title: Age and mental health predict early device-specific quality of life in patients receiving prophylactic implantable defibrillators.
abstract: BACKGROUND
  Ventricular arrhythmia is a significant cause of sudden death. Implantable cardioverter-defibrillators (ICDs) offer at-risk patients a prophylactic treatment option. This prophylaxis is largely responsible for growth in utilization of ICDs. Identification of factors that may impact device-specific quality of life (QOL) is warranted. The influence of preimplant patient variables on postimplant device-specific QOL is unknown. The study aimed to determine whether preimplant psychosocial, generic health-related quality of life (HRQOL), personality disposition, or demographic factors predicted early postimplant device-specific QOL.
  
  
  METHODS
  A prospective cohort study design was employed in 70 adults receiving an ICD for primary prevention. Preimplant, we measured generic HRQOL, personality disposition, depressive symptoms, age, and sex. The primary outcome was 3-month ICD device-specific QOL as measured by the Florida Patient Acceptance Scale (FPAS). We applied hierarchical multivariate regression analysis.
  
  
  RESULTS
  Mean age was 64.8 ± 9.4 years; 12.9% were women. Most had ischemic heart disease (77%) and a heart failure history (54.3%). Preimplant prevalence of elevated depressive symptoms was 30%. Three months post implant, the mean adjusted FPAS score was 76.8 ± 12.98. Of the variance in FPAS scores, 37% was explained by the independent variables. Younger age and poor preimplant mental HRQOL contributed most to lower FPAS scores.
  
  
  CONCLUSIONS
  Patient support and psychosocial interventions should target younger ICD candidates and those reporting poor preimplant mental HRQOL; these patients may be at risk for poor postimplant device-specific QOL.
authors.affiliation: School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. carroll@mcmaster.ca
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Carroll
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
authors.forename: Donna
authors.initials: D
authors.lastname: Ciliska
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
mesh_terms: D000367:Age Factors; D000368:Aged; D002605:Character; D015331:Cohort Studies; D017147:Defibrillators, Implantable / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000523:psychology; D009864:Ontario; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000517:prevention & control* / Q000523:psychology*