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July 21, 2003


Emory Study Helps Implantable Cardiac Defibrillator Patients Calm Symptom Distress and Find PEACE Of Mind

ATLANTA -- Implanted cardiac defibrillators (ICDs) can shock irregular hearts back to normal rhythms. But they can also deliver a jolt to newly implanted patients' psyches, since the lifesaving devices discharge their voltages unexpectedly, in response to irregular heartbeats. The sensation has been likened to a soft thump, or a punch in the chest. And apprehension over when the next jolt will come has led to anxiety, fear, and depression in some patients.

A study being conducted by researchers at the Nell Hodgson Woodruff School of Nursing at Emory University, is attempting to reduce the emotional side effects of living with the ICD device. The Psychoeducational Intervention in Internal Cardiac Defibrillator Patients (PEACE) Trial is designed to improve physical and emotional recovery in the 12-month period after initial ICD implantation.

During the weeks following the procedure, ICD patients are usually keenly aware of the new implant, which is slightly larger than the size of a pacemaker and inserted under the skin in the chest area. Patients may also experience some pain, limitations of arm movement, and sleep difficulties, though these side effects tend to subside after the first six weeks.

The randomized PEACE trial divides patients into three groups. One group receives a combined education and counseling intervention in four group sessions, another receives education and counseling via four telephone consultations, and a control group receives standard care from their providers. Both the telephone and group participants receive a booster session several months after their initial intervention.

The control group receives the usual patient teaching in a hospital setting, follow-up in a pacemaker clinic or standard teaching from a nurse. Patients who receive intervention are taught how to manage symptoms of pain and sleep disruption and are taught active coping strategies to help them develop a positive outlook and to deal with the emotional aspects and vulnerable feelings related to having an abnormal heart rhythm and ICD. Those who receive intervention also get an extensive follow-up at one, three and six months, and then again at a year after the device has been implanted.

"Previous work has found that patients have a better psychological outcome if they were able to view their situation with hope and optimism and use more active problem-solving and coping strategies," says Sandra Dunbar, RN, DSN, FAAN, a professor of adult and elder health and principal investigator of the study. "Our goal is to help ICD recipients feel more in control and to shift from a victim to survivor mindset."

Dr. Dunbar hopes the study will help identify those for which the intervention will be most beneficial. And although all the data has yet to be analyzed, the response to interventions has been extremely positive, she says.

"One patient came to our first meeting and admitted that he had been preparing his last will and testament and funeral arrangements. But after the last group session he says he is back to planting tomatoes in his garden," Dr. Dunbar says. "Although the case seems extreme, itís indicative of just how helpful interventional counseling can be. The ICD device confers a sense of security for some, but others need a little more support. And as science and technology develops in healthcare, itís equally important to study the human response to living with these sophisticated devices."

First-time ICD patients are being recruited from Emory University Hospital and Emory Crawford Long Hospital, but patients may self-initiate participation in the study if their procedure is being performed at another hospital. Study participants must be at least twenty-one years old, live within a 100- mile radius of Emory University, and have no history of psychiatric disorders. Interested patients may contact Dr. Dunbar at 404-727-6939 or the project office at 404-727-8811.

The PEACE Trial is being conducted in the Center for Research on Symptoms, Symptom Interactions, and Health Outcomes at the Nell Hodgson Woodruff School of Nursing, Emory University. The Center is one of nine exploratory nursing research centers funded by the National Institutes of Health, National Institute for Nursing Research. The purpose of the Center is to facilitate symptom-related research, including the development and testing of interventions designed to reduce negative symptomatology and improve health outcomes in clinical populations.

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