ISSN 1671-5411 CN 11-5329/R
Volume 18 Issue 9
Sep.  2021
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Please cite this article as: Merchant FM, Larson J, Darghosian L, Smith P, Kiani S, Westerman S, Shah AD, Hirsh DS, Lloyd MS, Leon AR, El-Chami MF. Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange. J Geriatr Cardiol 2021; 18(9): 720−727. DOI: 10.11909/j.issn.1671-5411.2021.09.007
Citation: Please cite this article as: Merchant FM, Larson J, Darghosian L, Smith P, Kiani S, Westerman S, Shah AD, Hirsh DS, Lloyd MS, Leon AR, El-Chami MF. Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange. J Geriatr Cardiol 2021; 18(9): 720−727. DOI: 10.11909/j.issn.1671-5411.2021.09.007

Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange

doi: 10.11909/j.issn.1671-5411.2021.09.007
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  •  BACKGROUND Little is known about health status and quality of life (QoL) after implantable cardioverter-defibrillator (ICD) generator exchange (GE). METHODS We prospectively followed patients undergoing first-time ICD GE. Serial assessments of health status were performed by administering the 36-Item Short Form Survey (SF-36). RESULTS Mean age was 67.5 ± 14.3 years, left ventricle ejection fraction (LVEF) was 36.5% ± 15.0% and over 40% of the cohort had improved LVEF to > 35% at the time of GE. SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being (P < 0.001 for each comparison). Physical health scores were significantly worse among those with medical comorbidities including diabetes, chronic obstructive pulmonary disease and atrial fibrillation. Mean follow-up was 1.6 ± 0.5 years after GE. Overall SF-36 scores remained stable across all domains during follow-up. Survival at 3 years post-GE was estimated at 80%. Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin. Four patients experienced appropriate ICD shocks after GE, three of whom had LVEF which remains impaired LVEF (i.e., < 35%) at the time of GE. CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being, which is associated with the presence of medical comorbidities. In terms of clinical outcomes, the incidence of appropriate shocks after GE among those with improvement in LVEF is very low, and most deaths post-procedure appear to be non-arrhythmic in origin. These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.
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