Quality-of-life of pacemaker patients: A reappraisal of current instruments

Current clinical practice permits the use of single chamber ventricular or dual chamber pacemakers. However, it is not known which type of pacemaker r esults in superior clinical and patient outcomes. This is of growing import ance because of the higher costs and increased risk of technical failures o f dual chamber pacemakers. Patient outcomes can be assessed with quality of life questionnaires, but if is unclear which questionnaires are valid for use in pacemaker patients. This article reappraises studies on quality of l ife instruments for pacemaker patients. We searched MEDLINE (1985-1998) for studies assessing quality-of-life in general and in pacemaker patients. Th e SF-36 appeared to be the best among generic questionnaires because of its psychometric characteristics and experience of use. Concerning disease spe cific instruments, the Karolinska qualify of life questionnaire has desirab le content validity but lacks more rigorous psychometric validation, which constitutes a serious limitation. Previous studies suggested that implantat ion of atrioventricular pacemakers improves quality-of-life compared to ven tricular pacemakers, but since no well-designed and validated questionnaire exists, these results should be interpreted with caution. The best outcome measure to evaluate quality-of-life in pacemaker patients would be a combi nation of a generic health profile with established reliability and validit y supplemented with a cardiovascular assessment adjusted to suit pacemaker patients. By doing so, individual scores can be compared within a disease c ohort and to same-aged, nondiseased persons, as well as other diseased popu lations. The development and validation of such an instrument is currently needed.