Factors influencing health-related quality of life in patients with an implantable cardioverter defibrillator: A systematic review.
BACKGROUND
Implantable cardioverter defibrillator is a medical treatment to increase survival from sudden cardiac death attributed to lethal arrhythmias. Previous reports on the effect of implantable cardioverter defibrillators on the health-related quality of life are unclear. Inadequate knowledge is known about factors on health-related quality of life.


OBJECTIVE
The objective was to identify factors influencing health-related quality of life in patients with implantable cardioverter defibrillators.


METHODS
This review was limited to studies on adult patients who received implantable cardioverter defibrillators either for primary or secondary prevention. Randomised controlled trials, pseudo-randomised trials, cohort, case control and descriptive studies that utilised a variety of health related quality of life outcome measures were considered.


METHODS
A thorough literature search was performed for relevant studies written in English or Chinese from 1985 to August 2011 via various healthcare related electronic databases, review of reference list of all relevant studies, and Google Scholar. Cochrane Library and JBI COnNECT were searched for similar systematic reviews were also conducted.


METHODS
Eleven studies were included. Nine cohort and two descriptive studies were critically appraised for methodological quality by two independent reviewers using standardised critical appraisal checklists from Joanna Briggs Institute. The methodological quality of all included studies was high.


METHODS
A predefined data extraction form (adapted from the standardised Joanna Briggs Institute) was used.


RESULTS
A meta-analysis was not appropriate due to the nature of the review and statistical heterogeneity across the included studies. The evidence was therefore presented in narrative summary.


RESULTS
In eleven studies, total sample size was 1146 ranging from 42 to 223 participants. The range of mean age was between 51 and 74 years old. Factors were categorised into non-modifiable and modifiable factors. Old age (≥60 years old), implantable cardioverter defibrillator shock experience, anxiety, and depression have been identified as important factors for health-related quality of life outcomes. The full understanding was uncertain due to insufficient evidence and statistical inconsistency.


CONCLUSIONS
Based on evidence presented in this review, factors including old age (≥60 years old), implantable cardioverter defibrillator shock experience, anxiety, and depression, are the key predictors of health-related quality of life. Although a comprehensive understanding of factors influencing health-related quality of life is still unconfirmed, the findings of this review has provided direction for future nursing care development and research areas in this population.


CONCLUSIONS
Further prospective studies with longer follow-up period and larger sample size are needed. Studies are needed to further explore factors influencing health related quality of life outcomes in patients with implantable cardioverter defibrillator for a better understanding of risk factors in order to understand more about patients' needs and develop appropriate intervention.


CONCLUSIONS
Understanding factors influencing health-related quality of life can help nurses identify patients with implantable cardioverter defibrillator at risk for negative outcomes. Knowledge of such factors can help guiding development of implantable cardioverter defibrillator management protocol by removing or mitigating negative modifiable factors, such as implantable cardioverter defibrillator shock, anxiety, and depression and strengthening support for better health-related quality of life.
1. Hong Kong Centre for Evidence Based Nursing: a JBI collaborating centre for Evidence Rev. The Chinese University of Hong Kong (CUHK), Shatin, NT, Hong Kong.
Florence
F
Wong
Janet
J
Sit
Eliza
E
Wong