Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator

Patients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management. The objectives were to determine common s...

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Bibliographic Details
Published in:Journal of pain and symptom management 2020-03, Vol.59 (3), p.658-667
Main Authors: Streur, Megan M., Thompson, Elaine A., Dougherty, Cynthia M.
Format: Article
Language:English
Subjects:
Activities of daily living
Anxiety
Clinical outcomes
Clinical trials
Defibrillators
Health risk assessment
Health status
Implantable cardioverter defibrillator
Membership
Mental depression
Multiple symptoms
Patients
Physical symptoms
Psychological problems
Quality of life
Symptom management
symptom profile
Symptoms
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Summary:Patients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management. The objectives were to determine common symptoms after initial ICD implantation, identify classes of individuals with similar symptom profiles, describe patient characteristics associated with different symptom profiles, and determine if symptom profiles at hospital discharge predicted outcomes three and 12 months after implantation. This was a secondary data analysis of a randomized controlled trial that compared patient + partner versus patient-only interventions designed to help patients manage symptoms, prepare for ICD shocks, and resume daily activities. Symptoms were measured with the Patient Concerns Assessment. Latent class regression analysis was used to identify symptom classes at baseline, three-month, and 12-month follow-up. Associations between patient characteristics, class membership, and outcomes were examined using chi-square, analysis of variance, and Poisson regression. The study included 301 patients (74% male, mean age 64 ± 11.9 years). Three classes were identified: Multi-Symptom (N = 119, 40%), Tired-Rundown (N = 130, 43%), and Mostly Asymptomatic (N = 52, 17%). Patients in the Multi-Symptom class were younger (59.9 years, P 
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2019.10.024