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American Journal of Critical Care. 2008;17: 222-230
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CE Article

Long-term Effects of Implanted Cardioverter-Defibrillators on Health Status, Quality of Life, and Psychological State

By Diane L. Carroll, PhD, CNS-BC and Glenys A. Hamilton, RN, DNSc. Diane L. Carroll is the Yvonne L. Munn Nurse Researcher at Yvonne L. Munn Center for Nursing Research, Institute for Patient Care, Massachusetts General Hospital, Boston. Glenys A. Hamilton is a research consultant for Ullevål University Hospital and Aker University Hospital in Oslo, Norway.

Corresponding author: Diane L. Carroll, PhD, CNS-BC, Yvonne L. Munn Center for Nursing Research, Professional Office Building 429, Massachusetts General Hospital, 275 Cambridge St, Boston, MA 02114 (e-mail: dcarroll3{at}partners.org).

Background Living with an implanted cardioverter-defibrillator increases survival, but the effects of the device on health status, quality of life, and psychological state over time are not clear.

Objectives To investigate changes in health status, quality of life, and psychological state associated with implantation of a cardioverter-defibrillator from implantation to 4 years later.

Methods A prospective, longitudinal design was used to measure changes in scores on the Short Form 36 of the Medical Outcomes Study, the Quality of Life Index–Cardiac III, and the Profile of Moods States short form at implantation, 6 months, and 1, 2, 3, and 4 years later.

Results A total of 30 men and 11 women (mean age, 60.4 years) completed all 4 years of follow-up. The physical and mental health composite summary scores of the Short Form 36 changed significantly over time; the mental health score improved (F = 2.95; P = .03), and the physical score worsened (F = 3.69; P = .003). Scores on the Quality of Life Index–Cardiac III did not change significantly. Negative moods were significantly fewer, and the total psychological distress score was significantly lower (F = 10.21; P < .001) during the 4 years of follow-up.

Conclusions Patients had improved mental health and reduced psychological distress by 6 months after implantation. Perception of physical health declined during the 4 years after implantation; the role physical subscore of the Short Form 36 indicated significant improvement in functioning at 6 months and a trend toward reduced functioning at 3 and 4 years after implantation.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the indications for placement of an implantable cardioverter-defibrillator (ICD) and the population of patients for whom this treatment is appropriate
  2. Identify the emotional and physical responses most commonly experienced by ICD recipients
  3. Discuss clinical implications for nurses caring for ICD recipients
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.






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