July 21, 2000 -- Pacemakers and implanted heart defibrillators have improved survival rates for heart patients for 50 years. But how do patients feel about the quality of their lives once they feel the activity of these little devices?
Pacemakers help the heart keep its normal time by sensing when it slows down too much and sending a tiny electrical impulse to an area of the heart that causes it to beat faster. Defibrillators are little devices that are implanted in the heart to shock the heart back to a normal rhythm when it starts beating irregularly.
Most patients find the shocks from internal defibrillators moderately uncomfortable, but tolerate them because of the lifesaving protection they provide, according to recent research. Still, one-fourth of patients "dreaded" the shocks, saying they felt like "a blow to the body or a punch to the chest."
Three studies and an editorial tackle the important issues of quality of life in patients with pacemakers and internal heart defibrillators in a recent issue of the medical journal Pacing and Clinical Electrophysiology.
Given the growing numbers of patients with both pacemakers and internal defibrillators -- and the greater-than-ever lifespan of these patients -- quality of life is becoming more important to patients' medical professionals.
In one study, Maha Ahmad, MD, and colleagues from the New Jersey Pacemaker and Defibrillator Evaluation Center at Beth Israel Medical Center in Newark, address the topic of patients' attitudes about pacemakers.
In a review of 118 patients with internal cardiac defibrillators, researchers observed that, despite their occasional discomfort, the devices appear to offer a sense of security for the patient. Earlier research has shown that most patients felt more comfortable with an internal heart defibrillator or pacemaker than before, and most said it was worth having the system implanted.
But according to Cecilia Linde, MD, in the department of cardiology at Karolinska Hospital in Stockholm, Sweden, it depends on age. "Whereas older patients viewed the internal cardiac defibrillators device as an extension of life, younger patients associated [it] with dramatic life changes, decreased independence, and concerns with body image." However, pacemaker recipients generally appear to cope well, Linde says.
In another study, Samuel F. Sears, MD, and colleagues from the University of Florida surveyed 261 health care providers about the psychological and social adjustments that patients make after receiving pacemakers. The results were a "wake-up call" to doctors, who need to become more sensitive to the psychosocial issues of pacemaker patients, revealing that when it comes to dealing with issues of emotional well-being, health care providers are often uncomfortable.
Other researchers looked for pacemaker-specific patient questionnaires and found dozens were in use. But Monique Stofmeel, MD, and colleagues from cardiac centers throughout the Netherlands deemed only two effective and adequate to measure how the patient perceived life after implantation. Better survey instruments are needed to know how patients are coping, they concluded.
But when it comes right down to it, quality-of-life issues often arise in the physician's office. "All aspects of quality of life -- medical, social, psychosocial, and spiritual -- are important," says James B. Martins, MD, professor of medicine at the University of Iowa in Iowa City. While he views these aspects as his role and listens to the patient, pays attention, and tries to deal with their concerns, he says "people learn to cope with the side effects of their treatment, whatever it is." Martins has been involved with large pacemaker studies.
It may be encouraging to know that, in general, "there is no overall difference of quality of life for patients with devices, compared with those on medication," Martins says.-->