Studies on SCA and Survival

Surviving sudden loss: when life, death, and technology collide.
Clements PT, Stenerson HJ. 

College of Nursing, University of New Mexico, Albuquerque 87131-0001, USA.

Patients who survive sudden cardiac arrest are at risk for anxiety, depression, and other psychosocial difficulties. By exploring the impact of surviving sudden cardiac arrest as it relates to the expectations and emotions of patients and their families, nurses can promote realistic and readily usable processes for facilitation of healthy grieving, adaptive coping, and reinvestment in life.

Short-term efficacy of a telephone intervention by expert nurses after an implantable cardioverter defibrillator.
Dougherty CM, Lewis FM, Thompson EA, Baer JD, Kim W.

The ICD is a common therapy for treatment of ventricular arrhythmias and prevention of sudden cardiac death. After ICD therapy, 50% of survivors are known to have significantly elevated anxiety, depression, anger, and fear in getting back to normal physical activities. Despite these problems, few interventions to improve adjustment have been rigorously evaluated within a clinical trial format. This article reports the short-term efficacy of a structured weekly educational telephone intervention (8 weeks) delivered by expert cardiovascular nurses to recipients of an ICD. To test these effects, a two-group (n = 84/group) randomized clinical trial design was used with measures at baseline (hospital discharge), 1 month, and 3 months after ICD therapy. The study sample were first time ICD recipients for secondary prevention of sudden cardiac arrest. Primary outcomes included (1) physical functioning (Patient Concerns Assessment [PCA], Short-Form Health Survey [SF-12], ICD shocks), (2) psychological adjustment (State-Trait Anxiety Inventory [STAI]), Centers for Epidemiologic Studies-Depression (CES-D), (3) knowledge (Sudden Cardiac Arrest [SCA] knowledge assessment), and (4) health care use (emergency room visits, outpatient visits, hospitalizations). The intervention group, as compared to the control group, significantly reduced mean PCA symptoms at 1 month (11.3-8.8 vs 9.7-9.3, respectively, P < 0.02), and reduced state anxiety (36.1-31.9 vs 33.1-33.0, respectively, P < 0.08), and enhanced knowledge (21.8-22.4 vs 21.4-21.7, respectively, P < 0.02) at 3 months. The intervention did not significantly impact short-term health care use. A structured telephone intervention delivered during the first 8 weeks after ICD therapy by expert cardiovascular nurses decreased ICD related physical symptoms and anxiety, and increased SCA knowledge over 3 months.

Activity and Life After Survival of a Cardiac Arrest (ALASCA) and the effectiveness of an early intervention service: design of a randomised controlled trial.
Moulaert VR, Verbunt JA, van Heugten CM, Bakx WG, Gorgels AP, Bekkers SC, de Krom MC, Wade DT.

Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands.


Cardiac arrest survivors may experience hypoxic brain injury that results in cognitive impairments which frequently remain unrecognised. This may lead to limitations in daily activities and participation in society, a decreased quality of life for the patient, and a high strain for the caregiver. Publications about interventions directed at improving quality of life after survival of a cardiac arrest are scarce. Therefore, evidence about effective rehabilitation programmes for cardiac arrest survivors is urgently needed. This paper presents the design of the ALASCA (Activity and Life After Survival of a Cardiac Arrest) trial, a randomised, controlled clinical trial to evaluate the effects of a new early intervention service for survivors of a cardiac arrest and their caregivers.

Domains of concern of intimate partners of sudden cardiac arrest survivors after ICD implantation.
Dougherty CM, Pyper GP, Benoliel JQ.

University of Washington School of Nursing, Department of Biobehavioral Nursing & Health Systems, Seattle, Wash 98195, USA.


There is limited research that describes the experiences of intimate partners of sudden cardiac arrest (SCA) survivors. The purposes of this article are to (1) describe the domains of concern of intimate partners of SCA survivors during the first year after internal cardioverter defibrillator (ICD) implantation and (2) outline strategies used by partners of SCA survivors in dealing with the concerns and demands of recovery in the first year after ICD implantation.

Redefining life while forestalling death: living with an implantable cardioverter defibrillator after a sudden cardiac death experience.
Dickerson SS.

University at Buffalo, State University of New York, USA.

Secondary analysis is a resourceful approach for making further use of existing data sets to answer questions not previously addressed or to expand on content not specifically examined in the original study. Using Heideggerian hermeneutics, the author analyzed transcripts of the stories of individuals with implantable cardioverter defibrillators (ICD) from three of her earlier phenomenological studies to obtain a description of the experience of living with an ICD after a sudden cardiac death experience. Three related themes emerged: (a) losing control: technology as lifesaving yet changing everything; (b) getting on with living: regaining control or conditional acceptance; and (c) creating a new vision: transformation or tenuous truce. The constitutive pattern was redefining life while forestalling death.

Psychological stress preceding idiopathic ventricular fibrillation.
Lane RD, Laukes C, Marcus FI, Chesney MA, Sechrest L, Gear K, Fort CL, Priori SG, Schwartz PJ, Steptoe A.

Department of Psychiatry, University of Arizona, Tucson, AZ 85724-5002, USA.


Emotional stress is well established as a trigger of sudden death in the context of coronary heart disease (CHD), but its role in patients experiencing cardiac arrest with apparently normal hearts is unknown. This study sought to determine the role of psychosocial stress as a precipitant of cardiac arrest in patients with apparently normal hearts, so-called idiopathic ventricular fibrillation (IVF).

Quality of Life and Psychological Functioning of ICD Patients
Sears Jr SF, Conti JB

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The use of the implantable cardioverter-defibrillator (ICD) for life threatening ventricular arrhythmias is standard therapy, in large part because clinical trials data have consistently demonstrated its superiority over medical treatment in preventing sudden cardiac death.

This success prompts closer examination and refinement of quality of life (QOL) outcomes in ICD patients. Although no universal definition of QOL exists, most researchers agree that “quality of life” is a generic term for a multi-dimensional health outcome in which biological, psychological, and social functioning are interdependent. To date, the clinical trials demonstrating the efficacy of the ICD have focused primarily on mortality differences between the ICD and medical treatment. While the majority of the QOL data from these trials is yet to be published, many small studies are available for review and support the concept that ICD implantation results in desirable QOL for most ICD recipients. In some patients, however, these benefits may be attenuated by symptoms of anxiety and depression when a shock is necessary to accomplish cardioversion or defibrillation. This paper reviews the published literature on QOL and psychological functioning of ICD patients and outlines the clinical and research implications of these findings

Effective Management of ICD Patient Psychosocial Issues and Patient Critical Events
Samuel F. Sears, Ph.D., Melissa Matchett, Psy.D., and Jamie B. Conti, M.D.

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The clinical management of implantable cardioverter-defibrillator (ICD) patients involves successful medical and psychosocial care to reduce mortality and morbidity. Desirable quality of life (QoL) and psychosocial outcomes for ICD patients are achievable for a majority of ICD patients. Patient critical events, such as ICD shocks or ICD recalls, may occur that can dramatically alter the course of patient adjustment if not properly managed. Continuing care strategies that attend to patient critical events as they emerge may improve the psychosocial adjustment and improve the return to optimal daily functioning for ICDpatients. This paper reviews QoL and psychosocial outcomes for ICDpatients, patient critical events, and clinical implications for patient care. Patient critical events discussed in this paper include perioperative education, ICD shock events, device recalls, and end of life. The clinical management strategies for each of these patient critical events are suggested including patient education, psychosocial information provision, activity prescriptions, recall planning, and shock planning.

Female-Specific Education, Management, and Lifestyle Enhancement for Implantable Cardioverter Defibrillator Patients: The FEMALE-ICD Study
Lauren D. Vasquez, PhD, Jamie B. Conti, MD, Samuel F. Spears, PhD

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Significant rates of psychological distress occur in implantable cardioverter defibrillator (ICD) patients. Research has demonstrated that women are particularly at risk for developing distress and warrant psychosocial attention. The major objectives were to implement and test the effectiveness of a female-specific psychosocial group intervention on disease-specific quality of life outcomes in outpatient female ICD recipients versus a wait-list control group.

Sexual Functioning in Female Implantable Cardioverter Defibrillator Recipients
Lauren D. Vazquez, Ph.D. Ochsner Medical Center, Department of Psychiatry, New Orleans, LA; Jamie B. Conti, M.D. University of Florida, Division of Cardiovascular Medicine, Gainesville, FL; Samuel F. Sears, Ph.D. East Carolina University, Departments of Psychology and Cardiovascular Sciences, Greenville, NC


  • Effective sexual functioning represents an often overlooked aspect of quality of life for women with ICDs. 
  • The purpose of this study was to examine the incidence of sexual complaints and dysfunction in a sample of women with ICDs. 


  • The Arizona Sexual Experiences Scale (ASEX), a measure of self-reported sexual dysfunction, was completed by 29 female ICD recipients. 
  • Items on the ASEX are used to quantify sex drive, arousal, vaginal lubrication, ability to reach orgasm, and satisfaction from orgasm. Scores range from 5-30 with higher scores indicating greater sexual dysfunction. 
  • A diagnosis of sexual dysfunction has been defined as a total ASEX score ≥ 19, any one item with a score ≥ 5, or any three items with a score ≥ 4. 


  • Of the total sample, nine women (31%) had a total baseline ASEX score ≥ 19 indicating a significant sexual dysfunction. Additionally, two women (7%) reported a specific symptom with high magnitude (score ≥ 5), also meeting criteria for a sexual dysfunction. No women had any three items with a score ≥ 4. In all, 11 out of 29 women (38%) met criteria for sexual dysfunction based on ASEX scoring criterion. 
  • The majority of the sample were Caucasian (93.1%), married (75.9%), had at least some college education (72.3%), and were retired (41.4%). 
  • Mean time since ICD implantation was 3.78 ± 3.07 years. Thirty-four percent had received prior shock therapies, 72.4% had congestive heart failure, 37.9% had coronary artery disease, and 10.3% had long QT syndrome. 


  • This study is the first to establish base rates of sexual dysfunction in a female ICD population. 
  • Results suggest that approximately 38% of females with ICDs report symptoms consistent with a diagnosis of sexual dysfunction. 
  • Multidisciplinary research and clinical care, involving effective treatment strategies focused on patient medical, psychological, and social needs may be warranted in this population. 

Drs. Vazquez, Conti, and Sears have received speaker honoraria from Medtronic and St. Jude Medical. Drs. Conti and Sears serve as consultants to Medtronic and have or have had research grants from Medtronic and St. Jude Medical and have received speaker honoraria from Boston Scientific. Dr. Sears has also received speaker honoraria from Biotronik.

Sexual Health for Patients With an Implantable Cardioverter Defibrillator
Lauren D. Vazquez, Samuel F. Sears, Julie B. Shea and Paul M. Vazquez 

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Studies examining the quality of life of implantable cardioverter defibrillator (ICD) patients have consistently demonstrated that ICD patient quality of life is at least equal to, if not better than, that of patients treated with medications alone.1 Quality of life may be related in part to the patient’s ability to resume “pre-ICD” activities; however, sexual activity is rarely included as part of the patient education process. Sexual functioning has not been well studied in ICD patients, but preliminary research has suggested that patients commonly express concerns about fear of ICD shock during sex, varying interest and pattern of sexual activity, and a desire for more information and sexual counseling.2 The purpose of this Cardiology Patient Page is to identify typical issues related to sexual functioning in ICD patients and offer possible strategies for effective management.

SCA Psychosocial Presentations & Survivor Study Presentations
SCAA: Survey of Survivors and Their Loved Ones (Microsoft PowerPoint Presentation

The 7th Link: Rehabilitation and Recovery (Microsoft PowerPoint Presentation)

Expanding the Chain: The 7th Link (Microsoft PowerPoint Presentation)

Living and Loving Life: After Cardiac Arrest (Microsoft PowerPoint Presentation)

Clinical Excellence in Cardiology
Roy C. Ziegelstein, MD

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On the basis of interviews with 24 academic physicians deemed “clinically excellent,” Christmas et al1 identified 7 domains of clinical excellence relevant to all disciplines in medicine: (1) communication and interpersonal skills, (2) professionalism and humanism, (3) diagnostic acumen, (4) skillful negotiation of the health care system, (5) knowledge, (6) taking a scholarly approach to clinical practice, and (7) having passion for clinical medicine. What follows is a discussion of clinical excellence in cardiology that identifies aspects within each of the 7 domains that are of particular relevance to this specialty.

Post−Cardiac Arrest Syndrome 

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