Reemployment following implantation of the automatic cardioverter defibrillator

doi:10.1016/0002-9149(89)90457-8

The American Journal of Cardiology

Volume 64, Issue 3, 15 July 1989, Pages 199-202

https://doi.org/10.1016/0002-9149(89)90457-8 Get rights and content

Abstract

One hundred one patients who received an implantable automatic cardioverter defibrillator (ACD) were evaluated to determine the reemployaient rate and factors associated with return to work. Forty-seven were employed before ACD implantation. Their mean (± standard deviation) age was 53 ± 11 years, 83% were men, 75% had coronary artery disease, 76% presented with cardiac arrest and 28% had concomitant cardiac surgery. The mean ejection fraction of these patients was 0.41 ± 0.15. At follow-up, 29 patients (62%) had resumed work at 11 ± 9 weeks after implantation. Those who returned to work were better educated (15 vs 11 years, p < 0.001) and less likely to have a history of prior myocardial infarction (p < 0.05). There were no significant differences between patients who returned to work and those who did not in terms of age, sex, race, functional class, ejection fraction, extent of coronary artery disease, reason for ACD, or concomitant surgery. Multivariate analysis revealed that level of education was the single best predictor of reemployment status. The only other factors found to add significant predictive power in a stepwise analysis were extent of coronary artery disease and marital status. The model using these 3 variables had a sensitivity of 83% and a specificity of 72%. It was concluded that (1) most patients employed before ACD implantation are able to return to work after the procedure, and (2) nonmedical factors play an important role in the resumption of work-related activities. These findings have important quality-of-life and cost-effectiveness implications for ACD implantees.

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Cited by (51)

Multi-morbidity burden, psychological distress, and quality of life in implantable cardioverter defibrillator recipients: Results from a nationwide study
2019, Journal of Psychosomatic Research
Citation Excerpt :
The loss of a job or unstable financial situations can negatively affect QOL [59]. This is particularly pronounced in individuals who are the breadwinners for their family or single [60]. Little is known about the perceived experience of ICD recipients.
The prevalence of multi-morbidity in implantable cardioverter defibrillator (ICD) recipients is approximately 25%. Multi-morbidity is associated with poor health and psychological outcomes in this population and may affect ICD recipients' quality-of-life (QOL). The purpose of this study was to determine the prevalence of psychological distress (anxiety, depressive symptoms, and Type-D personality) in ICD recipients with varying levels of comorbidities, and to examine the association between multi-morbidity burden and QOL in this population.
All adults listed in the Swedish ICD and Pacemaker Registry in 2012 with an ICD implanted for at least one year were invited to participate in this study. Binary logistic regression was used to predict QOL using the EQ-5D mean index dichotomized based on median QOL scores. Multi-morbidity burden scores were based on quartile groupings.
A total of 2658 ICD recipients participated in the study (with a mean age of 65, 20.6% female, mean implant duration of 4.7 years, with 35.4% implanted for primary prevention of sudden cardiac arrest). Greater multi-morbidity burden, female sex, not working outside the home, history of ICD shock, negative ICD experience, higher levels of ICD-related concerns, and the presence of anxiety, depression, or Type D personality were associated with worse QOL in ICD recipients. Predictors differed by multi-morbidity burden level.
Multi-morbidity burden and psychological distress is an essential factor related to QOL. This issue should be discussed with potential ICD recipients prior to implant. Further exploration of increased recognition and treatment of psychological distress in ICD recipients is warranted.
Quality of life and psychological state of patients with implantable cardioverter-defibrillators
2008, Revista Espanola de Cardiologia Suplementos
Los pacientes con desfibrilador automático implantable (DAI) constituyen una población en riesgo de presentar alteraciones psicológicas y una peor calidad de vida. Sin embargo, datos derivados de la mayoría de los grandes ensayos clínicos aleatorios con DAI ponen de manifiesto que el efecto del dispositivo sobre la calidad de vida es beneficioso o neutro. El principal predictor de empeoramiento de la calidad de vida y ajuste psicológico al DAI, tras el implante, es el número de descargas del dispositivo. Otros predictores son la juventud, los antecedentes de trastornos de ansiedad o depresión, y el escaso apoyo social o familiar. En la mayor parte de los estudios se han realizado evaluaciones de la calidad de vida a corto plazo y se desconoce si ésta puede cambiar a más largo plazo. Además, hay menos información sobre la calidad de vida en pacientes con indicación de DAI como prevención primaria. Disponemos de diversos recursos para ayudar al paciente en el proceso de adaptación a la vida con DAI. Una adecuada programación de los criterios de detección y las terapias de estimulación antitaquicardia reducirá significativamente el número de descargas y hará menos probable el deterioro de la calidad de vida. En pacientes que han experimentado una reducción en ésta tras el implante de DAI, diversas terapias psicológicas, tanto farmacológicas como de intervención psicoterapéutica, han demostrado ser eficaces en la mejoría de la calidad de vida.
Patients with an implantable cardioverter–defibrillator (ICD) form a population that is at an increased risk of presenting with a psychological disorder or a poor quality of life. However, most large randomized clinical studies demonstrate that ICD use leads to a normal or improved quality of life. The main predictor of a poor quality of life and of psychological disturbance after ICD implantation is the frequency of device firing. Other predictors are young age, a history of anxiety or depression, and poor family or social support. The majority of studies have evaluated quality of life over only the short term, and it is not known whether it could change over the long term. In addition, few data are available on the quality of life of patients using an ICD for primary prevention. A range of resources are available for helping patients adapt to life with an ICD. Accurate programming of the parameters for tachycardia detection and antitachycardia pacing therapy significantly reduces the number of ICD discharges and makes a deterioration in quality of life less likely. A range of psychological therapies, involving drugs as well as psychotherapeutic interventions, have proven effective in improving the quality of life of patients who have experienced a decline after device implantation.
Implantable cardioverter-defibrillators
1999, American Journal of Medicine
Implantable defibrillators have become the dominant therapeutic modality for patients with life-threatening ventricular arrhythmias. Current defibrillators are small (<60 mL) and implanted with techniques similar to standard pacemakers. They provide high-energy shocks for ventricular fibrillation and rapid ventricular tachycardia, antitachycardia pacing for monomorphic ventricular tachycardia, as well as antibradycardia pacing. Newer devices incorporating an atrial lead allow dual-chamber pacing and better discrimination between ventricular and supraventricular tachyarrhythmias. Randomized controlled trials have shown superior survival with implantable defibrillators than with antiarrhythmic drugs in survivors of life-threatening ventricular tachyarrhythmias and in high-risk patients with coronary artery disease. Complications associated with implantable defibrillator therapy include infection, lead failure, and spurious shocks for supraventricular tachyarrhythmias. Most patients adapt well to living with an implantable defibrillator, although driving often has to be restricted. Limited evidence suggests that implantable defibrillator therapy is cost-effective when compared with other widely accepted treatments. The use of implantable defibrillators is likely to continue to expand in the future. Ongoing clinical trials will define further prophylactic indications of the implantable defibrillator and clarify its cost-effectiveness ratio in different clinical settings.
Survivors of out of hospital cardiac arrest: Their prognosis, longevity and functional status
1997, Resuscitation
This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. From 1980 to 1993 Göteborg EMS treated 3754 out-of-hospital cardiac arrests. 9% (n=324) were discharged from the hospital alive. Survivors' median age was 67 and 21% (n=67) were women. Mortality rate was: 21% (n=61) at 1 year; 56% (n=78) by 5 years; and 82% (n=32) by 10 years following the arrest. During the first 3 years, 16% (n=46) experienced another cardiac arrest, 19% (n=53) had an acute myocardial infarction and a total of 81% (n=232) were rehospitalized for various conditions. 14% (n=40) returned to previous employment, and 74% (n=229) had retired before their arrest occurred. Cerebral performance categories (CPC) scores were: At hospital discharge N=324; Data available for 320—1=53% (n=171), 2=21% (n=66), 3=24% (n=77), 4=2% (n=6). One year post arrest N=263; Data available for 212—1=73% (n=156), 2=9% (n=18), 3=17% (n=36), 4=1% (n=2). Overall, 21% (n=61) of cardiac arrest survivors died during the first year, and an additional 16% (n=46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.
Securing life through technology acceptance: The first six months after transvenous internal cardioverter defibrillator implantation
1996, Heart and Lung: Journal of Acute and Critical Care
To understand the experience of living with a transvenous internal cardioverter defibrillator (ICD) during the first 6 months after implantation.
A grounded theory approach was used to gain an understanding of the antecedents, conditions, and consequences of the core process.
Two midwestern community medical centers and patients' homes within a 250-mile radius from the medical centers.
Ten women and 14 men between 22 and 78 years of age, who had undergone a new transvenous ICD implantation within the last week.
The core process that described the experience of living with a transvenous ICD during the first 6 months after implantation was the process of “securing life through technology acceptance.” This core process was characterized by three major categories: choosing life with technology, integrating technology into life, and living life through technology.
Nursing interventions related to individualized assessment, education, and counseling are warranted to facilitate patient and family understanding and to plan for the cyclic process involved in integrating a transvenous ICD into their lives. Directions for further research are provided.
Changes in health status, psychological distress, and quality of life in implantable cardioverter defibrillator recipients between 6 months and 1 year after implantation
2002, European Journal of Cardiovascular Nursing

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Reemployment following implantation of the automatic cardioverter defibrillator

Abstract

JACC

Am J Cardiol

Am J Cardiol

The automatic implantable cardioverter-defibrillator: the U.S. experience

Automatic implantable cardioverter defibrillators and survival of patients with left ventricular dysfunction and malignant ventricular arrhythmias

Ann Intern Med

Changes in working status of patients following coronary bypass surgery

JAMA