Changes in daily life of Iranian patients with implantable cardioverter defibrillator: a qualitative study

Background: Although Implantable Cardioverter Defibrillator [ICD] saves the life of patients with life-threatening ventricular dysrhythmias, it causes various challenges in their life span. Considering the increase in the number of ICD users, more knowledge is required regarding changes in the patients' life after device implantation. The aim of this study was description of changes in daily life of patients after ICD implantation

Methods: This qualitative study was conducted through content analysis method. The participants were selected through purposive sampling. They included 3 women and 9 men whose ages ranged from 24 to 74 years, with the mean age of 42.58+1.55 years. They had implanted ICDs in order to treat life-threatening dysrhythmias. The study data were collected through interview and field notes from November 2013 to October 2014. The data were simultaneously analyzed using constant comparative analysis

Results: Through analysis of the study data, 2 categories were emerged representing dimensions of changes in daily life of the patients with ICD. These categories were changes in the social role and familial challenges after implantation. Change in social role included the following subcategories: "Change in manifestation of routines", "Shift in leisure time", "Change in job and education status", and "Change in interaction between the patient and society members". In addition, familial challenges after implantation consisted of 2 subcategories, namely "Difficulty in marriage" and "ICD implantation and a range of familial changes"

Conclusion: The study findings can be of great importance in nurses' clinical practice for providing the patients with holistic care, education, support, and follow-up. They can also be used as a guide assisting clinical treatment of the patients with ICD

Signal-averaged electrocardiography in patients with advanced heart failure: a better indicator of left ventricular enlargement compared with conventional electrocardiography

The signal-averaged electrocardiograph is a noninvasive method to evaluate the presence of the potentials generated by tissues activated later than their usual timing in the cardiac cycle. The purpose of this study was to demonstrate the correlation between the filtered QRS duration obtained via the signal-averaged electrocardiography and left ventricular dimensions and volumes and then to compare it with the standard electrocardiography. We included patients with advanced systolic left ventricular dysfunction [ejection fraction

Risk factors for contrast-related acute kidney injury according to risk, injury, failure, loss, and end-stage criteria in patients with coronary interventions

Although a series of risk factors for contrast-induced nephropathy are known, data on significance of some of the risk factors such as age, sex, hypercholesterolemia, hyperuricemia, and dose of contrast medium are inconsistent. Our aim was to identify risk factors for contrast-related acute kidney injury [AKI]. In this prospective study, 290 consecutive patients with a serum creatinine level lower than 3 mg/dL undergoing percutaneous angiography were analyzed. Contrast-related AKI was evaluated using the risk, injury, failure, loss, and end-stage [RIFLE] criteria, and its correlation with clinical and laboratory data of the patients was analyzed. Contrast-related AKI was found in 15.5% of the patients, with a maximum RIFLE category [risk in 13.8%, injury in 1.4%, and failure in 0.3%]. Serum creatinine level, contrast volume, safe contrast volume factor, diabetes mellitus, and dehydration were significantly associated with contrast-related AKI. Age, sex, and serum uric acid level did not differ significantly between those with and without contrast-related AKI. Multiple logistic regression analysis disclosed diabetes mellitus to be the strongest predictor for being at risk of contrast-related AKI [odds ratio, 5.1; 95% confidence interval, 1.9 to 11.0; P=.001], followed by hypercholesterolemia [odds ratio, 4.6; 95% confidence interval, 1.1 to 8.3; P=.03], and an estimated glomerular filtration rate lower than 90 mL/min/1.73 m[2] [odds ratio, 3.0; 95% confidence interval, 1.8 to 5.7; P=.003]. Our results indicate that diabetes mellitus, hypercholesterolemia, and underlying chronic kidney disease are the major factors of contrast-related AKI