THE IMPACT OF THE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR ON QUALITY-OF-LIFE

The implantable cardioverter defibrillator (ICD) is an established tre atment for patients with life-threatening ventricular arrhythmias. Whi le it clearly reduces the incidence of-death from recurrent arrhythmia , little is known about the impact on patients' quality-of-life. In th is prospective study, quality-of-life was assessed by questionnaire be fore and after ICD implantation. The ''Sickness Impact Profile'' (SIP) , which evaluates physical, psychosocial, and other activities, as wel l as functions of daily life, was used. Employment and rehospitalizati on rates were also examined. Twenty-one of 23 consecutive patients, ag ed 58 +/- 11 years, undergoing ICD implantation at Royal Perth Hospita l were studied. During the 14 +/- 8 month follow-up, 4 patients died. Functional capacity was unchanged in all but one of the survivors in w hom it improved from New York Heart Association Class III to II. Four of 8 survivors employed before implant have since retired. Six patient s required rehospitalization on 23 occasions, problems related to arrh ythmias or the ICD. Overall SIP scores preimplant (22.2 +/- 9.3; P < 0 .05) were significantly worse at 6-month follow-up (21.7 +/- 18.2), bu t returned to preimplant levels by 12-month follow-up (8.8 +/- 10.8; N S). This was primarily due to transient problems in the areas of emoti onal behavior, alertness, and social interaction. SIP psychosocial dim ension scores: preimplant: 7.2 +/- 9.0; 6-month: 17.8 +/- 28.2 (P < 0. 05); and 12-month: 8.6 +/- 10.3 (NS). Early retirement and hospitaliza tions due to arrhythmias may still be expected even after implantation of an ICD; however, quality-of-life appears only to temporarily decli ne.