Table 4.

Content themes of implantable cardioverter defibrillator patient education material

Theme	Content	Publication sources
Purpose and function of the ICD	Risk for sudden cardiac death: arrhythmias such as ventricular tachycardia, ventricular fibrillation, and bradycardia (2) Purpose of the ICD: variously described as “a device that monitors and treats abnormal heart rhythms” Function of the ICD: explication of the device’s monitoring and data storage capabilities, how it detects and treats arrhythmias, and general parts descriptions	ICD manufacturers, hospitals, cardiac health support groups
Anatomy, physiology and pathophysiology	Anatomy and physiology of electrical and mechanical systems of the heart, basic heart anatomy, ejection fraction, normal and abnormal heart rhythms Pathophysiology of sudden cardiac arrest, heart attack, heart failure, and arrhythmias such as ventricular tachycardia, ventricular fibrillation, and bradycardia	ICD manufacturers and hospitals
Diagnostic tests	Echocardiograms One hospital provided information on other possible tests including multi-gated angiography (MUGA), electrophysiology study (EPS), their graded exercise test, and electrocardiograms	ICD manufacturers and hospitals
Pre-operative instruction	Fasting before the procedure, taking medications prior to the procedure, and having someone drive the patient to and from the hospital for the procedure	Hospitals
Implantation process	Decisions around implant site, description of incision(s), explanation of lead placement, testing to ensure correct function, and description of sedation and day surgery	Two hospitals
Post-operative care	Care instructions and suggestions for up to six weeks post-implantation Incision care, signs of infection, exercise, refraining from heavy lifting and physical activity, pain management, medications, and other short-term medical care issues	Hospitals
The ICD shock	Shock event and post-shock instructions, the sensation of the shock, possible transfer of shock to others, post-shock follow-up care, abnormal heart rhythm symptom, indications to seek medical attention, importance of support from family and friends, and refrain from leaning on counters or hard surfaces The shock was described as a, “kick in the chest” (22) by many sources. It was indicated to “stop what you are doing” (22) when receiving a shock by many sources.	ICD manufacturers and hospitals
Maintenance of the ICD	Importance of follow-up visits and content of these visits Device checked for proper function bring; data retrieved and reviewed; ICD settings can be adjusted during appointments; ICD replacement procedure; having a medic alert bracelet and keeping files up to date; battery life; carrying ICD identification at all times; keep diary of medications and shocks; bring all medications to appointments; check-up for incision site	ICD manufacturers and hospitals
Lifestyle	Short-term and long-term lifestyle changes including preparing for and preventing a possible shock Activities of daily living such as, travelling, intimacy/sex, driving, leisure activities (i.e. bowling, golf, etc.), and returning to work Restrictions around being near electrical & magnetic fields (i.e. medical diagnostics, household appliances), diet, and medications Support groups were suggested in manufacturer generated documents. Appearance of the incision and what to wear was also discussed	ICD manufacturers and hospitals
Complications	Risk of infection Implant procedure risks Inappropriate or missed therapy Psychological obstacles	ICD manufacturer and hospital
End-of-life Issues	Only one document provided a statement that the device can be buried with the deceased individual or removed if they are to be cremated.	Hospital
Additional Resources	Sources for additional information on the device, procedure, and patient care.	ICD manufacturer, hospital and cardiac health support organizations