Patients, intimate partners and family experiences of implantable cardioverter defibrillators: Qualitative systematic review

Department of Nursing, Universidad Rey Juan Carlos, Madrid, Spain.
Journal of Advanced Nursing (Impact Factor: 1.74). 05/2011; 67(12):2537-50. DOI: 10.1111/j.1365-2648.2011.05694.x
Source: PubMed


This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others.
An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks.
A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research.
Twenty-two papers were included. The critical appraisal skills programme and prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence.
People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped.
Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.

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Available from: Domingo Palacios-Ceña
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    • "Notable advances in cardiac rhythm management and the concomitant increased use of implantable cardioverter defibrillators (ICD) have dramatically altered cardiac care in the U.S. The recovery post-ICD implantation is complex and at times prolonged, placing new demands on significant others who provide support and care. Although there are some recent findings regarding the physical and psychosocial adjustment of patients following ICD implantation (Magyar-Russell et al., 2011; Palacios-Ceña et al., 2011; van den Broek et al., 2011), little is known about the impact of the cardiac illness on the overall health of partners and how this impacts patient recovery. Research indicates that the physical health and psychological wellbeing of the patient's intimate partner is important in recovery after cardiac illness (Hwang et al., 2010; Pycha et al., 1990). "
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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.
    Full-text · Article · Sep 2015 · Journal of Behavioral Medicine
    • "Cutitta et al. (2014) reported that most patients (64.6%) reported the ability to resume sex, but sexual activity was avoided by 51%. Similar to prior reports, lack of sexual interest, erectile dysfunction (ED), partner overprotectiveness, and fear of the device firing during sexual activity contributed to changes in sexual function (Berg et al., 2013; Palacios-Ceña et al., 2011). Heart failure as a chronic condition also impacts sexual function, with sexual problems experienced by approximately 60% of patients, and up to 81% reporting ED specifically (Jaarsma, Fridlund, & Mårtensson, 2014). "
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    ABSTRACT: The aim of this study was to examine change in sexual activity before and after cardiac diagnosis in men and women by medication class. Decline in sexual activity after cardiac diagnosis frequently occurs, with adverse effects of medications believed to play a role, although literature by subclass of drugs are conflicting. Mixed methods approach was used to evaluate cardiac patients' (N=211) self-reported medications and changes in sexual activity before and after cardiac diagnosis via mailed survey. Chi square, logistic regression, and thematic analysis were used. First and third generation beta blockers, class 1 calcium channel blockers, vasodilators, diuretics, and loop diuretics adversely affected sexual activity. Significant predictors of change in sexual activity were number of medications, education level, and income; the overall model predicted 25.7% of the variance in sexual activity. Sexual assessment and discussion of sexual concerns and side effects of medications by nurses are important to support sexual function. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Apr 2015 · Applied Nursing Research
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    • "A recent review acknowledged the patients' experience of ICDs and shocks (especially inappropriate shocks) is a barrier to informed consent and inhibits decision-making [17] . Patients with ICDs report a number of emotional changes after receiving an ICD with frequent shocks having a negative effect on emotions including an increase in psychological stress and depressive symptoms [27] "
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    ABSTRACT: This case report aims to outline the psychological effect an arrhythmia can have on a patient and their spouse and how anxiety has a profoundly negative effect on how a patient learns. This case report also highlights the difficulties nurses perceive in attempting to educate and engage the patient and spouse, and the problems in balancing nursing care between technology (in this case the need for constant cardiac monitoring) and more focused on patient concerns (fear of dying and defibrillator discharging). As nursing care incorporates the use of more advanced technology, it is important to ensure care remains patient-focused not technology-focused. The impact of anxiety on cognition and patient learning cannot be underestimated.
    Full-text · Article · Jul 2012
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