1. Cleveland Clinic Science Internship Program for Nursing Patient Perception: Quality of Life Before and After Pacemaker Implantation Dedra Teel, Cathy Cerny CNP, Donna Waite M.D. Cleveland Clinic - Marymount Hospital Background Hypothesis Today, more than 3 million people have pacemakers to help to better maintain their health and quality of life. The journey of pacemakers has been long but rewarding. It has been 53 years since the first implantation. During this time they have become smaller in size but their capabilities have increased tremendously. These life changing devices are made up of 2 components, the battery and leads. The pacemaker is positioned in a pocket right beneath the clavicle. The leads are then threaded through the subclavian vein that enters the heart. One lead is placed in the right atrium and the other in the right ventricle. Here, the leads are able to conduct electrical impulses appropriate to the heartbeats. The battery can detect when the heart is beating at a lower than satisfactory rate and will send an impulse to pace the heart at regular intervals until it reaches a normal rate. Not all patients require two leads; in some cases one is sufficient. The average lifespan of the battery is 5 to 11 years. Abnormal beatings of the heart, known as arrhythmias, are the most common reason for pacemaker implantation. Arrhythmias occur when the natural pacemaker, the sinoatrial node, is the not able to efficiently send electrical impulses to the ventricles. In most cases, a pacemaker is implanted into a patient with bradycardia, or a slow heartbeat. A wide range of people are affected but the average age is in the 80s. The main objective of a pacemaker is to help the heart pump properly in order to get adequate oxygen throughout the body. If a patient has bradycardia, the brain and other parts of the body do not receive the necessary amount of oxygen and daily activities become increasingly difficult as well as the patient feeling subsequent symptoms such as dizziness, fainting, and fatigue. Methodology Results Description of Health BeforeAfter 35% of patients felt an improvement in their health 41% remained the same, 24% had a declined description of health. Physical Limitations Before Conclusions Quality of Life BeforeAfter Recommendations It is recommended that this study be repeated with a larger sample population. The investigation should place a greater emphasis on cardiac conditions to limit outside influences in responses. Data This study consisted of 17 patients interviewed before and after pacemaker implantation. Interviews were conducted primarily in person at Marymount, however follow up phone calls were also administered. Participating patients were asked 13 questions regarding their physical and mental health. The questions were based on the Qualitymetric sf12v2 Health Survey. The purpose of this study is to evaluate patient’s perceptions of their quality of life before and after pacemaker implantation. It is hypothesized that there will be an overall improvement in quality of life. It is also hypothesized that females will be better able to express the improvements that they noticed. Physical abilities were also observed in both genders, however the greatest improvements in physical limitations will be seen in males. Average Age: 85 Highest: 94 Lowest: 72 Indication for Pacemaker Number of Patients Atrial Fibrilation1 Bradycardia10 Heartblock5 Physical Activity Not at allA littleA lot Vigorous647 Moderate962 Climbing Stairs 1214 Bending Kneeling 872 Physical Activity Not at allA littleA lot Vigorous539 Moderate872 Climbing Stairs 863 Bending Kneeling 1052 18% of patients felt they had less physical limitations 47% stayed the same before and after 35% felt they had more physical limitations After 35% of patients had an improvement in their quality of life 47% remained the same 18% felt a declinein their quality of life Results Patients descriptions of health went from a standard bell curve in the Before graph to a more centralized After graph with “Very Good” as the most common response. This is an overall improvement from the Before graph that had an emphasis on the “Good” description. Only 18% felt physical activities became easier however, 47% remained the same. A difficulty of this study was patients accounting other illnesses or conditions as a part of their physical limitations. In many cases, patients are admitted with another diagnosis and then receive a pacemaker during their stay. The majority of patients felt an improvement or remained the same for their quality of life. The results were consistent with the hypothesis that women would respond better, but by a very small margin. Only a fifth of the study population felt their quality of life declined. Conditions beside heart problems may have influenced patient’s responses