DOI: 10.5176/2251-3833_GHC17.15

Authors: Wong MF Florence


Abstract: Implantable cardioverter defibrillator (ICD) patients are found to have poorer health-related quality of life (HRQoL) and heightened psychological distress, particularly depression. Coronary artery disease (CAD) is evidenced to be associated with lowered HRQoL and more negative emotions. Since CAD patients have had a higher risk of sudden cardiac arrest (SCA), ICD is the favorable treatment to reduce the mortality rate. This study was to examine psychological status and HRQoL as well as identify factors associated with these two areas among ICD patients with a history of CAD. Of 57 ICD patients with CAD, most of them (91.2{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) aged 60 or older with mean age 63.04 years old (SD=14.58). A majority of them were married (84.2{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) and self-care dependent (89.5{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}). All participants had a history of SCA experience. Almost 80{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} were the first ICD recipients and had ICD implantation more than one year. Only two of them had ICD shock experience. The participants were more depressive (mean 3.67±3.57). About 8.8{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} of patients had severe clinical depression (score ≥8) and 19.3{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} had severe clinical anxiety (score ≥8). The participants had relatively poorer mental health (mean 58.35±9.31) than physical health (mean 38.15±14.98). Female gender was found to have positive association with anxiety; whereas, having a history of DM has positive association with depression. Self-care dependence was the most significant factor associated with anxiety and depression. Depression was found to be negatively associated with physical health; whereas, anxiety was negatively associated with mental health. By contrast, having occupation and having a history of hyperlipidemia were found to be positively associated with physical health. The results provide new knowledge about psychological well-being and HRQoL of ICD patients with CAD. Identification of factors associated with anxiety and depression as well as physical health and mental health enables nurses to develop strategies to remove or reduce the negative effects but to provide more support to foster the positive effects arising from the factors. The study results are crucial to design appropriate interventions for early detection of heightened psychological distress and poorer HRQoL. Therefore, the study results can direct healthcare policy makers implement strategies for optimizing HRQoL and reducing psychological burdens.

Keywords: implantable cardioverter defibrillator; coronary artery disease; psychological distress; depression; anxiety; health-related quality of life

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