Quality of life predicts one-year survival in patients with implantable cardioverter defibrillators

PurposeThis study examines the contributions of known predictors of survival and quality of life (QOL) to 1-year survival in ICD recipients.MethodsThis study used the data set from the antiarrhythmia versus implanted defibrillator (AVID) controlled clinical trial conducted by the National Institutes of Health, National Heart, Lung, and Blood Institute. The 507 patients randomly assigned to the ICD treatment were included in the analysis. Patients were mostly male (78.3%), with mean age of 64.85 ± 10.81  and mean left ventricular ejection fraction of 32.2 ± 13.45%. QOL was measured with the medical outcomes study 36-item short form health survey (SF-36) and quality of life index-cardiac version (QLI-CV). Data were analyzed with descriptive statistics and logistic regression.ResultsFifty-four (10.6%) patients died in the first year after ICD implantation. Angiotensin-converting enzyme inhibitor (ACE) medication, age, and QLI-CV were significant independent predictors of 1-year survival. The odds of survival of a younger patient with ACE medication and good QOL were approximately three times (OR = 3.96) greater than for an older patient, without ACE medication and with poor QOL.ConclusionQuality of life is an important factor predicting 1-year survival in patients with ICDs. ACE medication and younger age also predict 1-year survival independent of QOL and each other.

[1]  John E. Ware,et al.  SF-36 Health Survey. , 1990 .

[2]  L. Delunas,et al.  Adaptation after treatment for heart disease: preliminary examination within a stress appraisal context. , 1999, Heart & lung : the journal of critical care.

[3]  M. Gold,et al.  Effect of an implantable cardioverter defibrillator with atrial detection and shock therapies on patient-perceived, health-related quality of life. , 2003, American heart journal.

[4]  J J Heger,et al.  Sudden cardiac death. , 1998, Circulation.

[5]  F. Marchlinski,et al.  Shock Occurrence and Survival in 241 Patients With Implantable Cardioverter‐ Defibrillator Therapy , 1993, Circulation.

[6]  P. Touboul,et al.  Improved appraisal of the quality of life in patients with automatic implantable cardioverter defibrillator: a psychometric study. , 1996, Psychotherapy and psychosomatics.

[7]  P. Armstrong,et al.  Implantable cardioverter defibrillators in primary and secondary prevention: a systematic review of randomized, controlled trials. , 2003, Annals of internal medicine.

[8]  W. Tierney,et al.  Generic versus Disease-Specific Health Status Measures , 1998, Evaluation & the health professions.

[9]  S. Feldstein,et al.  Health‐Related Quality‐of‐Life Assessment of Patients with Life‐Threatening Ventricular Arrhythmias , 1999, Pacing and clinical electrophysiology : PACE.

[10]  B. Fridlund,et al.  Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study. , 2001, Journal of clinical nursing.

[11]  T. Guarnieri,et al.  Predictors of First Discharge and Subsequent Survival in Patients With Automatic Implantable Cardioverter‐Defibrillators , 1991, Circulation.

[12]  S. Deshpande,et al.  Comparison of outcome of implantable cardioverter defibrillator implantation in patients with severe versus moderately severe left ventricular dysfunction secondary to atherosclerotic coronary artery disease. , 1997, The American journal of cardiology.

[13]  Thomas E. Moritz,et al.  Health-Related Quality of Life As a Predictor of Mortality Following Coronary Artery Bypass Graft Surgery , 2000, Survey of Anesthesiology.

[14]  B. Yates,et al.  Quality of life comparisons after coronary angioplasty and coronary artery bypass graft surgery. , 1999, Heart & lung : the journal of critical care.

[15]  Judy Powell,et al.  Quality of Life in the Antiarrhythmics Versus Implantable Defibrillators Trial: Impact of Therapy and Influence of Adverse Symptoms and Defibrillator Shocks , 2002, Circulation.

[16]  M. Keller,et al.  A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. , 1997, The New England journal of medicine.

[17]  R. Myerburg,et al.  Ventricular arrhythmias in congestive heart failure , 1989, Clinical cardiology.

[18]  P. Schuster,et al.  The psychosocial and physiological experiences of patients with an implantable cardioverter defibrillator. , 1998, Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses.

[19]  M. Eckert,et al.  How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families? , 2002, International journal of nursing practice.

[20]  S Greenland,et al.  Modeling and variable selection in epidemiologic analysis. , 1989, American journal of public health.

[21]  R. Cappato,et al.  Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). , 2000, Circulation.

[22]  M. Hegel,et al.  Anxiety and Depression in Patients Receiving Implanted Cardioverter-Defibrillators: A Longitudinal Investigation , 1997, International journal of psychiatry in medicine.

[23]  John E. Ware,et al.  SF-36 Health Survey Update , 2000, Spine.

[24]  A. Sossong.  Living With an Implantable Cardioverter Defibrillator: Patient Outcomes and the Nurse's Role , 2007, The Journal of cardiovascular nursing.

[25]  Brian Baker,et al.  Quality of life in the Canadian Implantable Defibrillator Study (CIDS). , 2002, American heart journal.

[26]  M. Scheinman,et al.  Mortality benefit of implantable cardioverter-defibrillator therapy in patients with persistent malignant ventricular arrhythmias despite amiodarone treatment. , 1997, The American journal of cardiology.

[27]  A. Hoes,et al.  Predicting mortality in patients with heart failure: a pragmatic approach , 2003, Heart.

[28]  T. Sensky,et al.  How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life? , 2001, Heart.

[29]  S L Winters,et al.  Predictors of long-term survival in patients with malignant ventricular arrhythmias. , 1997, The American journal of cardiology.

[30]  M. Linden,et al.  Determinants of the quality of life (QoL) in patients with an implantable cardioverter/defibrillator (ICD) , 2004, Quality of Life Research.

[31]  R. Hauer,et al.  ICD: a qualitative study of patient experience the first year after implantation. , 2004, Journal of clinical nursing.

[32]  Riccardo Cappato,et al.  Randomized Comparison of Antiarrhythmic Drug Therapy With Implantable Defibrillators in Patients Resuscitated From Cardiac Arrest The Cardiac Arrest Study Hamburg (CASH) , 2000 .

[33]  J. Merino,et al.  Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators. , 1996, Circulation.

[34]  Limited access data sets from studies funded by the National Heart, Lung, and Blood Institute , 2004, Clinical trials.

[35]  D. Haines,et al.  Use of a regional wall motion score to enhance risk stratification of patients receiving an implantable cardioverter-defibrillator. , 1993, Journal of the American College of Cardiology.

[36]  T. Nilstun,et al.  Patients with ischemic heart disease: Quality of life predicts long-term mortality , 2005, Scandinavian cardiovascular journal : SCJ.

[37]  D. Carroll,et al.  Quality of life in implanted cardioverter defibrillator recipients: the impact of a device shock. , 2005, Heart & lung : the journal of critical care.

[38]  George A. Mensah,et al.  Sudden Cardiac Death in the United States, 1989 to 1998 , 2001, Circulation.

[39]  David W. Hosmer,et al.  Applied Logistic Regression , 1991 .

[40]  S. Fetzer.  The patient with an implantable cardioverter defibrillator. , 2003, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[41]  H. Calkins,et al.  Implantable cardioverter-defibrillator therapy in 300 patients with coronary artery disease presenting exclusively with ventricular fibrillation. , 1994, American heart journal.

[42]  Mark Josephson,et al.  Implantable Defibrillators and Sudden Cardiac Death , 2004, Circulation.

[43]  J. Windle,et al.  The quality of life of patients with life-threatening arrhythmias. , 1995, Archives of internal medicine.

[44]  G. Laufer,et al.  Survival Benefit of the Implantable Cardioverter-Defibrillator in Patients on the Waiting List for Cardiac Transplantation , 2001, Circulation.

[45]  J. Fernsler,et al.  Perceived quality of life before and after implantation of an internal cardioverter defibrillator. , 1995, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[46]  J. Conti,et al.  QUALITY OF LIFE AND PSYCHOLOGICAL FUNCTIONING OF ICD PATIENTS , 2002, Heart.

[47]  C. Herrmann,et al.  Standardized Assessment of Psychological Well‐Being and Quality‐of‐Life in Patients with Implanted Defibrillators , 1997, Pacing and clinical electrophysiology : PACE.

[48]  B. Podesser,et al.  Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators , 1998, Cardiology.

[49]  V. Kühlkamp,et al.  Initial experience with an implantable cardioverter-defibrillator incorporating cardiac resynchronization therapy. , 2002, Journal of the American College of Cardiology.

[50]  R. Virmani,et al.  Sudden cardiac death. , 1987, Human pathology.

[51]  A. Elhendy,et al.  Association of myocardial ischemia with mortality and implantable cardioverter-defibrillator therapy in patients with coronary artery disease at risk of arrhythmic death. , 2005, Journal of the American College of Cardiology.

[52]  J. Windle,et al.  Quality‐of‐Life Six Months After CABG Surgery in Patients Randomized to ICD Versus No ICD Therapy: Findings from the CABG Patch Trial , 1999, Pacing and clinical electrophysiology : PACE.

[53]  A. Moss,et al.  Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. , 1996, The New England journal of medicine.

[54]  Health-related quality of life as a predictor of hospital readmission and death among patients with heart failure. , 2005 .

[55]  A. Hallstrom,et al.  Psychosocial status predicts mortality in patients with life-threatening ventricular arrhythmias. , 2008, Heart rhythm.

[56]  B. Fridlund,et al.  Long-term quality of life and uncertainty in patients living with an implantable cardioverter defibrillator. , 2005, Heart & lung : the journal of critical care.

[57]  J. Spertus,et al.  Health Status Predicts Long-Term Outcome in Outpatients With Coronary Disease , 2002, Circulation.

[58]  M. Powers,et al.  Psychometric assessment of the Quality of Life Index. , 1992, Research in nursing & health.

[59]  M Gent,et al.  Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. , 2000, Circulation.