Ventricular Tachycardia Clinical Trial
Official title:
Impact of ICD Support Groups in Veterans Receiving Internal Cardioverter Defibrillators
In this study, we will compare the quality of life in veterans having ICD who attend the ICD support groups to those who do not. We ask them to answer a set of quality of life questionnaires at baseline and then at 3,6,9 and 12 month visits. These questionnaires would be analyzed to assess if attending support groups made a difference. These results will be compared to a similar study done at Emory University on non veterans.
Sudden cardiac death (SCD) is a major clinical problem, responsible for 400,000 deaths
annually in the US(2) Ventricular fibrillation/ventricular tachycardia (VF/VT) is the most
common arrhythmia associated with SCD(3). ICD implantation is the only preventive treatment,
and clinical trials have clearly established the efficacy of ICD placement for both primary
and secondary prevention of SCD(4). Since 1996, ICD implantation has increased dramatically,
from 20,000 per year, to 200,000 implanted per year in the US.
Patients are likely to experience varying degrees of psychological, social and physical
adjustment both leading up to and following ICD implant. Poor quality of life and depression
are common in patients with ICD(5). Anxiety is particularly common, with approximately 24 -
87% of ICD recipients experiencing increased symptoms of anxiety after implantation and
diagnostic rates for clinically significant anxiety disorders ranging from 13-38%(6). The
occurrence of ICD shocks is generally faulted for this psychological distress, but its
causal influence is confounded by the presence of a life threatening medical condition.
Depressive symptoms are reported in 24-33% of ICD patients(7). ICD shock related fears are
universal and may be the most pervasive psychosocial adjustment challenge ICD patients face.
The literature suggests that ICD recipient QOL is not as high as that among recipients of
more benign cardiac devices such as pacemakers. Concerns about ICD shocks and the negative
effect of ICDs on patients' sense of control, social interactions, driving, sexuality,
capacity to work, and ability to engage in leisure activities appear to adversely influence
ICD recipients' perception of health and well being(8).
Support groups are a popular adjunctive treatment for ICD patients because they provide an
efficient conduit for patient education spanning the biopsychosocial domains.(9) The active
ingredients of support groups probably centre on the universality of many patient concerns
and the sharing of information and strategies to deal effectively with these concerns.
Dickerson et al found that ICD recipients and their support persons coped with traumatic
experience of sudden cardiac death by using story telling in the support group to work
through the anxiety and place the event into a manageable explanation(10). Clinical nurse
specialist (CNS) - facilitated support group are beneficial if offered, especially if they
contact the ICD recipients early during hospitalization and making them aware of this
resource(11).
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Observational Model: Case Control, Time Perspective: Prospective
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