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Comparison of patient and partner quality of life and health outcomes in the first year after an implantable cardioverter defibrillator (ICD)

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Abstract

Recovery following an implantable cardioverter defibrillator (ICD) impacts both the patient and partner, often in divergent ways. Patients may have had a cardiac arrest or cardiac arrhythmias, whereas partners may have to perform CPR and manage the ongoing challenges of heart disease therapy. Currently, support for post-ICD care focuses primarily on restoring patient functioning with few interventions available to partners who serve as primary support. This descriptive study examined and compared patterns of change for both patients and partners during the first year post-ICD implantation. For this longitudinal study, the sample included 42 of 55 (76.4 %) patient–partner dyads who participated in the ‘usual care’ group of a larger intervention RCT with patients following ICD implant for secondary prevention of cardiac arrest. Measures taken at across five time points (at hospital discharge and at 1, 3, 6 and 12 months follow up) tracked physical function (SF-12 PCS, symptoms); psychological adjustment (SF-12 MCS; State-Trait Anxiety Inventory; CES-D); relationship impact (Family Functioning, DOII; Mutuality and Interpersonal Sensitivity, MIS); and healthcare utilization (ED visits, outpatient visits, hospitalizations). Repeated measures analysis of variance was used to characterize and compare outcome trends for patients and partners across the first 12 months of recovery. Patients were 66.5 ± 11.3 (mean + SD) years old, predominately Caucasian male (91 %), with Charlson co-morbidities of 4.4 ± 2.4. Partners were 62.5 ± 11.1 years old, predominantly female (91 %) with Charlson co-morbidities of 2.9 ± 3.0. Patient versus partner differences were observed in the pattern of physical health (F = 10.8, p < 0.0001); patient physical health improved while partner health showed few changes. For partners compared to patients, anxiety, depression, and illness demands on family functioning tended to be higher. Patient mutuality was stable, while partner mutuality increased steadily (F = 2.5, p = 0.05). Patient sensitivity was highest at discharge and declined; partner sensitivity increased (F = 10.2, p < 0.0001) across the 12-month recovery. Outpatient visits for patients versus partners differed (F = 5.0, p = 0.008) due most likely to the number of required patient ICD visits. Total hospitalizations and ED visits were higher for patients versus partners, but not significantly. The findings highlight the potential reciprocal influences of patient and partner responses to the ICD experience on health outcomes. Warranted are new, sound and feasible strategies to counterbalance partner needs while simultaneously optimizing patient recovery outcomes.

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Acknowledgments

Funding source

National Institutes of Health, National Institute for Nursing Research, RO1 NR04766.

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Authors and Affiliations

  1. Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, 1959 NE Pacific Street, HSB T615A, Box 357266, Seattle, WA, 98195-7266, USA

    Cynthia M. Dougherty

  2. Hall Health Center, University of Washington, Seattle, WA, USA

    Allison M. Fairbanks

  3. University of Washington School of Nursing, Seattle, WA, USA

    Linda H. Eaton, Megan L. Morrison & Mi Sun Kim

  4. Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA

    Elaine A. Thompson

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  1. Cynthia M. Dougherty
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  2. Allison M. Fairbanks
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  5. Mi Sun Kim
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  6. Elaine A. Thompson
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Correspondence to Cynthia M. Dougherty.

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Cynthia M. Dougherty, Allison M. Fairbanks, Linda H. Eaton, Megan L. Morrison, Mi Sun Kim and Elaine A. Thompson declare that they have no conflicts of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Written informed consent was obtained from all patients and partners prior to being included in the study.

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Dougherty, C.M., Fairbanks, A.M., Eaton, L.H. et al. Comparison of patient and partner quality of life and health outcomes in the first year after an implantable cardioverter defibrillator (ICD). J Behav Med 39, 94–106 (2016). https://doi.org/10.1007/s10865-015-9671-0

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  • DOI: https://doi.org/10.1007/s10865-015-9671-0

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