Recipients' of implanted cardioverter-defibrillators actual and perceived adaptation: a review of the literature.

PURPOSE: To identify qualitative studies that have examined actual and perceived adaptation of patients to an implanted cardioverter-defibrillator (ICD). The question explored was do recipients of ICDs experience real or perceived physical or psychological adaptation distress? Do themes expressed indicate a need for intervention that will facilitate postimplantation adjustment? DATA SOURCES: A systematic search of the scientific literature uncovered 153 studies of which 12 met the following inclusion criteria: qualitative English research of psychological adaptation to the implantable defibrillator or qualitative research literature reviews. Exclusion criteria included unpublished studies, studies involving cardiac pacemaker devices without defibrillator, and quantitative research studies.
CONCLUSION: Multiple themes pertaining to adjustment to ICD therapy were identified, which warrants further study for potential therapeutic interventions. Themes identified by ICD recipients and their partners include perception of fear, anxiety, and dependence, and the desire for enhanced support and information. Increasing awareness of the complex adaptation issues related to ICD implantation should be a priority of primary care clinicians who provide follow-up care for these patients. IMPLICATIONS FOR PRACTICE: ICD recipients have reported multiple physical and psychological adjustment issues that require further study to determine gravity and duration. Clinicians must be familiar with adjustment difficulty expressed by ICD recipients in order to facilitate appropriate tailored interventions. The findings of this literature review emphasize a need for support groups for ICD recipients and their partners; behavioral and sexual counseling; continued education after discharge; and a supportive healthcare provider who is knowledgeable in device adjustment issues. The research indicates a need for a post-ICD implantation plan, and data are available for the design testing of tailored interventions.