Abstract 13860: Patient and Partner (P+P) Intervention to Improve Outcomes After and Implantable Cardioverter Defibrillator (ICD): Three Month Physical Health Outcomes
Introduction: Partners of patients who get an ICD play a pivotal role in the patient’s adjustment over the initial 3 months. The purpose of this study was to compare 2 intervention programs after an initial ICD: an intervention for the patient-only (P) was compared to an intervention involving both the patient and their intimate partner (P+P).
Hypothesis: The P+P intervention will demonstrate better patient reported outcomes than the (P)-only intervention.
Methods: A prospective randomized control trial (RCT) comparing 2 interventions after an initial ICD on patient and partner outcomes, was conducted with 301 intimate couples in the Pacific NW. The self-efficacy based nurse telephone intervention was delivered over the 1st 12 weeks following ICD implant for primary (60%) or secondary (40%) prevention. Patient physical health outcomes were measured at baseline hospital discharge and 3 months later using the Patient Concerns Assessment (PCA), SF-36 PCS, total steps taken on a Step Watch physical activity monitor, and the Sudden Cardiac Arrest Self-Efficacy (SCA-SE) scale. Structural equation modeling was used to test the hypothesized effects of the intervention and the mediating effects of self-efficacy on patient physical health.
Results: ICD patients (N=150) in P-only were (mean±SD) 65.0±12.3 years old, 90.1% Caucasian, 70.2% were male, with Charlson scores of 2.26±1.4, EF% 33.8±13.5, & household income $30-49,000 (23%). ICD patients (N=151) in P+P were 63.3±12.5 years old, 92% Caucasian, 77.3% were male, with Charlson scores of 2.2±1.5, EF% 34.4±15.2. From baseline to 3 months, PCA symptoms were reduced in both groups p=0.84, and SF-36 physical health (p=0.62) and total steps/day (p=0.26) improved in both groups. The direct effect of the intervention on patient self-efficacy at 3 months was significant (B=0.11, p=0.03). Improvements in patient self-efficacy were associated with a reduction in 3 month physical symptoms (B=-0.19, p<0.001), and improved physical health (B=0.16, p<0.001), but not total steps/day (B=0.07, p=0.07). Fit indicies met standards for model fit: CFI=0.90, RMSEA=0.08.
Conclusions: The intervention arm involving the partner (P+P) resulted in higher levels of patient physical health after an initial ICD.
Author Disclosures: C.M. Dougherty: None. E.A. Thompson: None. A. Dobra: None. P.J. Kudenchuk: None.
- © 2016 by American Heart Association, Inc.