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Heart failure (HF) is an alarm leading public health concern approximately 23 million people worldwide.  Moreover, the threat of developing HF is one in five. Patients with HF are at high risk of sudden death. 1.By 2030 projections indicate that the prevalence of HF will increase by 25% from 2013 estimates in the US 2. As well, The estimated costs of direct and indirect medical for cardiovascular disease CVD will be increased by 61%, Moreover, the real medical costs of CHD and Heart Failure are anticipated to increase by ? 200% over the next 20 years 2-13. As reported by the Media and Health awareness Information Centre at the Ministry of Health (MOH), almost 23 million people will die from CVDs mostly from heart disease and stroke by 2030 2.

According to the WHO and the Ministry of Health (MOH) Statistical Yearbook, CVDs are the reason of 42 % of the Kingdom’s non-communicable disease deaths in 20133-20. HF has been presented to be associated with increased mortality in the Middle East 4.  About one-third of mortality in HF is due to sudden cardiac death. HF is a serious illness, where the heart muscle is powerless to pump enough blood through to meet the body’s need for blood and oxygen, 5. Heart failure may be due to failure of  ventricles both the right or left. Common signs and symptoms related with heart failure such as shortness of breath, fatigue, cough, and swelling and sometimes more severe. Several comorbidities play an important role, particularly hypertension and diabetes mellitus 6.

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Management of heart failure includes either medical or surgical or device driven interventions. medical treatment, surgical include while clinicians might use devices like implantable Cardioverter Defibrillators (ICD) or cardiac resynchronization therapy  (CRTD) have been found to be a key help in treating congestive heart failure7. Patients suffering from repeated arrhythmias can be managed by medical devices such as a pacemaker, implantable cardioverter defibrillator (ICD) and (CRT-P) can help by continuously checking the heart’s electrical system and providing programmed correction when an arrhythmia starts to occur. 5. Furthermore, most arrhythmias are harmless, but some can be serious or even life-threatening.

ICD is a medical device useful for people with recurrent arrhythmias, function by continuously monitoring the hearts electrical system and provide automatic correction 5. An ICD is a battery-powered device positioned under the skin that keeps track of your heart rate. Two thin wires connect the ICD to one or more of the chambers in your heart. The heart sends electric signals to the ICD. The ICD can deliver an electric pulse or shock to help restore a normal heartbeat to your heart if it is beating unsystematically and much too fast. Cardiac defibrillation is a way to return an abnormally fast or unsystematic heartbeat to regular with an electric shock. AHA 5. Newer-generation ICDs may have a dual function which consist of the ability to function as a pacemaker. The pacemaker feature would stimulate the heart to beat if the heart rate is recognized to be too slow 5.  Research has shown that ICDs can improve quality of life and extend life. You may live more confidently with an ICD by understanding more about the conditions that succeeded to implantation. (ICDs) reduce sudden cardiac death more recently randomized trials have shown that ICDs reduce all-cause mortality rates. 8

CRTD is a life-saving device for individuals which life-threatening ventricular arrhythmias by delivers synchronized stimulation shock to tree chambers of the heart, enabling the heart to pump blood more efficiently and increase blood flow 7.  Furthermore, Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF). The procedure start by inserting a half-dollar sized pacemaker, usually just below the collarbone. Three wires (leads) connected to the device monitor the heart rate to detect heart rate irregularities and release tiny pulses of electricity to correct them. In effect, it is “resynchronizing” the heart 9.

Since CRT improves the heart’s efficiency and increases blood flow, patients have reported alleviations of some heart failure symptoms – such as shortness of breath 9.

Several recent studies have provided evidence that CRTD has contributed in decreasing hospitalization and mortality and improve quality of life. Despite some randomized studies reported that worsening of QOL in sensation with multiple shocks 8-10.  In addition, normal activities are affected and become more difficult to accomplish. Cardiologist used classification system for heart failure patients (the New York Heart Association (NYHA) based on the physical activity limitation 5-11.

Patients with ischemic or non-ischemic cardiomyopathy, NYHA class II to III HF, and LVEF ? 35% have a significant survival benefit from an implantable cardioverter-defibrillator (ICD) for the primary prevention of SCD 11-18. Assessment of functional capacity is important to investigate the impact of the disease on a patient’s life, to determine the degree of constraint imposed by CVD, as well as by being a factor in diagnosis, prognosis and a strong predictor of mortality 12.

Questionnaires are an inexpensive, simple and safe tool to assess the functional or clinical status that might be used before the exercise test to determine a patient’s ability to perform appropriate effort. The Duke Activity Status Index (DASI) is a questionnaire, originally established in English to evaluate the functional capacity. DASI has been used mostly to assess patients with cardiovascular illnesses, such as coronary artery disease, heart failure, myocardial ischemia and infarction.  In clinical practice, DASI can be used to measure the effects of medical treatments and cardiac rehabilitation and to support clinical decisions. In controlled clinical trials, DASI can serve to evaluate interventions and as a component of the assessment of the treatment cost/benefit 8-13.

Quality of life is a most important factor in clinician decision and can be classified into physical and mental health assessment 14-15-16. Exposure to multiple shocks, benign at risk of cardiac arrest also, Getting an ICD may cause new emotions or depression 10.  Patients may experience feeling like anxiety or depression especially in the first months or year after implantation, expressing your concerns about the ICD/CRTD and your reactions to it, you might avoid or alleviate potential anxiety or depression 15. Your mental and emotional well-being are essential to your physical well-being 15-21.

Several previous types of research have investigated the impact of CRTD on patient quality of life. However, results of this research are not conclusive with some studies showing improvement and others not finding so 7. In addition, no researchers have been conducted about that topic in Middle East countries including Saudi Arabic. Such research is needed to inform clinicians about the level of life quality expected for those who will use this device and will help doctors and patients to make an informed decision accordingly.  Living with an implanted cardioverter-defibrillator increases survival, but the effects of the device on health status, quality of life, and psychological state over time are not addressed yet in the Saudi population.

 

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