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Quality of life in the Canadian Implantable Defibrillator Study (CIDS)
Jane Irvine1, Paul Dorian, Brian Baker
1Department of Psychology, York University, University of Toronto, Ontario, Canada. jirvine@yorku.ca
Insights
Implantable cardioverter defibrillator (ICD) therapy improves quality of life compared to amiodarone. However, patients receiving multiple ICD shocks did not experience these quality-of-life benefits.
Area of Science:
- Cardiology
- Medical Devices
- Quality of Life Research
Background:
- The Canadian Implantable Defibrillator Study (CIDS) investigated quality-of-life outcomes for patients receiving implantable cardioverter defibrillator (ICD) therapy versus amiodarone.
- A secondary objective was to assess the impact of device shocks on patient quality of life.
Purpose of the Study:
- To compare quality-of-life outcomes between ICD therapy and amiodarone treatment.
- To evaluate the effect of shocks from an ICD on quality of life.
Main Methods:
- Quality of life was assessed using the Mental Health Inventory (MHI) and Nottingham Health Profile (NHP) in 317 participants.
- Data collection occurred at baseline and at 2, 6, and 12 months post-treatment via mailed questionnaires.
- Follow-up assessments at 6 and 12 months were completed by 62% of patients.
Main Results:
- Significant interactions between time and treatment group were observed for MHI and NHP scales, indicating differing quality-of-life trajectories.
- ICD therapy led to significant improvements in emotional and physical health scores compared to amiodarone.
- Patients receiving five or more shocks from their ICD did not show improvements in quality of life.
Conclusions:
- ICD therapy offers superior quality-of-life outcomes compared to amiodarone treatment.
- The positive quality-of-life effects of ICDs are diminished in patients who experience frequent shocks.
Background:
The primary aim of this study was to compare quality-of-life outcome between patients randomized to implantable cardioverter defibrillator (ICD) therapy and patients randomized to amiodarone treatment in the Canadian Implantable Defibrillator Study (CIDS). A secondary aim was to evaluate the effects on quality-of-life outcomes of receiving shocks from the device.
Methods:
Quality of life was assessed in 317 English-speaking participants by use of the Rand Corporation's 38-item Mental Health Inventory (MHI) and the Nottingham Health Profile (NHP). Assessments were done in the hospital at baseline and with mailed questionnaires after 2, 6, and 12 months of follow-up. Sixty-two percent of patients completed the follow-up assessments at 6 and 12 months.
Results:
Repeated measures analysis of variance revealed significant time by treatment group interaction effect on total MHI and the psychological distress and psychological well-being sub-scales, and on 5 of the 7 NHP scales (energy, physical mobility, emotional reactions, sleep disturbance, and lifestyle impairment) (P <.05). Emotional and physical health scores were shown to improve significantly in the ICD group and were either unchanged (emotional health) or deteriorated (energy and physical mobility) in the amiodarone-treated group by means of post-hoc comparisons. Quality of life did not improve in the subgroup of patients in the ICD-treated group who received > or =5 shocks from their device.
Conclusion:
Quality of life is better with ICD therapy than with amiodarone therapy. The beneficial quality-of-life effects from an ICD are not evident in patients who receive numerous shocks from their device.