Psychological Status and Health-Related Quality of Life and Associated Factors in Heart Failure Patients with Implantable Cardioverter Defibrillator

Special Article - Sudden Cardiac Arrest

Austin Cardiol. 2017; 2(1): 1007.

Psychological Status and Health-Related Quality of Life and Associated Factors in Heart Failure Patients with Implantable Cardioverter Defibrillators

Wong FMF*

School of Nursing, Tung Wah College, Hong Kong

*Corresponding author: Florence MF Wong, School of Nursing, Tung Wah College, Hong Kong

Received: April 18, 2017; Accepted: May 22, 2017; Published: May 29, 2017


Introduction: Heart Failure (HF) patients receive Implantable Cardioverter Defibrillator (ICD) to improve survival rate from sudden cardiac death. Poor psychological condition and Health-Related Quality of Life (HRQoL) were reported in those patients. However, these two areas are under-reported in this specific population.

Objective: To examine psychological status (depression and anxiety) and HRQoL and identify associated factors in HF patients with ICD.

Methods: A cross-sectional design was conducted using a convenience sampling to recruit eligible patients at two acute general hospitals. Data were collected through the structured face-to-face interview. The self-reported Hospital Anxiety and Depression Scale (HADS) and Short Form-36 Health Survey (SF-36v2) were used for measuring anxiety and depression and HRQoL respectively.

Results: About 11.8% and 22.1% of HF patients with ICD reported significant levels of anxiety and depression respectively. The results showed that physical component summary was poorer than mental component summary. Moreover, numerous factors were identified but only depression was negatively associated with both physical and mental health. Self-care dependence had positive association with both anxiety and depression.

Conclusion: HF patients with ICD may perceive significant clinical anxiety and depression. Self-care dependence was significantly associated with anxiety and depression. Depression was the significant factor negatively associated with both physical and mental quality of life. However, anxiety was not associated with both physical and mental quality of life. The findings enrich the knowledge on psychological condition and HRQoL. Strategies targeting associated factors with psychological distress and HRQoL are crucial to improve care for this specific population.

Keywords: Heart failure; Cardiac nursing; Depression; Anxiety; Healthrelated quality of life; Associated factors


AF: Atrial Fibrillation; AHA: American Heart Association; ATP: Anti-Tachycardia Pacing; B: Regression Coefficient; CRP: Cardiac Resynchronization Therapy; DM: Diabetes Mellitus; SE: Standard Error; CRT-D: Cardiac Resynchronization Therapy Defibrillator; HADS: Hospital Anxiety and Depression; HF: Heart Failure; HRQoL: Health-Related Quality of Life; ICD: Implantable Cardioverter Defibrillator; MCS: Mental Composite Summary; PCS: Physical Composite Summary; SCD: Sudden cardiac Death; SF-36v2: Short Form-36 Health Survey; SSQ6: Short Form Social Support Questionnaire; VF: Ventricular Fibrillation; VT: Ventricular Tachycardia


Heart Failure (HF) is one of the most concerned cardiac problems because its incidence and mortality rates are high and these two areas have been increasing at an alarming rate in many regions globally [1-4]. According to the Statistical Report from American Heart Association (AHA) in 2016, an estimated 5.1 million Americans have had HF. The prevalence of HF was projected to increase by 46% from 2012 to 2030 [1,5]. The mortality of HF still remains high as about 50% HF patients die within five years of diagnosis [5]. Current healthcare service will have a huge rise in the total cost of healthcare service and rehabilitation aiming to prolong survival, reduce hospitalization period and re-hospitalization, and maintain optimal Health-Related Quality of Life (HRQoL) [1,3].

HRQoL encompasses multidimensional aspects, including physical, mental, and social domains that affect health of individual or a group over time considering various correlates, such as health risks and socioeconomic status [6]. It is an important tool to evaluate the effectiveness of medical treatment and healthcare service [7]. Previous studies reported that patients with HF commonly experience poor HRQoL, particularly in physical aspects, [8-10] and more psychological distress, especially anxiety and depression [8,11,12]. It was attributed to physical restriction and disability resulting from insufficient cardiac function in HF [8,11]. As a result, self-care ability declines and affects daily activities of living [3,8,13].

Anxiety and depression are psychological distress commonly found in patients with HF [11,14]. Anxiety refers to an unpleasant and abstract negative emotional reaction that results from the perception of a particular situation being threatened [15,16]. Depression refers to a mental condition with depressed mood, loss of interest, feelings of guilt, low self-worth, disturbed sleep, loss of appetite, low energy and poor concentration [17]. These two emotions can adversely affect health status [18-21] and are closely associated with mortality in cardiac patients [22,23].

Patients with HF are reported to be at higher risk of Sudden Cardiac Death (SCD) [1,2]. SCD refers to an unexpected death that occurs within an hour of onset of symptoms or within 24 hours without prior symptoms [24,25]. SCD is caused by life-threatening ventricular arrhythmias, commonly Ventricular Tachycardia (VT), or Ventricular Fibrillation (VF) [25]. To reduce SCD occurrence in HF patients, an Implantable Cardioverter Defibrillator (ICD) is commonly used as a favourable medical treatment for SCD [24,26]. Apart from the delivery of ICD shock, current ICD’s are built as a combination of two important functions: Anti-Tachycardia Pacing (ATP) and Cardiac Resynchronization Therapy (CRT). ATP is a function that delivers a faster rhythm to override the tachycardia and CRT delivers impulses to stimulate both ventricles to contract simultaneously to improve cardiac performance. This device is called Cardiac Resynchronization Therapy Defibrillator (CRT-D) [27-29].

Despite its mortality reduction, ICD was reported to increase psychological distress and lower HRQoL [30-32]. The HF population was reported to have a poorer psychological status [12,15,26] and HRQoL [8-10]. Although the application of ICD in the HF population has increased, there is still insufficient knowledge about psychological status and HRQoL among HF patients who have received ICD. Therefore, this study aimed to 1) understand psychological status and HRQoL perspectives of this specific population and 2) identify associated factors in order to formulate strategies targeting risk factors for optimizing HRQoL outcomes.

To facilitate the understanding of factors associated with psychological distress (anxiety and depression) and HRQoL (physical and mental health), a modified conceptual framework (Figure 1) was used based on the original version was developed by Wong et al. [13].