Quality of Life and its Associated Factors among Patients with Cardiac Implantable Electronic Devices Implanted At Jakaya Kikwete Cardiac Institute

Abstract

Background: Cardiac implantable electronic device is a term that encompasses pacemakers, implantable cardioverter defibrillators and cardiac resynchronization therapy. These lifelong devices are established treatments and are known to improve survival in patients with cardiac arrhythmias (1,2), however, in any chronic therapy or illness entails physical, psychological and social challenges that can interfere with daily activities of a patient and influence their quality of life (3). Individual’s own perception of their health and illness plays a critical role to help health professionals to gain insight on the effectiveness of therapy and challenges faced by the patients in order to improve care (4). Objectives: To assess the QOL and its associated factors among patients with cardiac implantable electronic devices implanted at JKCI. Methodology: A hospital based cross-sectional study, involving patients with cardiac implantable electronic devices implanted at JKCI was conducted from October 2019 to January 2020. All patients who were registered to undergone device insertion were interviewed after informed consent was obtained. A standardized generic Kiswahili version questionnaires Short form-36 (SF-36) and a disease specific AQUAREL were filled. Baseline socio-demographic and clinical characteristics were collected from patient’s files. Statistical analysis was conducted on SPSS 23.0 and a p-value of <0.05 was considered significant. Ethical clearance was obtained from the MUHAS directorate of research and publications. Results: There were 171 patients, 52% were females and 75.4% were ≥60years. The QOL was overall good as patients scored above 50 for most domains on the SF-36 and AQUAREL except on social functioning domain on SF-36 with. Age was negatively associated with general health (R²=75.0%, p≤0.001), increasing implant years was positively associated with physical functioning (R²=22%, P≤0.001), role physical (R²=5.6%, P≤0.001), bodily pain (R²=12%, P≤ 0.002), emotional health (R²=74%, P<0.002) and vitality (R²= 19.6% p<0.018). On mental health domains on SF-36, female sex compared to male sex (R²= 18.4%, P<0.025) as well as widow status compared to married status (R²= 9.2%, P<0.05) were negatively associated with mental health. Conclusion: Patients with cardiac implantable electronic devices at JKCI had overall good QOL however, had poor social functioning. As number of years post implant increases, the QOL gets better and with old age the QOL starts to decline. Female patients and widows have poor mental health compared to male patients and married respectively. In terms of disease-specific effects with reference to chest discomfort, dyspnea and arrhythmia most patients had high scores on AQUAREL indicating to be free of symptoms.