RV patients, investigators, and institutions for their participation.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Louisville School of Medicine, 550 So. Jackson St., ACB/A3L41, Louisville, KY, 40202, USA

    Rakesh Gopinathannair

  2. Cardiovascular Systems, Inc, St. Paul, MN, USA

    Darin R. Lerew

  3. Department of Veterans Affairs, Greenville Community Based Outpatient Clinic, Greenville, NC, USA

    Natalie J. Cross

  4. Department of Psychology, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA

    Samuel F. Sears

  5. The Integra Group, Brooklyn Park, MN, USA

    Scott Brown

  6. University of Iowa Hospitals, Iowa City, IA, USA

    Brian Olshansky

Authors
  1. Rakesh Gopinathannair
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darin R. Lerew
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natalie J. Cross
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Samuel F. Sears
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Scott Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Brian Olshansky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rakesh Gopinathannair.

Ethics declarations

Sources of funding

This study was funded by Boston Scientific CRM.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gopinathannair, R., Lerew, D.R., Cross, N.J. et al. Longitudinal changes in quality of life following ICD implant and the impact of age, gender, and ICD shocks: observations from the INTRINSIC RV trial. J Interv Card Electrophysiol 48, 291–298 (2017). https://doi.org/10.1007/s10840-017-0233-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-017-0233-y

Keywords

Search

Navigation