Implantation of cardiac devices was associated with large improvements in quality of life, with pre-post effect sizes of g=1.64 for LVADs, g=1.32 for pacemakers, and g=0.64 for ICDs.
Meta-Analysis
Does the implantation of cardiac devices improve quality of life in patients?
Implantation of cardiac devices, including LVADs, pacemakers, and ICDs, is associated with significant improvements in patient-reported quality of life.
Effect estimate: LVAD g = 1.64, pacemaker g = 1.32, ICD g = 0.64
The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.
Willy et al. (Wed,) conducted a meta-analysis in Cardiac arrhythmias. Cardiac devices (ICD, pacemakers, LVAD) vs. Pre-implantation (pre-post comparison) was evaluated on Quality of life (LVAD g = 1.64, pacemaker g = 1.32, ICD g = 0.64). Implantation of cardiac devices was associated with large improvements in quality of life, with pre-post effect sizes of g=1.64 for LVADs, g=1.32 for pacemakers, and g=0.64 for ICDs.