1. Presentation Title l August 16, 2015 l 1 Patient Perception: Quality of Life Before and After Pacemaker Implantation Dedra Teel Marymount Hospital

2. Presentation Title l August 16, 2015 l 2 The Heart – Organ composed of muscle to pump blood throughout the body – Composed of 4 chambers – Beats approximately 72 times per minute Cardiac Function Blood flow is controlled by the Sinus Node The sinus node sends electrical impulses to the Atrioventricular Node where the impulses are slowed down to allow the ventricle to fill completely before pumping out to the rest of the body

3. Pacemaker Comparison Size of shoe polish can Lasted 3 hours Plutonium battery Size of a ½ dollar coin Lasts 5 to 11 years Lithium-ion battery

4. Pacemaker: How it works 2 components – Pulse Generator – Positioned in a pocket under the clavicle – Leads – Electrical wires threaded through the subclavian vein that enters the right atrium and right ventricle The battery can detect irregular heart beats and sends appropriate electrical impulses Presentation Title l August 16, 2015 l 4

5. Pacemaker Purpose To maintain an adequate heart rate which relieves patients of dizziness, fatigue, weakness, and shortness of breath due to insufficient amount of oxygen in the blood To help the heart pump properly to maintain a healthy heart rate Presentation Title l August 16, 2015 l 5

6. Hypothesis 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 after pacemaker implantation. Also, females will be better able to express the improvement that they noticed Physical abilities were also being observed in both genders, however the greatest improvement in physical limitations will be seen in females Presentation Title l August 16, 2015 l 6

7. Methodology 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 Presentation Title l August 16, 2015 l 7

8. Data Presentation Title l August 16, 2015 l 8 Average Age: 85 Highest: 94 Lowest: 72 Ages of Participants Number of Responses

9. Indications for Pacemakers Atrial fibrillation – irregular electrical impulses from the atria that causes the heart to quiver Bradycardia – when an individual has a resting heart rate of below 60 beats per minute. It can cause shortness of breath, dizziness, and fainting Tachycardia – when the heart rate exceeds 100 beats per minute. A high heart beat is more demanding of the heart itself to get oxygen throughout the body Tachybrady syndrome – describes a patient with intermittent fast and slow heart rates Heartblock – condition that affects transmission of impulses through the heart. It can result in ` abnormally low heart rate Presentation Title l August 16, 2015 l 9

10. Patient Indications Presentation Title l August 16, 2015 l 10 IndicationResponses Atrial Fibrillation1 Bradycardia10 Heartblock5

11. Description of Health Before Presentation Title l August 16, 2015 l 11

12. Description of Health After Presentation Title l August 16, 2015 l 12

13. Results 35% of patients felt an improvement in their overall health 41% remained the same 24% had a decline in their description of health 81% of males felt improvement or remained the same 67% of females felt improvement or remained the same

14. Physical Limitations Before Presentation Title l August 16, 2015 l 14 Physical Activity Not at allA littleA lot Vigorous Activities 647 Moderate Activities 962 Climbing Stairs 1214 Bending or Kneeling 872

15. Physical Limitations After Physical Activity Not at allA littleA lot Vigorous Activities 539 Moderate Activities 872 Climbing Stairs 863 Bending or Kneeling 1052

16. Results 18% of patients had decreased physical limitations 47% stayed the same before and after 35% felt an increase in physical limitations 72% of males had a decrease in physical limitations or remained the same 50% of females had a decrease in physical limitations or remained the same

17. Quality of Life Before Presentation Title l August 16, 2015 l 17 Number of Patients Number of Responses

18. Quality of Life After Presentation Title l August 16, 2015 l 18 Number of Responses Number of Patients

19. Results 35% of patients had an improvement in their quality of life 47% remained the same 18% felt a decline in their quality of life 82% of males had an improvement quality of life or remained the same 83% of females had an improvement quality of life or remained the same

20. Conclusions Description of Health –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. –76% had an increased or maintained the same description of health.

21. Conclusions Physical limitations -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 Presentation Title l August 16, 2015 l 21

22. Conclusions Quality of Life – Over 82% of both males and females felt a improvement or stayed the same for their quality of life – Consistent with hypothesis by a 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 Presentation Title l August 16, 2015 l 22

23. Recommendations Presentation Title l August 16, 2015 l 23 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.

24. Acknowledgments Mentors: Cathy Cerny CNP Donna Waite MD Office of Civic Education: Rosalind Strickland Nedra Starling, MPH, ABD Presentation Title l August 16, 2015 l 24