| 61. |
- Thylén, Ingela, et al.
(författare)
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Characteristics associated with anxiety, depressive symptoms, and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients
- 2014
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Ingår i: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 77:2, s. 122-127
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAlthough most patients with implantable cardioverter defibrillators (ICDs) adjust well, some have considerable psychological distress. Factors associated with psychological adjustment in ICD-recipients are still not well understood. Our purpose was to describe quality-of-life (QoL) and prevalence of self-reported symptoms of anxiety and depression in a large national cohort of ICD-recipients, and to determine socio-demographic, clinical, and ICD-related factors associated with these variables.MethodsA cross-sectional, correlational design was used. All eligible adult ICD-recipients in the Swedish ICD- and Pacemaker Registry were invited to participate. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and QoL with the EuroQol-5D.ResultsA total of 3067 ICD-recipients (66 ± 11 years, 80% male) were included. The mean HADS score was 3.84 ± 3.70 for anxiety symptoms and 2.99 ± 3.01 for symptoms of depression. The mean EQ-5D index score was 0.82 ± 0.21. The probability of symptoms of anxiety and depression was associated with younger age, living alone, and a previous history of myocardial infarction or heart failure. Additionally, female ICD-recipients had a higher probability of symptoms of anxiety. A higher level of ICD-related concerns was most prominently related to symptoms of anxiety, depressive symptoms and poorer QoL, while number of shocks, ICD-indication and time since implantation were not independently related.ConclusionsIn this large cohort of ICD-recipients, the association of ICD-related concerns with symptoms of anxiety, depressive symptoms, and poor QoL suggests that ICD specific factors should be addressed in order to improve outcomes.
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| 62. |
- Thylén, Ingela, et al.
(författare)
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Concerns about implantable cardioverter-defibrillator shocks mediate the relationship between actual shocks and psychological distress.
- 2016
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 18:6, s. 828-835
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Although most implantable cardioverter-defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not yet been investigated. Our objective was to examine whether the relationship between receipt of defibrillating shocks and psychological distress was mediated by patients' concerns related to their ICD.METHODS AND RESULTS: All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3067 completing the survey (55% response rate). Their mean age was 66 ± 11 years, and 80% were male. One-third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression [odds ratio (OR) 1.58 and OR 3.04, respectively]. The association between receipt of shocks and psychologically distress was mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety, and 54% of the relationship between shocks and symptoms of depression.CONCLUSION: Implantable cardioverter-defibrillator-related concerns have a bigger impact on psychological distress than receipt of an actual shock. Assessing ICD-related concerns in clinical practice can identify patients at risk for psychological distress. Further research on assessment of, and interventions targeting, ICD-related concerns is warranted.
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| 63. |
- Thylén, Ingela, et al.
(författare)
-
Concerns about implantible cardioverter defibrillator shocks mediate the relationship between shocks and psycological distress.
- 2014
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Konferensbidrag (refereegranskat)abstract
- Background: Although most implantable cardioverter defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not been investigated. Our objectives were to (1) describe ICD-related concerns, and (2) examine whether the relationships between receipt of defibrillating shocks and psychological distress were mediated by patients’ concerns related to their ICD. Methods and Results: All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3,067 completing the survey (55% response). Their mean age was 66+11 years, and 80% were male. One third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression (OR 1.58 and OR 3.04, respectively). The association between receipt of shocks and psychologically distress were mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety,and 54% of the relationship between shocks and symptoms of depression, see Figure 1. Conclusion: Having high ICD-related concerns has a bigger impact on psychological distress than receipt of an actual shock. Screening for ICD-related concerns in clinical practice may identify patients at risk of psychological distress, which could provide a specific target for intervention. Interventions tailored to individual patients’ needs can - besides addressing device-related education and anxiety about shocks - also include relaxation and stress management, cognitive restructuring, social support and/or group discussions, and exercise programs.
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| 64. |
- Thylén, Ingela, et al.
(författare)
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Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator
- 2014
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Ingår i: European Journal of Cardiovascular Nursing. - London, United Kingdom : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 13:2, s. 142-151
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Tidskriftsartikel (refereegranskat)abstract
- Background: Due to extended indications and resynchronization therapy, many implantable cardioverter defibrillator (ICD) recipients will experience progressive co-morbid conditions and will be more likely to die of causes other than cardiac death. It is therefore important to elucidate the ICD patients' preferences when nearing end-of-life. Instead of avoiding the subject of end-of-life, a validated questionnaire may be helpful to explore patients' experiences and attitudes about end-of-life concerns and to assess knowledge of the function of the ICD in end-of-life. Validated instruments assessing patients' perspective concerning end-of-life issues are scarce. Aim: The purpose of this study was to develop and evaluate respondent satisfaction and measurement properties of the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients' Questionnaire' (EOL-ICDQ). Methods: The instrument was tested for validity, respondent satisfaction, and for homogeneity and stability in the Swedish language. An English version of the EOL-ICDQ was validated, but has not yet been pilot tested. Results: The final instrument contained three domains, which were clustered into 39 items measuring: experiences (10 items), attitudes (18 items), and knowledge (11 items) of end-of-life concerns in ICD patients. In addition, the questionnaire also contained items on socio-demographic background (six items) and ICD-specific background (eight items). The validity and reliability properties were considered sufficient. Conclusions: The EOL-ICDQ has the potential to be used in clinical practice and future research. Further studies are needed using this instrument in an Anglo-Saxon context with a sample of English-speaking ICD recipients.
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| 65. |
- Thylén, Ingela, et al.
(författare)
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Device Adjustment and Recovery in Patients With Heart Failure Undergoing a Cardiac Resynchronization Therapy Implantation A Longitudinal Study
- 2022
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Ingår i: Journal of Cardiovascular Nursing. - : LIPPINCOTT WILLIAMS & WILKINS. - 0889-4655 .- 1550-5049. ; 37:3, s. 221-230
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Tidskriftsartikel (refereegranskat)abstract
- Background Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure. Purpose The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation. Methods In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions. Results A total of 133 patients, 79% male, with a mean age of 70 +/- 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved. Conclusions Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.
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| 66. |
- Thylén, Ingela, et al.
(författare)
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First medical contact in patients with STEMI and its impact on time to diagnosis : an explorative cross-sectional study
- 2015
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 5:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: It is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients' FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis.SETTING: Multicentred study, Sweden.METHODS: Cross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission.RESULTS: We included 109 women and 336 men (mean age 66±11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1:59 vs 1:21 h, p<0.001).CONCLUSIONS: Using other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.
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| 67. |
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| 68. |
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| 69. |
- Thylén, Ingela, et al.
(författare)
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Intimate relationships and sexual function in partnered patients in the year before and one year after a myocardial infarction : A longitudinal study
- 2015
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 14:6, s. 468-477
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Intimate relationships and sexuality are essential to an individual's health and longevity after a myocardial infarction (MI).AIMS: To explore and compare partnered first-time MI patients' ratings of intimate relationship satisfaction and sexual function before the MI as compared to one year after the event.METHODS: Longitudinal study with 92 men and 36 women, aged 62.4±9.3 years. Self-reported data was collected one year before, and one year after, the MI.RESULTS: The majority were sexually active before (86%) as well as after (80%) their MI (ns). High satisfaction was reported with intimate relationships, which were stable over time (Relationship assessment scale score 4.56±0.50 and 4.53±0.52, respectively, ns). No significant differences in intimate relationships between genders were found. Women reported lower ratings in their sexual function than men before the MI (Watts sexual function score 45.92±6.55 and 48.59±4.96, respectively, P<0.05). The year after the event, women described an unchanged sexual function (45.08±7.25), while men (47.10±5.16) had decreased theirs (P<0.05). Both female and male patients enjoyed sexual activity less frequently the subsequent year. Men regarded having sex as being less important in their lives, were less satisfied with the frequency of sexual activity, and felt that they more often ejaculated prematurely the year after the MI.CONCLUSIONS: Partnered first-time MI patients continue to be sexually active the year after the event, and are highly satisfied with their intimate relationship. While the MI event seems to have a more negative impact on men's sexual functioning than women's, the women still rate their sexual function lower in comparison.
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