Circulation. 2002;105:589-594
doi: 10.1161/hc0502.103330
doi: 10.1161/hc0502.103330
(Circulation. 2002;105:589.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Quality of Life in the Antiarrhythmics Versus Implantable Defibrillators Trial
Impact of Therapy and Influence of Adverse Symptoms and Defibrillator Shocks
From the Clinical Trials Group, National Heart, Lung, and Blood Institute (E.B.S.), Bethesda, Md; University of Calgary (D.V.E.), Canada; University of Washington (Q.Y.), Seattle; and AVID clinical sites at the University of Maryland, Baltimore (L.S.J.), St Luke’s Medical Center, New York, NY (J.S.S.), Baystate Medical Center, Springfield, Mass (J.R.C.); MCP Hahnemann University Hospital, Philadelphia, Pa (S.P.K.); Brigham and Women’s Hospital, Boston, Mass (P.L.F.), University of Alabama at Birmingham (R.S.B.); UT Southwestern, Dallas, Tex (R.L.P.); and University of Seattle, Wash (J.P.).
Correspondence to Derek V. Exner, MD, 3330 Hospital Dr NW, Room G208, Calgary, AB, Canada T2N 4N1. E-mail exner{at}ucalgary.ca
Background— Implantable cardioverter defibrillator (ICD) use reduces mortality in patients with serious ventricular arrhythmias compared with antiarrhythmic drug (AAD) use. However, the relative impact of these therapies on self-perceived quality of life (QoL) is unknown.
Methods and Results— Three self-administered instruments were used to measure generic and disease-specific QoL in Antiarrhythmics Versus Implantable Defibrillators trial participants. Generalized linear models were used to assess the relationships between self-perceived QoL and treatment (AAD versus ICD) and adverse symptoms and ICD shocks. To minimize the impact of missing data, only patients surviving 1 year were included in the primary analyses. Baseline characteristics among QoL participants (n=905) and nonparticipants (n=111) were similar, but participants who survived 1 year (n=800) were healthier at baseline than nonsurvivors (n=105). Of the 800 patients in the primary analysis, characteristics of those randomized to AAD (n=384) versus ICD (n=416) were similar. Overall, ICD and AAD use were associated with similar alterations in QoL. The development of sporadic shocks and adverse symptoms were each associated with reduced physical functioning and mental well-being and increased concerns among ICD recipients, whereas development of adverse symptoms was associated with reduced physical functioning and increased concerns among AAD recipients.
Conclusions— ICD and AAD therapy are associated with similar alterations in self-perceived QoL over 1-year follow-up. Adverse symptoms were associated with reduced self-perceived QoL in both groups, and sporadic shocks were associated with reduced QoL in ICD recipients.
Key Words: quality of life • antiarrhythmia agents • heart arrest • tachyarrhythmias • defibrillation
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