Abstract
BackgroundLittle is known about health-related quality of life (HRQoL) in pediatric patients with cardiac rhythm devices. This study aims to compare self- and proxy-reported HRQoL in patients with pacemaker (PM) and implantable cardioverter-defibrillator (ICD) to that in sex- and age-matched healthy controls and to examine predictors for generic and disease-specific HRQoL.MethodsThe study included 72 PM and ICD patients (39% females) and 72 sex- and age-matched healthy controls from 3 to 18 years of age. HRQoL data was obtained by the PedsQL 4.0 Generic Core Scales and Pediatric Cardiac Quality of Life Inventory. Medical data was collected retrospectively from medical records.ResultsPatients had significantly lower self- and proxy-reported generic overall HRQoL and lower physical health than healthy controls, and ICD patients also had lower psychosocial health. On multivariate analyses, generic overall HRQoL and physical health was significantly predicted by current cardiac medication (β = −.39, p = .02 for overall HRQoL, respectively β = −.44, p = .006 for physical health). Disease-specific overall HRQoL was only marginally predicted by child age, device type, and the presence of a structural congenital heart disease (p < .10).ConclusionsThis study shows that PM and ICD patients have lower HRQoL than healthy controls and that patients who need cardiac medication are seen by their parents at great risk for lower generic overall HRQoL. Our study also indicates a trend towards higher risk for low disease-specific HRQoL in younger patients, ICD patients, and patients with a structural congenital heart disease. Special attention should be given to these patients as they may benefit from a timely clinical evaluation in order to provide supportive interventions.
Highlights
Little is known about health-related quality of life (HRQoL) in pediatric patients with cardiac rhythm devices
Our analyses showed that parents of PM and implantable cardioverter-defibrillator (ICD) patients reported significantly lower overall HRQoL and lower physical health summary scores than did parents of healthy controls
This study shows that pediatric PM and ICD patients have lower generic HRQoL than age- and sex-matched healthy controls, and that patients who need cardiac medication are seen as being at great risk for reduced generic HRQoL
Summary
Little is known about health-related quality of life (HRQoL) in pediatric patients with cardiac rhythm devices. Pediatric patients with PM or ICD deal with life-long dependence on medical assistance and must cope with restrictions in daily activities and reduced life expectancy [4, 5]. This can be very stressful and negatively impact their healthrelated quality of life (HRQoL). Medical risk factors for impaired HRQoL have not been studied systematically One of these studies with PM and ICD patients identified the presence of CHD and ICD as key drivers of lower HRQoL [7]. Two studies found no association between generic HRQoL and cardiac illness severity in ICD patients [8, 12], and one other study found left ventricular ejection fraction lower than 55% and intake of cardiovascular drugs associated with lower generic HRQoL [15]
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