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Life situation of patients with an implantable cardioverter defibrillator: a descriptive longitudinal study
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Sahlgrenska University Hospital, Göteborg, Sweden.
Sahlgrenska University Hospital, Goöteborg, Sweden.
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2001 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, 563-572 p.Article in journal (Refereed) Published
Abstract [en]

• The aim of this study was to describe changes in the life situation of patients with an implantable cardioverter defibrillator over a period of 1 year. A sample of 56 consecutive patients took part in the study.

•  Life situation was measured through uncertainty in illness, satisfaction, and fear of the life situation. Descriptive statistics were used to present results, and analytical statistics were used to map out changes over time.

• Overall uncertainty showed a decrease over time. A statistically significant difference was found within the domain uncertainty related to information (P < 0.001).

• Satisfaction increased within the domains health-functioning, socio-economic, psychological–spiritual, and family.

• The ability to act within the domain health-functioning showed a statistical significance (P < 0.05).

• The domain life changes within fear in the life situation decreased and showed a statistical significance (P < 0.05).

• The overall life situation showed increased satisfaction as well as lower uncertainty and fear in the life situation.

•  The research indicates that patients need more information about changes in the life situation after the implantable cardioverter defibrillator-implantation. The study encourages more humanistic, holistic research about patients’ life situations as well as more education in teaching skills for health care personnel.

Place, publisher, year, edition, pages
2001. Vol. 10, no 4, 563-572 p.
Keyword [en]
Implantable cardioverter defibrillator, patient experiences, uncertainty, information, satisfaction
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-18520DOI: 10.1046/j.1365-2702.2001.00494.xISI: 000169890600020PubMedID: 11822504OAI: oai:DiVA.org:liu-18520DiVA: diva2:220140
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator
Open this publication in new window or tab >>Living with life-saving technology: Long-term follow up of recipients with implantable cardioverter defibrillator
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The evidence that treatment of life-threatening arrhythmia (LTA) with an Implantable Cardioverter Defibrillator (ICD) can prolong life is convincing. Living with a lifelong heart disease will gradually influence the everyday life and encompasses some or all aspects of life. In order to influence health outcomes, the impact of the ICD must be considered in a broader context including not only the physical, but also the psychological and social functioning of the individual.

The general aim of this thesis was to describe everyday life in recipients living with an ICD in a longterm perspective. The aim in Paper I was to describe changes in the life situation of recipients’ with an ICD over a period of 1 year. The aim in Paper II was to describe quality of life (QOL) and uncertainty in recipients who have an ICD and to predict QOL at long-term follow-up. Fifty-six recipients participated (I) and 35 of these recipients, who had survived at least five years, were further included (II). The Quality of Life Index-Cardiac version (I, II), Mishel Uncertainty in Illness Scale-Community version (I, II), Patient ICD Questionnaire (I) and multiple regression analysis (II) were used. Higher scores indicate higher QOL and uncertainty. The questionnaires were completed before implantation, three and twelve months after implantation (I) and also five years after implantation i.e. long-term follow up (II). At the long-term follow up, the average ICD recipient had lived with an ICD for six years and nine months (6.9 years). The results showed the overall QOL and QOL in the health/functioning domain were unchanged over time. QOL in the socio-economic (p= .002) and psychological/spiritual domains (p= .012) decreased in the first year. From baseline to long-term follow up, the QOL in the family domain (p= .011) and overall uncertainty (p= .002) decreased. Uncertainty related to the information decreased at year 1 in relation to baseline (p= .001).

The aim in Paper III was to illuminate the main concern of recipients living with an ICD and how they handle this in their daily life. Sixteen recipients who had lived with an ICD between six to twenty-four months were interviewed. Data was collected and analysed in a simultaneous process according to guidelines for classical grounded theory. In the analysis, a substantive theory was generated explaining the main concern of ICD recipients and how they handle this in their daily life. The core category, labelled “Striving to resume command”, illuminates the main concern of ICD recipients. To manage this main concern, the recipients used the following strategies: Economizing resources, Distracting oneself, Submitting to one’s fate and Re-evaluating life.

The aim in Paper IV was to explore relationships between OQL, coping strategies, anxiety, depression and perceived control in recipients living with an ICD and to compare those having received an ICD less or more than one year ago and those with a primary or secondary preventive indication. A cross-sectional, correlational, multicenter design was used, and 147 recipients who had lived with an ICD between six to twenty-four months completed Quality of Life Index-Cardiac version, Jalowiec Coping Scale, Hospital Anxiety and Depression Scale and Control Attitude Scale. The results showed that anxiety, depression and perceived control were predictors of QOL. Anxiety was also a predictor of coping with optimistic coping being the most used coping strategy. There was no relationship between QOL and coping. No differences were found in QOL, coping, anxiety, depression and perceived control between recipients implanted either on a primary or secondary preventive indication or having the device less or more than one year.

In this thesis, it was concluded that the ICD recipients strived to resume command over their life (III) and the more control the recipients perceived the more satisfied they were with their QOL (IV) and the more symptoms of anxiety, depression and uncertainty they experienced the less satisfied they were with their QOL (II, IV). Coping strategies were used more frequently by ICD recipient perceiving more anxiety (IV). QOL was fairly good 6,9 years after implantation and ICD recipients felt less uncertain once they had passed the first year of their illness.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1116
Keyword
Anxiety, arrhythmia, defibrillators, depression, grounded theory, perceived control, qualitative, quality of life, uncertainty
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18524 (URN)978-91-7393-654-5 (ISBN)
Public defence
2009-05-28, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-29 Created: 2009-05-29 Last updated: 2013-09-03Bibliographically approved
2. Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias: a 5 year follow-up
Open this publication in new window or tab >>Health-related quality of life in recipients with an implantable cardioverter defibrillator due to life-threatening arrhythmias: a 5 year follow-up
2004 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to describe self-reported health-related quality of life (HRQoL) in recipients with an implantable cardioverter defibrillator (ICD) due to life-threatening arrhythmias over a 5-year period. The design was prospective and longitudinal. Fifty-six patients participated in Paper I, and 35 of these patients, who had survived at least five years, were included in paper II. All patients had received their ICD as a form of secondary prevention. The Quality of Life Index-Cardiac version (QLI-C), Mishel Uncertainty in Illness Scale-Community version (MUIS-C), and multiple regression analysis were used. Higher scores indicate higher HRQoL and uncertainty. The questionnaires were completed on four occasions: before implantation, at three months and at 1 year and 5 years after implantation. ICD recipients were also asked how many shocks they had perceived. At the 5-year data collection, the average ICD recipient had lived with an ICD for 6 years and 9 months. In general HRQoL was lower at year 1 than at baseline (p = 0-033). A decrease in the socioeconomic domain was observed at year 1 (p = 0.006) but improved again at year 5 (p = 0.027) although it remained below the baseline value. ICD recipients' satisfaction with the family domain decreased from the time of the ICD implantation (p < 0.001) and from year 1 (p = 0.039) to year 5 after implantation. Uncertainty related to information had decreased at year 1 in relation to baseline (p < 0.001). A decrease in overall uncertainty was observed at year 5 in relation to year 1 (p = 0.009) as well as at year 6 in relation to baseline (p = 0.009). The longer the ICD recipient had lived with the device, the greater the risk of receiving a shock. However, ICD recipients who received shocks reported being less troubled by them over time. Uncertainty was identified as a predictor of Low HRQoL. The recipients reported a higher level of HRQoL at year 5 than at year 1. HRQoL was reasonably good 5 years after implantation, and the ICD recipients felt more secure and perceived their ICD as a lifesaver.

Publisher
52 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 67
Series
Omvårdnadsforskning vid Hälsouniversitetet i Linköping, 13
Keyword
defibrillators implantable, ICD shocks, life-threatening arrhythmia, quality of life, satisfaction, uncertainty
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24302 (URN)3921 (Local ID)91-7373-844-1 (ISBN)3921 (Archive number)3921 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-09-10

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Flemme, IngerBolse, Kärstin

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