Abstract 10016: Impact of Cardiac Devices on the Quality of Life in Pediatric Patients and Parents
Background: Cardiac devices are increasingly utilized in children. The impact of devices on quality of life (QoL) in this population is poorly understood.
Objective: To compare QoL scores between pediatric device patients and healthy controls, and determine the key drivers of QoL in pediatric device patients.
Methods: Multi-center, cross-sectional study at 8 pediatric centers. Subjects were 8-18 yrs and had a pacemaker or implantable defibrillator (ICD). Patient-parent pairs completed the: Pediatric Quality of Life Inventory (PedsQL) and Pediatric Cardiac Quality of Life Inventory (PCQLI) to assess patient QoL; Self Perception Profile to assess patient self-perception; and the Child Behavior Checklist to assess patient behavioral functioning. T-tests were used to test for differences between study sample and healthy control patient and parent-proxy PedsQL Total scores. Structural Equation Modeling was used to test for differences in PCQLI Total score between: 1) ICD and pacemaker patients; 2) CHD and non-CHD patients; and 3) hypothesized key drivers of QOL: device type, presence of CHD, activity restrictions, device complications, self-perception, and behavioral functioning.
Results: 173 patient-parent pairs [40 ICD/133 pacemaker; 50% CHD; 50% male; age 13 (8 - 18) yrs] were included. Compared to healthy controls, both patients (86 vs. 75, p<0.001) and parents (85 vs. 69, p<0.0001) reported significantly lower PedsQL Total score. ICD patients had lower PCQLI Total scores than pacemaker patients (65 vs. 74, p<0.001). CHD patients had lower PCQLI Total score than non-CHD patients (64 vs. 74, p<0.001). The key drivers of patient QoL were presence of ICD (p<0.001), CHD (p<0.001), and worse self-perception (p<0.001). For parent reporters, patient QoL was driven by internalizing behavioral problems (anxiety, depression, somatization) (p<0.001). Activity restrictions and device complications did not impact QoL.
Conclusions: Pediatric device patients have a lower QoL than healthy controls. ICD and CHD patients demonstrated lower QoL. Drivers of lower QoL included device type, presence of CHD, and worse patient self-perception and behavior functioning. Whether these factors can be mitigated through the use of psychotherapy needs to be assessed.
- Pediatric electrophysiology
- Pediatric cardiology
- Quality of life
- Implantable cardioconvert defibrillator
- © 2011 by American Heart Association, Inc.