Advertisement

Irish Journal of Medical Science

, Volume 180, Issue 2, pp 369–374 | Cite as

Clinical and psychological impact of prophylactic implantable cardioverter-defibrillators in a community heart failure population

  • S. Arnous
  • N. F. Murphy
  • P. Pyne-Daly
  • Z. Nawoor
  • D. Keane
  • M. Ledwidge
  • K. McDonald
Original Article
  • 149 Downloads

Abstract

Aims

ICD implantation for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction (ejection fraction ≤35%) has increased since the publication of the SCD-HEFT and MADIT-II data. The aim of this study is to examine the effectiveness and safety of prophylactic ICD use in a community heart failure population and to assess the impact on patient’s quality of life.

Methods and results

Seventy-one ICDs were inserted between the years 2002 and 2006. The mean follow-up from time of insertion was 24 ± 11 months. Eighteen patients (25%) had potentially life-saving therapy. Seven (10%) patients received inappropriate shocks. Complications were encountered in five patients (7%).

Conclusion

In a community heart failure population, prophylactic ICD implantation is associated with a high incidence of life-saving therapy, a low complication rate and a high level of tolerability. These data indicate translation of clinical trial benefits to the general heart failure population.

Keywords

Implantable cardioverter-defibrillator Chronic heart failure Left ventricular systolic dysfunction Anxiety Complications 

References

  1. 1.
    Bardy GH, Lee KL, Mark DB et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352(3):225–237PubMedCrossRefGoogle Scholar
  2. 2.
    Beck AT, Steer RA, Brown GK (2000) BDI-Fast Screen for medical patients manual. The psychological corporation, San AntonioGoogle Scholar
  3. 3.
    Bostwick JM, Sola CL (2007) An updated review of implantable cardioverter/defibrillators, induced anxiety, and quality of life. Psychiatr Clin North Am 30(4):677–688PubMedCrossRefGoogle Scholar
  4. 4.
    Bradfield J, Warner A, Bersohn MM (2009) Low referral rate for prophylactic implantation of cardioverter-defibrillators in a tertiary care medical center. Pacing Clin Electrophysiol 32(Suppl 1):S194–S197PubMedCrossRefGoogle Scholar
  5. 5.
    Burke JL, Hallas CN, Clark-Carter D et al (2003) The psychosocial impact of the implantable cardioverter defibrillator: a meta-analytic review. Br J Health Psychol 8(Pt 2):165–178PubMedCrossRefGoogle Scholar
  6. 6.
    Camm AJ, Nisam S (2000) The utilization of the implantable defibrillator—a European enigma. Eur Heart J 21(24):1998–2004PubMedCrossRefGoogle Scholar
  7. 7.
    Dickstein K, Cohen-Solal A, Filippatos G et al. (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29(19):2388–2442Google Scholar
  8. 8.
    Duru F, Buchi S, Klaghofer R et al (2001) How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life? Heart 85(4):375–379PubMedCrossRefGoogle Scholar
  9. 9.
    Groeneveld PW, Matta MA, Suh JJ et al (2007) Quality of life among implantable cardioverter-defibrillator recipients in the primary prevention therapeutic era. Pacing Clin Electrophysiol 30(4):463–471PubMedCrossRefGoogle Scholar
  10. 10.
    Heidbuchel H (2007) The cost of implantable defibrillators: how the perception of reality depends on perspective. Eur Heart J 28(4):386–387PubMedCrossRefGoogle Scholar
  11. 11.
    Herrmann C (1997) International experiences with the Hospital Anxiety and Depression Scale—a review of validation data and clinical results. J Psychosom Res 42(1):17–41PubMedCrossRefGoogle Scholar
  12. 12.
    Jacq F, Foulldrin G, Savoure A et al (2009) A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry 31(3):266–273PubMedCrossRefGoogle Scholar
  13. 13.
    Kadish A, Dyer A, Daubert JP et al (2004) Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 350(21):2151–2158PubMedCrossRefGoogle Scholar
  14. 14.
    Kamphuis HC, de Leeuw JR, Derksen R et al (2003) Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery: a prospective study. Europace 5(4):381–389PubMedCrossRefGoogle Scholar
  15. 15.
    Mark DB, Nelson CL, Anstrom KJ et al (2006) Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation 114(2):135–142PubMedCrossRefGoogle Scholar
  16. 16.
    McMurray J (2000) Heart failure: we need more trials in typical patients. Eur Heart J 21(9):699–700PubMedCrossRefGoogle Scholar
  17. 17.
    Moss AJ, Zareba W, Hall WJ et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346(12):877–883PubMedCrossRefGoogle Scholar
  18. 18.
    Schron EB, Exner DV, Yao Q et al (2002) Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation 105(5):589–594PubMedCrossRefGoogle Scholar
  19. 19.
    Sulaiman HM, O’Loughlin C, Daly M et al (2008) Need and evolution of need for device therapy in a community heart failure population. Eur J Heart Fail 10(6):601–607PubMedCrossRefGoogle Scholar
  20. 20.
    Thomas SA, Friedmann E, Kao CW et al (2006) Quality of life and psychological status of patients with implantable cardioverter defibrillators. Am J Crit Care 15(4):389–398PubMedGoogle Scholar
  21. 21.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370Google Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2010

Authors and Affiliations

  • S. Arnous
    • 1
  • N. F. Murphy
    • 1
  • P. Pyne-Daly
    • 1
  • Z. Nawoor
    • 1
  • D. Keane
    • 1
  • M. Ledwidge
    • 1
  • K. McDonald
    • 1
  1. 1.Heart Failure Unit, Department of CardiologySt Vincent’s University HospitalDublin 4Ireland

Personalised recommendations