***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION The effects of  implantable cardioverter defibrillators ( ICDs ) and ICD shocks on psychological state have previously been studied . However , it is still unclear how health-related quality -of-life changes over time using st and ardized assessment s. We sought to characterize the effects of ICDs and ICD shocks on psychological outcomes . METHODS Three hundred-eight patients receiving ICDs were prospect ively identified . Baseline QOL assessment s including st and ardized psychological surveys [ Hospital Anxiety and Depression Scale ( HADS ) , Impact of Events Scale-Revised ( IES-R ) , and Short Form 36 Health Survey ( SF-36 ) ] were obtained within 2 months of device implantation and at 6 and 12 months , respectively . Outcomes including ICD shocks were followed over the 12-month study period . RESULTS The number of patients meeting criteria for anxiety or posttraumatic stress disorder ( PTSD ) at baseline ( 78/223 , 35 % ) was higher than at 6 ( 34/223 , 15 % ) or 12 ( 34/223 , 15 % ) months ( P < 0.01 ) . There was a significant improvement over time in HADS ( P < 0.001 ) and IES-R ( PTSD ) scores ( P < 0.001 ) . Amongst the 20 patients who received ICD shocks , no significant differences were observed in IES-R , SF-36 , or HADS scores when compared with those who did not receive shocks at any time point . Patients who experienced electrical storms ( N = 5 ) had significantly higher baseline PTSD scores ( 29.6 + /- 11.4 vs 14.6 + /- 11.6 , P < 0.01 ) . CONCLUSIONS Patients receiving ICDs  have significant rates of baseline psychopathology after implantation . However , psychological assessment scores tend to improve with time . ICD shocks do not appear to significantly impact psychological state . These results suggest the importance of close screening and referral for possible psychopathology in patients receiving ICDs  , especially in the peri-implant period Background —Implantable cardioverter defibrillator ( ICD ) use reduces mortality in patients with serious ventricular arrhythmias compared with antiarrhythmic drug ( AAD ) use . However , the relative impact of these therapies on self-perceived quality of life ( QoL ) is unknown . Methods and Results —Three self-administered instruments were used to measure generic and disease-specific QoL in  Antiarrhythmics  Versus  Implantable Defibrillators  trial participants . Generalized linear models were used to assess the relationships between self-perceived QoL and treatment ( AAD versus ICD ) and adverse symptoms and ICD shocks . To minimize the impact of missing data , only patients surviving 1 year were included in the primary analyses . Baseline characteristics among QoL participants ( n=905 ) and non participants ( n=111 ) were similar , but participants who survived 1 year ( n=800 ) were healthier at baseline than nonsurvivors ( n=105 ) . Of the 800 patients in the primary analysis , characteristics of those r and omized to AAD ( n=384 ) versus ICD ( n=416 ) were similar . Overall , ICD and AAD use were associated with similar alterations in QoL. The development of sporadic shocks and adverse symptoms were each associated with reduced physical functioning and mental well-being and increased concerns among ICD recipients , whereas development of adverse symptoms was associated with reduced physical functioning and increased concerns among AAD recipients . Conclusions —ICD and AAD therapy are associated with similar alterations in self-perceived QoL over 1-year follow-up . Adverse symptoms were associated with reduced self-perceived QoL in both groups , and sporadic shocks were associated with reduced QoL in ICD recipients AIMS Studies indicate a poorer quality of life ( QoL ) for implantable cardioverter defibrillator ( ICD ) patients than for the general population . However , studies comparing the QoL of ICD patients with that of patients with other implantable cardiac devices are scarce . We hypothesized that ICD patients had a poorer QoL than pacemaker patients . METHODS AND RESULTS All ICD patients living in Icel and at the beginning of 2002 ( 44 subjects ) , and a comparison group of 81 r and omly selected patients with pacemakers were invited to participate . The Icel and ic Quality of Life Question naire ( IQL ) , the General Health Question naire ( GHQ ) , the Beck Anxiety Inventory ( BAI ) , and the Beck Depression Inventory ( BDI ) were su bmi tted to measure QoL , psychiatric distress , and symptoms of anxiety and depression . The ICD and pacemaker groups did not differ on IQL , BAI , BDI , or GHQ scores . ICD patients were as a group more fearful of death ( P = 0.056 ) and showed more concerns about returning to work ( P = 0.072 ) , although these items fell just short of statistical significance . CONCLUSION Contrary to our expectations , ICD patients had a comparable QoL with pacemaker recipients and were not more likely to suffer from anxiety , depression , or general psychiatric distress . These findings are encouraging in view of exp and ing ICD indications BACKGROUND The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study demonstrated that implantable cardioverter defibrillators ( ICDs ) significantly reduce the risk of sudden cardiac death in patients with nonischemic cardiomyopathy and an ejection fraction of 35 % or less , with no statistically significant decrease in overall mortality . The impact of ICD placement and shock on health-related quality of life ( HRQL ) in this population is unknown . METHODS The 12-Item Medical Outcomes Short-Form Health Survey and the Minnesota Living with Heart Failure Question naire were administered to 458 patients with nonischemic cardiomyopathy , an ejection fraction of 35 % or less , and either nonsustained ventricular tachycardia or 10 or more premature ventricular depolarizations per hour at baseline , 1 month after r and omization , and every 3 months thereafter throughout the trial . The subjects were r and omized to an ICD or st and ard medical therapy . Outcomes were compared using hierarchical linear regression . RESULTS Overall , there were no significant differences in HRQL throughout the trial between patients r and omized to an ICD or st and ard medical therapy . However , in patients with 1 or more ICD shocks , HRQL declined 0.5 + /- 0.2 ( mean + /- SD ) points per shock on the emotional scale of the Minnesota Living with Heart Failure Question naire ( P = .04 ) and 1.0 + /- 0.5 points per shock on the mental component score of the 12-Item Medical Outcomes Short-Form Health Survey ( P = .04 ) . CONCLUSIONS Overall , HRQL was not affected by ICD implantation in patients in the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study . Implantable cardioverter defibrillator shock was associated with a reduction in some measures of HRQL , but the effects were unlikely to result in a clinical ly observable alteration until 5 or more shocks were experienced Objective : To evaluate a minimal , easy , accessible intervention targeting anxiety and reduced quality of life in patients with an implantable cardioverter defibrillator ( ICD ) . An estimated 24 % to 87 % of patients experience anxiety , and 10 % to 15 % have reduced quality of life . Methods : A total of 119 ICD patients were assigned r and omly to usual medical aftercare ( n = 63 ) or additional psychological treatment ( n = 56 ) comprising of written information on medical and psychological consequences of an ICD plus 6 months of individual phone counseling .  Treatment efficacy was evaluated by comparing T0 ( immediately after implantation ) and T1 ( 6 months later ) assessment s. Results : Although 75 % of patients considered the program helpful , age moderated treatment efficacy . As indicated by triple interactions , only in the treatment group , anxiety ( HADS-Anxiety , p < .01 ) , psychological distress ( SCL-K-9 , p < .02 ) , and somatic quality of life ( SF-36-PCS , p < .01 ) improved in ICD patients aged < 65 years but deteriorated in older patients ( age , 65–75 years ) . Frequency of ICD discharges was associated with a symptom increase from T0 to T1 in all patients ( HADS-Depression , CAQ-Avoidance , and ICD-Constraints ; all p < .05 ) . Conclusions : Our findings confirm that psychological treatments can not be expected to have uniformly positive effects in ICD patients . Our minimal intervention may have adequately addressed ICD-related concerns in younger patients but may have fostered problems in older patients with fewer concerns . Therefore , our findings warrant custom treatment with particular attention to the elderly as well as patients with frequent ICD discharges . ANOVA = analysis of variance ; ATP = antitachycardia pacing ; BMI = body mass index ; CAQ = Cardiac Anxiety Question naire ; HADS = Hospital Anxiety and Depression Scale ; ICD = implantable cardioverter defibrillator ; MI = myocardial infa rct ion ; MANOVA = multivariate analysis of variance ; QoL = quality of life ; SCL-K-9 = Symptom Checklist , 9-item short form ; SF-36-MCS = Medical Outcome Study Short Form-36 Health Survey : mental component summary ; SF-36-PCS = Medical Outcome Study Short Form-36 Health Survey : physical component summary ; T0 = assessment immediately after ICD implantation ; T1 = assessment at the end of the intervention ( i.e. , 6 months later ) This study prospect ively examined the role of cognitive behavioral therapy ( CBT ) in ( 1 ) alleviating psychological and somatic distress , and ( 2 ) lowering arrhythmic events requiring shocks . Forty-nine of 61 consecutive patients were r and omized into therapy ( CBT , n = 25 ) or no therapy ( NT , n = 24 ) and completed a battery of self-report question naires at baseline and at 9-month follow-up . CBT was administered at preimplant , predischarge , and at seven routine follow-up visits . Patients were 65 + /- 10 years old , 65 % were men , and 92 % Caucasian . Eighteen ( 72 % ) CBT patients and 18 ( 75 % ) NT patients were retained at follow-up . Compared to CBT patients , NT patients reported higher levels of depression ( P = 0.046 ) , more anxiety ( P = 0.013 ) , more psychological distress ( P = 0.015 ) , poorer overall adjustment ( P = 0.009 ) , and poorer sexual functioning ( P = 0.003 ) . Mean number of shocks did not differ between the CBT and NT groups ( 2.85 vs 2.30 , respectively ) ; however , more patients in the CBT group ( 61 % ) than the NT group ( 33 % ) received shocks ( P = 0.070 ) . At follow-up , a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups . In conclusion , CBT was associated with decreased depression , decreased anxiety , and increased adjustment for ICD recipients , particularly among those patients receiving shocks . CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient Purpose This study examines the contributions of known predictors of survival and quality of life ( QOL ) to 1-year survival in ICD recipients . Methods This study used the data set from the antiarrhythmia versus implanted defibrillator ( AVID ) controlled clinical trial conducted by the National Institutes of Health , National Heart , Lung , and Blood Institute . The 507 patients r and omly assigned to the ICD treatment were included in the analysis . Patients were mostly male ( 78.3 % ) , with mean age of 64.85 ± 10.81 and mean left ventricular ejection fraction of 32.2 ± 13.45 % . QOL was measured with the medical outcomes study 36-item short form health survey ( SF-36 ) and quality of life index-cardiac version ( QLI-CV ) . Data were analyzed with descriptive statistics and logistic regression . Results Fifty-four ( 10.6 % ) patients died in the first year after ICD implantation . Angiotensin-converting enzyme inhibitor ( ACE ) medication , age , and QLI-CV were significant independent predictors of 1-year survival . The odds of survival of a younger patient with ACE medication and good QOL were approximately three times ( OR = 3.96 ) greater than for an older patient , without ACE medication and with poor QOL . Conclusion Quality of life is an important factor predicting 1-year survival in patients with ICDs . ACE medication and younger age also predict 1-year survival independent of QOL and each other BACKGROUND Life stresses and negative emotions , such as anxiety and depression , are associated with adverse cardiac events , including arrhythmia . Patients undergoing implantation of an automatic internal cardioverter defibrillator  provide a unique opportunity to characterize these relationships since all tachyarrhythmia episodes are recorded by the device . OBJECTIVES The purpose of this study was to examine the association of emotional status after  internal cardioverter defibrillator ( ICD ) implantation  and subsequent arrhythmia events . METHODS An analysis 
    Output:
    
Based on evidence presented in this review , factors including old age ( ≥60 years old ) , implantable cardioverter defibrillator shock experience , anxiety , and depression , are the key predictors of health-related quality of life .
IMPLICATION FOR PRACTICE Underst and ing factors influencing health-related quality of life can help nurses identify patients with implantable cardioverter defibrillator at risk for negative outcomes .