Patient Preference and Adherence (Feb 2023)
Evaluation of a Standardized Training and Adherence Surveillance Programme to Overcome Quality-of-Life Impairments and Enhance Compliance in Patients Treated with Wearable Cardioverter Defibrillator
Abstract
Antonia Kellnar,1 Stephanie Fichtner,2 Lauren Sams,1 Christopher Stremmel,1 Heidi L Estner,1 Korbinian Lackermair1 1Department of Medicine I, University Hospital Munich, Ludwig Maximilian University, Munich, Germany; 2Department of Cardiology, Krankenhaus Landshut-Achdorf, Landshut, GermanyCorrespondence: Antonia Kellnar, Department of Medicine I, University Hospital Munich, Marchioninistr. 15, Munich, DE-81377, Germany, Tel +49 89 4400 712621, Email [email protected]: Treatment with wearable cardioverter defibrillators (WCD) is a non-invasive, transient therapy option for prevention of sudden cardiac death (SCD) in patients with temporary contraindications for implantation of a permanent cardioverter defibrillator. Due to the constant risk of fatal arrhythmias, compliance is the fundamental requirement for effectiveness of a WCD, but this might be hindered by the poor quality-of-life (QoL) during WCD therapy. In this retrospective single-center study, we examined if a standardized WCD training and adherence surveillance programme could enhance compliance and QoL.Methods: All patients with a prescription for WCD treatment from January 2017 to August 2019 were included and received a standardized WCD training programme. QoL was validated using the modified EQ-5D-3L questionnaire. The findings were compared to a historical, previously published, retrospective cohort from our center (WCD prescription period 03/2012– 02/2016), not receiving the additional training programme. Endpoints comprised therapy adherence, arrhythmic episodes, and dimensions of QoL.Results: Ninety-two patients underwent WCD treatment in the study cohort for a median of 49 days. Median daily wear time was enhanced in the study cohort (historical cohort vs study cohort 21.9 vs 23.3 hours/per day, p< 0.01) and artefact alarms occurred less frequently (67.9% vs 48.9%, p 0.01). Major restrictions in QoL in the study cohort were found in mobility (48%), daily routine (44%), and sleep (49%), but the dimensions pain (36% vs 4%, p< 0.01), mental health (43% vs 29%, p 0.03), and restrictions in daily routine (48% vs 30%, p 0.04) improved.Conclusion: A standardized training and adherence surveillance programme might have beneficial effects on compliance and QoL. As these findings are essential for therapy success, they might potentially lead to a reduction in arrhythmic deaths in upcoming WCD trials.Keywords: wearable cardioverter-defibrillator, sudden cardiac death, quality-of-life, ventricular tachycardia, ventricular fibrillation, life vest
