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Editorial
A rehabilitative approach to patients with internal cardioverter-defibrillators
  1. R J P LEWIN
  1. D J FRIZELLE
  1. G C KAYE
  1. British Heart Foundation Rehabilitation Research Unit
  2. The University of York
  3. Genesis 6
  4. York Science Park
  5. Heslington
  6. York YO10 5DG, UK
  7. rjpl1@york.ac.uk
  8. Department of Clinical Psychology
  9. University of Hull
  10. Cottingham Road
  11. Hull HU6 7RX, UK
  12. Department of Cardiology
  13. Castle Hill Hospital
  14. Castle Road
  15. Cotingham
  16. East Yorkshire HU16 5JQ, UK

https://doi.org/10.1136/heart.85.4.371

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    In the UK the National Institute for Clinical Excellence has recently reviewed the value of internal cardioverter-defibrillators (ICDs) and has recommended an increase in their use. The guidance includes the recommendation that centres that implant devices should provide “A rehabilitative approach to aftercare which includes psychological preparation for living with an ICD”.1 The first solution that may occur to clinicians is to appoint a liaison nurse, but would this constitute a rehabilitative approach, or be the best solution for patients? We recently initiated a rehabilitation programme for ICD patients and, before doing so, reviewed the literature to answer two questions:

    • What benefits could ICD patients hope to gain from rehabilitation?

    • Do they have rehabilitation needs that differentiate them from other cardiac patients?

    What benefits could ICD patients receive from cardiac rehabilitation?

    Systematic review and meta-analysis have established that a cardiac rehabilitation programme can improve survival, functional ability, and quality of life in post-myocardial infarction and cardiac surgery patients. It is not, as many think, simply an exercise programme. To be effective it must include attention to secondary prevention through lifestyle change, and attention to the patient's psychological and social adjustment to coronary artery disease.2

    SURVIVAL BENEFITS

    It might be thought that ICD patients are protected from sudden death so have little to gain in this respect. Unfortunately arrhythmias remain the cause of death in 60% of these patients.3 It is not clear how cardiac rehabilitation reduces mortality but, as it does not reduce the rate of reinfarction, it may be through protecting the ischaemic heart from arrhythmia and this may be due to exercise. Animal work has shown that exercise training reduces lethal arrhythmias, probably through a shift in the autonomic balance towards an increased vagal effect4; similar shifts have been demonstrated in exercised post-myocardial infarction patients.5 Cardiac rehabilitation has also been shown to reduce …

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