The Registry Evaluating Functional Outcomes of Resynchronization Management (REFORM): quality of life and
Jessica Ford1, Samuel Sears, Brian Ramza
1Department of Psychology, East Carolina University, Greenville, North Carolina, USA.
Insights
Adding CRT-D to ICDs improved some QoL aspects for heart failure patients but led to worse device acceptance. Further research is needed on CRTD patient well-being.
Area of Science:
- Cardiology
- Psychology
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF).
- This study investigated the impact of CRT with defibrillator (CRTD) on psychological functioning compared to implantable cardioverter defibrillator (ICD) alone.
- Understanding psychological effects is crucial for optimizing HF device therapy.
Purpose of the Study:
- To evaluate the effect of CRTD implantation on psychological functioning in HF patients.
- To compare mental health, quality of life (QoL), and device acceptance between CRTD and ICD groups.
- To identify areas for improved patient well-being in device-treated HF.
Main Methods:
- A registry study of 99 HF patients undergoing ICD or CRTD implantation.
- Validated measures of anxiety, depression, QoL, and device acceptance were used.
- Mixed between-within analyses of covariance compared outcomes between device groups.
Main Results:
- Depressive symptoms significantly decreased at 9 months post-implantation in both groups (P = 0.01).
- CRTD patients showed improved mental component and disease-specific QoL.
- However, CRTD patients reported worse overall QoL and device acceptance compared to ICD patients at 9 months.
Conclusions:
- While CRTD offers some QoL benefits, challenges in psychological well-being and device acceptance persist.
- There is a need for increased research into the well-being of HF patients receiving CRTD.
- Clinical efforts should focus on enhancing the psychological support and device experience for these patients.
Background:
Cardiac resynchronization therapy (CRT) is a treatment for heart failure (HF) that improves cardiac, functional, and quality of life (QoL) outcomes. This study was designed to examine the effect of the addition of CRT (CRTD) to the implantable cardioverter defibrillator (ICD) on psychological functioning.
Methods And Results:
Overall, 99 participants completed batteries before and 9 months after ICD or CRTD implantation in a registry of HF patients receiving device treatment in 3 US centers. Measures included validated indices of mental health (State Trait Anxiety Inventory, Patient Health Questionnaire: Depression) and generic and disease/device-specific QoL (Medical Outcomes Study-Short Form-12, Kansas City Cardiomyopathy Questionnaire, Florida Patient Acceptance Survey, Florida Shock Anxiety Scale). Mixed between-within analyses of covariance were employed to compare device groups on each outcome controlling for cardiac and demographic covariates. Clinically significant anxiety was elevated in both groups at both time points (57% CRTD at baseline, 29% CRTD 9 months, 44% ICD at baseline, 45% ICD 9 months). Clinically significant depressive symptoms were high at baseline (38% CRTD, 31% ICD), but dropped at follow-up (16% CRTD, 7% ICD; P = 0.01). Participants with CRTD had improved mental component and disease-specific QoL following CRT; however, CRTD patients had worse QoL, worse mental component QoL at baseline, and worse device acceptance at 9-month follow-up than patients with ICDs (all P < 0.05).
Conclusions:
Evidence of low QoL, psychological functioning, and device acceptance provides the impetus to increase research on well-being of HF patients being implanted with CRTD in research and clinical work.
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