The Effect of Continuous Care Program on Short-Term Outcomes of Patients with Implantable Cardioverter-Defibrillator (ICD)

Abstract

Background: Ventricular dysrhythmia is a major cause of heart-related death. Despite the life-saving advantages of Cardioverter-defibrillator (ICD), patients with ICD experience adverse physical, psychological, and social consequences. Objectives: The aim of this study was to investigate the effect of continuous care program on short-term outcomes of patients with ICD. Methods: The present study is a randomized clinical trial, which was conducted on 79 patients (37 control and 42 intervention group) referred to the Cardiac Educational Center of Tehran, Iran, for the first time to receive an implantable cardioverter-defibrillator. The Continuous care program was provided for patients in the intervention group after receiving ICT along with routine care. Convenience sampling based on inclusion criteria was done, then random allocation was done by block randomization method. The allocation sequence was generated using a web-based system. Short-term consequences such as anxiety, mean number of shocks received, and the number of emergency outpatient visits to the medical center were measured by Spielberger State-Trait Anxiety Inventory (STAI) and checklist. The validity and reliability of STAI in Iran were checked and confirmed with the Cronbach's alpha coefficient of 0.93, and its scoring system ranges from 20 to 80, with a higher score indicating a higher level of anxiety. Data were analyzed by SPSS-16 software. Inferential statistics (independent Student, Mann-Whitney, paired t-test, and Wilcoxon) were used to compare the data. Results: The results showed that there were no significant differences in the mean age, height, weight, BMI, and demographic variables between the two groups (P > 0.05). Comparisons between groups before and after the intervention, and also before and after within each group, were done for anxiety. The number of shocks and outpatient visits were compared between the two groups after the intervention. After the intervention, a significant decrease in the level of anxiety was observed in the intervention group compared to the control group and also compared to before the intervention (P < 0.001). The mean and standard deviation of the number of shocks in the control group was 1.2 ± 4.4 and in the intervention group was 5.1 ± 12.3, and the independent t-test showed a significant difference in this regard (P = 0.02). However, no significant difference was observed between the two groups in terms of the number of emergency outpatient visits to the medical center (P > 0.05). Conclusions: The results of the present study revealed that the continuous care program can affect the short-term consequences of ICD insertion. It can also be used as an effective model in the care of cardiac patients with ICD.