QUALITY-OF-LIFE AND DRIVING IN RECIPIENTS OF THE IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR

The efficacy of a treatment is primarily based on objective criteria, such as mortality and morbidity. Besides these criteria, the interest in measuring quality of life (QOL) in relation to health care has incr eased in recent years. Although the concept of patients' QOL is inhere ntly subjective, and definitions vary, it can be assessed on a basis o f 3 major components: physical condition, psychological well-being, an d social activities. The basic requirements of QOL assessments are: mu ltidimensional construct, reliability, validity, sensitivity, responsi veness, appropriateness to question or use, and practical utility. The instruments to assess QOL can be disease specific or generic, dependi ng on the context. In 1991 a prospective and systematic evaluation of QOL in implantable cardioverter-defibrillator (ICD) recipients was sta rted at the University of Bonn: psychological profile and patient acce ptance were assessed in 57 consecutive patients using a specifically d esigned questionnaire. The results of this pilot study demonstrated th at the acceptance of the ICD was remarkably high. Restrictions on driv ing a vehicle may have a substantial impact on QOL in patients with IC Ds. A specifically designed questionnaire was addressed to 47 European national delegates in order to determine their present practices and criteria utilized when advising driving restrictions to patients after ICD implantation. Of the 39 (83%) respondents, 22 (56%) cardiologists advised all patients to abstain from driving-13 (33%) advising perman ent abstinence, while 26 (67%) recommended temporary driving abstinenc e for periods of 3-18 months (mean 9 +/- 4 months). Despite medical ad vice not to drive, one third of the patients resume driving; half of t he patients resumed driving after 6 months, with the vast majority dri ving within 12 months after ICD surgery. Two patients experienced ICD discharges while driving, but no motor vehicle accident occurred. Anot her patient had a motor vehicle collision with a fatal outcome, which was not caused by loss of consciousness or ICD discharge. Conclusions: (1) Fatal accidents or ICD discharges while driving are a rare findin g in ICD patients. (2) About half of the physicians always advise thei r patients to cease driving for a period of 9 +/- 4 months. Despite th is medical advice, the majority of the patients resume driving within 6 months of ICD implantation. (3) Criteria used in advising driving ab stinence are not uniform among physicians.