Jessica Ford

Shocktivity: ability and avoidance of daily activity behaviors in ICD patients.

BACKGROUND: Implantable cardioverter defibrillator (ICD) shocks terminate potentially life-threatening arrhythmias and may alter patient behavior. Patients are aware of which activities they have the ability to perform, but they may choose to avoid these behaviors after receiving a shock. This study examined ICD patient ability and avoidance of progressively exertive behaviors. METHODS: ICD patients (N = 443) across the United States were surveyed using an online measure including the 12-item Duke Activity Status Index. RESULTS: As expected, many patients reported being unable to participate in more physically exertive activities such as strenuous athletic exertion (68.8%), sex (35.4%), and running a short distance (49.0%). Avoidance rates were also relatively high, as patients who reported being able to participate in these activities also reported avoiding them (ie, strenuous athletics, 76.1%). Similarly, the majority of patients reported ability to engage in sexual activity (64.6%) but many chose to avoid sexual activity (51.0%). Multiple reasons were reported for avoidance, including fear of shock, fear of heart rate increase, doctor instruction, no desire, and an “other” option. CONCLUSION: Many ICD patients experience behavioral limitations because of both a perceived inability and preference to avoid exertive activities, and possibly a prescription to do so, particularly strenuous athletic exertion. Clinical and research attention to ICD patient activity levels and reasons for avoidance may improve daily functioning and help patients return to preimplant levels of activity.

A Patient’s Guide to Living Confidently With Chronic Heart Failure

Chronic heart failure (CHF) refers to the ongoing condition of your heart’s inability to pump sufficient blood to meet your body’s demands. The name of any medical condition that includes the word failure can be intimidating, particularly when it concerns your heart. After all, failure implies there is no hope, right? Wrong! The medical term “failure” can be demoralizing, but patients can identify ways to increase the chances of living longer and living well with CHF. To live successfully with CHF, it is important to develop confidence. For heart patients, confidence can refer to self-assurance, positive and healthy actions, and expectations that desirable health outcomes can be achieved. CHF is challenging because it requires patients and families to understand and monitor CHF symptoms, manage distress, accept the value of the implantable cardioverter-defibrillator (ICD), and pursue quality of life (QoL). For CHF patients, these ambitious goals involve developing confidence in each aspect of the treatment plan, spanning disease confidence, device confidence, and QoL confidence. Disease confidence is a way of thinking and feeling about your disease that results in a greater sense of personal security and empowerment. Disease confidence can be developed by taking appropriate self-care in managing your CHF. Self-care involves a level of understanding about your medical condition, as well as making informed decisions about your care to minimize symptoms and/or to respond effectively to symptoms that may occur.1 ### Understanding CHF CHF is a complicated disease state that is unique for each individual. For example, some patients will experience frequent bouts of excessive fluid retention, whereas others will note mild shortness of breath with exertion. The first and most important step in becoming disease confident is being knowledgeable about CHF and how it affects you. Similar to mastering subjects in school, a patient with heart failure can and should learn …

The Registry Evaluating Functional Outcomes of Resynchronization Management (REFORM): Quality of Life and Psychological Functioning in Patients Receiving Cardiac Resynchronization Therapy

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.

Cognitive–Behavioral Treatment of Posttraumatic Stress in Patients With Implantable Cardioverter Defibrillators: Results From a Randomized Controlled Trial

Approximately 20% of patients with implantable cardioverter defibrillators (ICDs) suffer from posttraumatic stress disorder (PTSD) due to a history of cardiac arrest, device implantation, and ICD shock. There has been very little examination of treatment of PTSD symptoms in these patients. This study evaluated the effect of a specific cognitive-behavioral therapy (CBT) intervention for ICD patients with high levels of PTSD symptoms: a manualized program consisting of 8 telephone sessions with a trained counselor, a patient education book, and a stress management procedure on compact disc. Participants were 193 ICD patients, who were randomized to CBT or usual cardiac care (UCC) who completed self-report surveys at the time of recruitment and 6 and 12 months after initial measurement. Previous publication on the primary research evaluation questions reported that the CBT condition resulted in greater improvement on PTSD and depression symptoms than the UCC for the general population of ICD patients, but did not evaluate the effect on those with elevated symptoms of PTSD. The authors conducted secondary analyses of the effect of treatment on high and low PTSD symptom groups based on a cutoff for the Impact of Event Scale-Revised (Weiss & Marmar, 1997). Participants in the CBT group who had high symptoms experienced significantly greater symptom reduction from baseline to 12 months (d = 2.44, p = .021) than the UCC group (d = 1.12). Participants with low symptoms had small reductions regardless of group assignment (d = 0.16, p = .031). ICD-focused CBT was sufficient to produce a large, statistically significant reduction in PTSD symptoms in ICD patients with indications for treatment.

Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs)

Rates of sleep disorders and associated adjustment were examined in patients with implantable cardioverter defibrillators (ICDs; n = 42; Mage = 61.57, SD = 12.60). One night of ambulatory polysomnography, 14 days of sleep diaries, and questionnaires (mood, sleepiness, fatigue, device acceptance) were administered. Controlling for ischemia, MANCOVA examined adjustment by sleep diagnosis. Apnea was most common (28.6%), followed by Insomnia (16.7%) and Comorbid Insomnia/Apnea (11.9%). Patients with insomnia reported poorer mood, greater sleepiness, and lower device acceptance than good sleepers; they also demonstrated poorer mood and less ICD device acceptance than patients with sleep apnea. Patients with comorbid insomnia/apnea also exhibited poorer mood and less ICD device acceptance than good sleepers; however, comorbid patients did not significantly differ from insomnia or apnea patients on any measure. Those with disordered sleep (regardless of type) reported greater fatigue than good sleepers. Assessment (and treatment) of difficulties with sleep, mood, fatigue, and device acceptance may be important for the comprehensive clinical management of ICD patients. Further research appears warranted.

Modern-day patient challenge: manage cardiac disease, accept devices, and minimize distress

This editorial refers to ‘Poor health status and distress in cardiac patients: the role of device therapy vs. underlying heart disease’ by M. Habibovic et al ., on page 355 Chronic heart failure (CHF) patients encounter a host of challenges as they strive to prevent premature death and morbidity from CHF. Specifically, CHF patients face barriers to optimal quality of life in the form of symptoms such as fatigue, dyspnoea, swelling, nausea, and irregular heartbeats; adherence to strict medication, drug, physical activity, and monitoring regimens; and often requirement to accommodate a device therapy. In fact, in an examination of patients with CHF, chronic obstructive pulmonary disease (COPD), and stage IV cancers, CHF patients had similar quality of life (QOL), worse functional status overall, worse anxiety levels, and depression levels similar to COPD patients and worse than those with stage IV cancers.1 The modern challenge of managing the threats of chronic disease to survival and quality of life can be overwhelming for patients and families. Anxiety and depression, in particular, are highly prevalent in CHF patients, with studies finding clinically significant depression in 10–60%2 of patients and clinically significant anxiety in 11–45% of patients.3 These co-morbidities undermine treatment in CHF and negatively affect survival via non-adherence.4–6 The worldwide population dynamics of the baby boomers ageing demand for greater clarity about contributions of CHF and its frequent co-morbidities to mental health and QOL outcomes. Modern multiple treatment modalities of medications and devices are welcome state-of-the-art interventions against this pressing health threat. However, daily living with CHF has a significant disease burden …

Compound risk: History of traumatic stress predicts posttraumatic stress disorder symptoms and severity in sudden cardiac arrest survivors

Background: Sudden cardiac arrest (SCA) survivors can develop posttraumatic stress disorder (PTSD) which is associated with worse clinical outcomes. The purpose of this study was to evaluate the prevalence and predictors of PTSD in a large sample of SCA survivors. Prior history of psychological trauma and the effects of repeated trauma exposure on subsequent PTSD and symptom severity after SCA were also explored. Methods: A retrospective, cross-sectional study of 188 SCA survivors from the Sudden Cardiac Arrest Association patient registry completed an online questionnaire that included measures of PTSD, trauma history, sociodemographics, general health, and cardiac history. Results: Sixty-three (36.2%) SCA survivors in this sample scored above the clinical cutoff for PTSD. Female gender, worse general health, and younger age predicted PTSD symptoms after SCA. Additionally, 50.2% of SCA survivors (n = 95) reported a history of trauma exposure and 25.4% (n = 48) of the total sample endorsed a traumatic stress response to a historic trauma. Results indicated that a traumatic stress response to a historic trauma was a stronger predictor of PTSD after SCA (odds ratio = 4.77) than all other variables in the model. Conclusions: PTSD symptoms are present in over one-third of SCA survivors. While demographic or health history variables predicted PTSD after SCA, a history of traumatic stress response to a previous trauma emerged as the strongest predictor of these symptoms. Routine assessment and interdisciplinary management are discussed as potential ways to expedite survivors’ recovery and return to daily living.

Are Type D personality and depression predictors of anxiety and posttraumatic stress symptoms among ICD patients?: EDITORIAL

In several articles,1–3 Habibovic, Versteeg, and colleagues have explored posttraumatic stress symptoms (PSS) and anxiety in a population of patients whose trauma reactions were largely ignored by the scientific community until Ladwig’s landmark longitudinal study which linked PSS to greater numbers of implantable cardioverter defibrillator (ICD) shocks and increased mortality rates.4 This work is critical to the biopsychosocial understanding of the whole patient and foundational as electrophysiology practices advance to include care that both reducesmortality and enhances quality of life. The authors should be applauded for their efforts to investigate predictors of psychological sequela which may complicate biomedical outcomes, adherence to treatment, and ultimately mortality rates. Further, the manuscript itself leverages complex statistical analyses in a way that provides useful clinical information and reflects new advances in the understanding of trauma-related symptoms. Specifically, not utilizing an artificial cut score or diagnostic criteria set, but treating PSS as dimensional is responsive to findings that PSS need not meet specific thresholds to have substantial deleterious effects nor fit diagnostic criteria in order to profit from intervention.5

eHealth literacy: How to choose quality Internet electrophysiology patient resources: GRIFFITH and FORD

Electrophysiology (EP) is the medical area that deals with electrical activity in the body. Your heart beat requires electrical signal. Sometimes a medical condition can cause an arrhythmia, or abnormal heart beat. This article is intended for people who have been diagnosed with an abnormal heart rhythm and are seeking information about their diagnosis or condition. It is meant to be a guide to finding and evaluating Internet content about arrhythmias thatmay be helpful to you as youmanage your condition. The growth in the number of online resources has made the Internet a popular place to obtain health-related information. In fact, 87% of people who participated in a survey of over 3,000 U.S. adults indicated that they use the Internet. Most of the people who were surveyed (72%) reported that they searched for health-related information in the past year.1 As an EP patient, you may find yourself concerned about managing your cardiac condition. You may want to obtain more information about your diagnosis or medical condition. The Internet is a valuable tool for reaching this goal. Youmay also wish to seek online support with others who have the same condition.2 The Internet is a great resource due to the sheer amount and variety of information formats available (e.g., general resources, reports, social media pages, blogs, discussion forums, smartphone applications). However, it can be overwhelming and difficult to determine which of those resources provide information you can trust and use. The California HealthCare Foundation (CHCF) has highlighted several commonproblemswith the quality of health information found online.3 These include issues such as (1) websites having gaps in information, (2) high reading levels, and (3) advertisements being difficult to separate from the relevant, accurate medical information on websites. Further, many unqualified individuals have the ability to post information on the Internet that is not reviewed to ensure accuracy. So, with many options readily available at the push of a button, how does one determine which resources are safe to use? How does one determine what information is trustworthy and accurate? The following recommendations can assist you inmaking those decisions as you seek online information or support related to your medical condition.

Cardiovascular Complaints in Adolescence: Clinical Considerations

Adolescents with cardiovascular disease face existential uncertainty, physical limitations, psychosocial and familial distress, and, sometimes, neurological and cognitive impairment during a time when most adolescents are developing autonomy. For the adolescent with cardiovascular disease, the aforementioned factors may present barriers to optimal quality of life (QoL) and transition to adulthood. This chapter will present information regarding the etiology, physical presentation, treatment, QoL, psychosocial difficulties, familial concerns, and neurocognitive sequelae found in adolescents with congenital heart defects, electrophysiological disorders, and cardiomyopathy. The chapter will close with discussion of measures that can be used in the psychosocial assessment of teens with cardiac conditions, as well as forms of intervention that may aide adjustment and development.