A literature review comparing the experiences and emergent needs of adult patients with permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs)

Abstract

Aims and objectives: This literature review aims to critically appraise any published studies that compare the experiences of patients with permanent pacemakers and those with implantable cardioverter defibrillators. It seeks to identify issues that are similar or unique to one or other group; whether identified needs are being met by current nursing practice and considers how any gaps might be addressed.

Background: Increasing numbers of patients are receiving pacemakers and implantable cardioverter defibrillators (ICDs) as indications for devices continue to expand worldwide. Technical follow-up of such patients is well structured. There is an increasing body of knowledge regarding ICD patients' experiences with promising work testing recovery interventions but less seems to be known about pacemaker patients.

Design: Systematic review.

Methods: Using an integrative approach, electronic searches using comprehensive search terms were supplemented by following reference lists and key journals from 1975-2008.

Conclusion: From the direct comparison studies identified, ICD patients who experience shocks are more likely to report lifestyle limitations than pacemaker patients. However, ICD and pacemaker patients share similar outcomes, with both groups reporting increased anxiety and depression. Whilst experiences of ICD patients have been well reported, experiences of patients receiving pacemakers for any reason and pacemakers or ICDs for heart failure (bi-ventricular devices or cardiac resynchronisation therapy - CRT) remain largely unknown. Although psychosocial interventions are suggested for both groups, these have apparently only been tested and reported for ICD patients.

Relevance to clinical practice: Nurses internationally encounter increasing numbers of patients with pacemakers and ICDs from primary to tertiary clinical care settings, therefore knowledge of patient experiences relating to such devices and their impact is important to inform care planning. Whilst interventions to assist ICD patients are being tested, further research is required regarding the experiences of patients with contemporary pacemakers to inform care planning and potential nursing support interventions.