The influence of age on the psychological profile of patients with cardiac implantable electronic devices: results from the Italian population in a multicenter study conducted by the European Heart Rhythm Association

  • Stefano FumagalliEmail author
  • Paolo Pieragnoli
  • Kristina H. Haugaa
  • Tatjana S. Potpara
  • Laura Rasero
  • Nicola Ramacciati
  • Giuseppe Ricciardi
  • Francesco Solimene
  • Giuseppe Mascia
  • Giosuè Mascioli
  • Giulia Zuo
  • Anna T. Roberts
  • Niccolò Marchionni
  • Radoslaw Lenarczyk
  • Serge Boveda
  • Nikolaos Dagres
Original Article



Cardiac implantable electronic devices (CIEDs) are widely used to treat bradyarrhythmias or improve the prognosis of patients with heart failure (HF).


To evaluate age-related (≤ 75 vs. > 75 years) attitudes, worries, psychological effects and needs in an Italian CIEDs population.


Patients attending their periodical ambulatory evaluation received a questionnaire conceived by the European Heart Rhythm Association Scientific Initiatives Committee as part of a multicenter, multinational snapshot survey. Seven countries participated in the study, and 1646 replies were collected. Of these, 437 (27%) were from Italy. Present results refer to the Italian population only. CIEDs were stratified into devices to treat bradycardia or HF.


The use of CIEDs was more common in advanced age. Older patients needed less information about CIEDs than younger ones (p = 0.044), who would prefer to be better informed about CIEDs-related consequences on psychologic profile (p = 0.045), physical (p < 0.001) and sexual (p < 0.001) activities, and driving limitations (p = 0.003). When compared to older subjects, younger individuals experienced more difficulties (p = 0.035), especially in their professional (p < 0.001) and private life (p = 0.033), feeling their existence was limited by the device (p < 0.001). Conversely, quality of life (HRQL) more often improved in the elderly (p = 0.001). Information about what to do with CIEDs at the end of life is scant independently of age.


HRQL after CIEDs implantation improves more frequently in older patients, while the psychological burden of CIEDs is usually higher in younger patients. End of life issues are seldom discussed.


Cardiac implantable electronic devices CRT ICD Elderly End-of-life issues Quality of life 



We would like to thank the EHRA Electrophysiology Research Network Centers, which allowed to reach a relevant number of patients participating to the survey. Thanks to Enrico Antonini, DLit, Mrs. Angela Dichiara and Mrs. Patrizia Mirone, for their support in the conduction of the study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Stefano Fumagalli
    • 1
    Email author
  • Paolo Pieragnoli
    • 2
  • Kristina H. Haugaa
    • 3
  • Tatjana S. Potpara
    • 4
  • Laura Rasero
    • 5
  • Nicola Ramacciati
    • 6
  • Giuseppe Ricciardi
    • 2
  • Francesco Solimene
    • 7
  • Giuseppe Mascia
    • 7
  • Giosuè Mascioli
    • 8
  • Giulia Zuo
    • 5
  • Anna T. Roberts
    • 1
  • Niccolò Marchionni
    • 1
  • Radoslaw Lenarczyk
    • 9
  • Serge Boveda
    • 10
  • Nikolaos Dagres
    • 11
  1. 1.Geriatric Intensive Care Unit and Geriatric Arrhythmia UnitUniversity of Florence and AOU CareggiFlorenceItaly
  2. 2.Electrophysiology LaboratoryUniversity of Florence and AOU CareggiFlorenceItaly
  3. 3.Oslo University HospitalOsloNorway
  4. 4.University of BelgradeBelgradeSerbia
  5. 5.Department of Health Sciences, Department of Health ProfessionsUniversity of Florence and AOU CareggiFlorenceItaly
  6. 6.Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
  7. 7.Montevergine Cardiology ClinicMercoglianoItaly
  8. 8.Clinical Institute Humanitas GavazzeniBergamoItaly
  9. 9.Silesian Center for Heart DiseasesZabrzePoland
  10. 10.Cardiology DepartmentClinique PasteurToulouseFrance
  11. 11.Department of ElectrophysiologyHeart Center of LeipzigLeipzigGermany

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