Abstract 1655: A Prospective Study of the Effect of ICD’s on Patient Quality of Life
Background: Implantation of ICDs has the potential to induce changes in quality of life (QOL). In an effort to elaborate on these effects, we performed a prospective study of 240 patients to assess QOL post-implantation.
Methods: We surveyed 240 patients implanted with ICDs at the Mayo Clinic-Rochester at initial implant, and at 6 and 12 months post-implantation. Initial surveys included anxiety scales (anxiety sensitivity index (ASI), a somatization scale (Barsky), and an optimism scale (Life Orientation Test (LOT)). Surveys performed at each time point included the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale-Revised (IES-R) (a measure of PTSD), SF-36 (a 36 question survey to assess patient physical and mental health), and an 11-question survey on activity levels and the impact of arrhythmia or medical concerns on activities.
Results: In patients with discharges (n=20), there was no difference at 6 or 12 month follow-up in SF-36, HADS, or IES-R from patients without discharges. However, patients with discharges (n=20 p<0.05), multiple discharges (n=6 p<0.001), or electrical storms (n=4 p<0.0001) within 12 months of follow-up were more likely to have decreased activity level secondary to concern about being too active, concern about triggering an arrhythmia, or being told by a doctor to limit activity at 6 months follow-up regardless of discharges occurring within 6 months (n=11) or after 6 months (n=9). At 12 months, there was no significant difference in activity levels and a return to initial levels in patients with discharges. Patients with significantly higher ASI and Barsky scores had significantly higher IES-R at 12 months (greater than 50% increase from initial) and significant decrease in physical or mental health (>25% reduction) from 0 to 12 months (p<0.01 for all comparisons) independent of discharge, NYHA class, or primary or secondary indications. Within this group, there was inverse correlation between IES-R and physical and mental health scores while there was no correlation in the overall population.
Conclusions: These data suggest that over the long term, discharges have little impact on QOL. Preimplant personality factors have a large impact on the QOL consequences of ICD implant and reaction to shocks.