• Ешқандай Нәтиже Табылған Жоқ

ДЕФИБРИЛЯТОРЛАР ТУРАЛЫ ПАЦИЕНТТЕРДІ ХАБАРЛАУ

Темирхан Бегисбаев1, https://orcid.org/0000-0001-7536-3947

Маржан Бримжанова1, https://orcid.org/0000-0003-3517-4687 Назгуль Ахтаева2, https://orcid.org/0000-0002-0835-9814 Ляззат Кошербаева2, https://orcid.org/0000-0001-8376-4345 Шаттык Е. Толеугали2, https://orcid.org/0000-0001-6496-6849

1 «Қоғамдық денсаулық сақтау жоғары мектебі» Қазақстандық медицина университеті, Алматы қ., Қазақстан Республикасы;

2 С.Д. Асфендияров атындағы Қазақ Ұлттық медицина университеті, Алматы қ., Қазақстан Республикасы.

Кіріспе. Имплантацияланатын кардиовертер дефибрилляторы (ИКД) көптеген елдерде аритмиядан кенеттен қайтыс болу қаупі жоғары науқастарды емдеу үшін енгізілді және тиімді екенін дәлелдеді. Медициналық көмектің жоғары сапасын қамтамасыз ету үшін жүйе пациентке бағытталуы керек екендігі анықталды. Сондықтан ИКД науқастарының кардиовертер-дефибрилляторлы имплантация туралы ақпаратпен қанағаттануы маңызды мәселе болып табылады.

Зерттеудің мақсаты-кардиовертер-дефибрилляторды имплантациялау технологиясы туралы ақпаратпен ИКД бар пациенттердің қанағаттанушылығын зерттеу.

Материалдар мен әдістері: онлайн-сауалнама телефон арқылы жүргізілді. Сауалнамаға қатысуға ауызша келісім алынды. Сауалнама пациенттің қалауына қарай орыс немесе қазақ тілдерінде жүргізіледі. Сауалнама 2020 жылы Алматы қаласы мен Қызылорда облысында 2017-2020 жылдар аралығында ИКД алған пациенттер арасында жүргізілді. Статистикалық өңдеу SPSS 13 бағдарламалық жасақтамасының көмегімен жүргізілді. "ҚДСЖМ"

Қазақстандық медицина университетінің этика жөніндегі жергілікті комитеті (Алматы, Қазақстан) зерттеуді мақұлдады.

Нәтижелері: Алматы қаласы респонденттерінің көпшілігі Қызылорда облысымен салыстырғанда ИКД-ның әсері (Р <0,009), ИКД-ның автомобиль жүргізуге, саяхатқа, спортпен шұғылдануға немесе басқа да қызмет түрлеріне әсері туралы ақпарат беру деңгейін қанағаттанарлықсыз бағалайды, шок деген нені білдіреді және ол қашан орын алады және күнделікті өмір қалай өзгереді (Р <0,046). Тек Алматы қаласының респонденттері имплантациядан кейін жараны қалай күту және үйге қайтып келгенде ауырсынуды, симптомдарды және дәрі- дәрмектерді қалай жеңу туралы ақпаратты бейтарап немесе қанағаттанарлықсыз деп бағалады (Р <0,004).

Қорытынды: Алматы қаласында ИКД технологиясының әсері туралы ақпарат беруді жақсарту қажет, ол Қызылорда облысымен салыстырғанда жоғары.

Түйінді сөздер: ИКД, пациенттердің қанағаттануы, ИКД туралы хабарлау, ИКД тиімділігі.

Bibliographic citation:

Begisbayev T.S., Brimzhanova M.D., Akhtaeva N.S., Kosherbayeva L.K., Toleugali Sh.E.Informing the patient about of implantable cardioverter defibrillators in Kazakhstan // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 1, pp.

64-70. doi 10.34689/SH.2022.21.1.008

Бегисбаев Т.С., Бримжанова М.Д., Ахтаева Н.С. Кошербаева Л.К., Толеугали Ш.Е. Информирование пациентов об имплантируемых кардиовертерах-дефибрилляторах в Казахстане // Наука и Здравоохранение. 2022. 1(Т.24). С.

64-70. doi 10.34689/SH.2022.24.1.008

Бегисбаев Т.С., Бримжанова М.Д., Ахтаева Н.С. Кошербаева Л.К., Толеугали Ш.Е. Қазақстанда имплантты кардиовертер-дефибриляторлар туралы пациенттерді хабарлау // Ғылым және Денсаулық сақтау. 2022. 1 (Т.24). Б.

64-70. doi 10.34689/SH.2022.24.1.008

Introduction

Over the past decade, cardiovascular disease (CVD) has been one of the leading causes of death worldwide; in 2016, CVD mortality accounted for 31% of all deaths in the world, of which 85% of deaths are caused by heart attack and stroke [9,24]. In Unites states of America a third of deaths from cardiovascular diseases occur before the age of 75, in Europe before 70 years, more than 2,200 Americans die from CVD every day, in Europe every year 60 million potential life years are lost due to cardiovascular diseases [20, 27]]. In Сentral Аsia, the burden of coronary artery disease showed significantly higher age-standardized rates than global levels [14]. Although the age-standardized rates of cardiovascular disease (CVD) are significantly higher in men, the disease has the most serious impact in women worldwide, as it is the leading cause of death in women and one of the most common causes of lost disability-adjusted life years [29].

Implantable cardioverter defibrillators (ICDs) reduce mortality in patients implanted for primary and secondary prevention of sudden cardiac death [13]. The development of the ICD began in the late 1960s, while the ICD was first installed in 1980 [19,11]. Since this period, a number of studies have been carried out confirming the effectiveness and efficiency of this technology [23, 16, 28, 25]. ICD plays an important role in the treatment of ventricular tachyarrhythmias and prevention of sudden cardiac death [6, 3], and among patients with noninfectious cardiomyopathy and ejection fraction ≤35% significantly improved survival [2].

ICD is cost-effective in UK at a threshold of £30 000 per quality adjusted life year (QALY) [18], the additional cost of QALY saved 46,729,026 Colombian pesos in Colombia, 246,016 Mexican pesos in Mexico and US $ 1,213,614 in Uruguay in Uruguay [7].

According to the European Heart Rhythm Association, 105,730 ICD surgeries were performed in 2555 centers in 2016. At the same time, the average number of centers increased from 2.38 in 2015 to 2.65 per million population in 2016, with an approximately equal average number of ICDs per million inhabitants: 101 in 2016 and 102 in 2015 [22]. In Kazakhstan the contingent of patients to whom cardioverter-defibrillators are implanted, men predominate (83.9%), women account for 16.1%, as a rule, patients were admitted to the hospital for emergency medical care (60.2%), days of hospitalization consist averaged 10.8 ± 2.93 [1, 15].

Patient-centered care in health care is defined as providing care that is consistent with the values, needs and desires of patients and is achieved when clinicians engage patients in discussions and decisions about health issues [5,17]. An increase in ICD surgical interventions is observed annually, and one of the tasks is to provide patients and family members with the information necessary to participate in future decisions about the end of the life of their device and other aspects [4,12].

The aim is to study the satisfaction of ICD patients with information about technology cardioverter-defibrillator implantation.

Materials and methods. In order to implement the set tasks, we have developed a questionnaire for patients with

the aim of studying the issues of informing patients about ICD. The questionnaire is adapted from the study by Pedersen S. co-authors [21]. Due to the epidemiological situation associated with COVID-19, the survey was conducted by phone. The patient's oral consent to participate in the survey was previously obtained. With the patient's consent, the survey was recorded, but not all patients agreed to the recording. The survey was conducted in the language preferred by the patient himself, Russian or Kazakh. The survey was conducted in the period 2020, among patients who received an ICD in the period from 2017 to 2020 in Almaty city and Kyzylorda region. Initially, it was planned to conduct a face-to-face survey, however, due to the epidemiological situation related to COVID, the results of an online survey were provided. It was also impossible to complete the survey of four respondents due to poor telephone connection.

Statistical processing was carried out using the SPSS 13 software (IBM, USA). The variables are presented as the median Me [Q1, Q3]. The analysis of frequency characteristics of qualitative indicators was carried out using nonparametric methods using the Pearson criterion (χ2).

Differences in the data were considered statistically significant at p <0.05.

The Local Ethics Committee of Kazakhstan’s Medical University «Higher School of Public Health» (Almaty, Kazakhstan) approved the study.

Results

The Almaty city 20.6% and Kyzylorda region 6.7%

respondents indicated neutral or unsatisfactory level of providing information on the effect of ICD (P <0.009).

More than a third of the respondents assessed neutral or unsatisfactory level of the received information about the impact of ICD on driving a car, traveling, playing sports or other activities: in Almaty city 33.4% (not satisfied (14.6%) or little dissatisfied (4.2%) neutral (14.6%)) and that of the Kyzylorda region 20.0% (not satisfied (6.7%) or little dissatisfied (13.3%)) (P <0.021). Only 39.7% of respondents are satisfied with the knowledge they received about what shock means and when they occur, where the participants in Almaty rated 12.5% as neutral and 62.5%

(not satisfied (45.8%) or little dissatisfied (16.7%)) as unsatisfactory, while the respondents from Kyzylorda oblast totaled 13, 4% (not satisfied (6.7%) or little dissatisfied (6.7%)) (P <0.001) and how daily life might change (not satisfied (6.7%) or little dissatisfied (13.3%) neutral (6.7%)) (P <0.046). A negative trend is that only 10.4% of the respondents in Almaty and 46.6% of the Kyzylorda region (P <0.001) assessed satisfactorily the information about what a family member or patient should expect in case of shock, as well as with whom it will be possible to contact when the state of shock occurs in the Kyzylorda region was 86.7% and in Almaty 33.4% (P <0.004).

Only respondents from Almaty indicated neutral or unsatisfactory 27.1% (not satisfied (10.4%) or little dissatisfied (4.2%) neutral (12.5%)) (P <0.004) on informing how to care for a wound after implantation and to manage pain, symptoms and medication when returning home 27.1% (not satisfied (8.3%) or little dissatisfied (4.2%) neutral (14.6%) (P <0.002) (see table 1).

Table 1.

Informing Patients About Cardioverter Defibrillator Implantation.

Kyzylord

a region Almaty

city Total Р < Male Female Total Р <

N (%) N (%) N (%) N (%) N (%) N (%)

Reasons for getting an ICD

neutral 1 (2,1) 1 (1,6) 0,156 1 (2,1) 1 (1,6) 0,670

satisfied enough 9 (18,8) 9 (14,3) 6 (12,5) 3 (20,0) 9 (14,3) very satisfied 15 (100,0) 38 (79,2) 53 (84,1) 41 (85,4) 12 (80,0) 53 (84,1) Total 15 (100,0) 48 (100,0) 63 (100,0) 48 (100,0) 15 (100,0) 63 (100,0)

How ICD works

Not/little satisfied 2 (4,2) 2 (3,2) 0,275 2 (13.4) 2 (3.2) 0,073

neutral 3 (6,3) 3 (4,8) 3 (6,3) 3 (4,8)

satisfied enough 8 (16,7) 8 (12,7) 5 (10,4) 3 (20,0) 8 (12,7) very satisfied 15 (100,0) 35 (72,9) 50 (79,4) 40 (83,3) 10 (66,7) 50 (79,4) What are the

benefits of ICD

Not/little satisfied 4 (8,4) 4 (6,4) 0,188 4 (26,7) 4 (6,4) 0,003

neutral 3 (6,3) 3 (4,8) 3 (6,3) 3 (4,8)

satisfied enough 8 (16,7) 8 (12,7) 5 (10,4) 3 (20,0) 8 (12,7) very satisfied 15 (100,0) 33 (68,8) 48 (76,2) 40 (83,3) 8 (53,3) 48 (76,2) Disadvantages of

ICD

Not/little satisfied 5 (10,4) 5 (7,9) 0,188 1 (2,1) 4 (26,7) 5 (7,9) 0,019

neutral 2 (4,2) 2 (3,2) 2 (4,2) 2 (3,2)

satisfied enough 8 (16,7) 8 (12,7) 5 (10,4) 3 (20,0) 8 (12,7) very satisfied 15 (100,0) 33 (68,8) 48 (76,2) 40 (83,3) 8 (53,3) 48 (76,2) What to do if an ICD

shock occurs

Not/little satisfied 10 (66,7) 29 (60,4) 39 (61,9) 0,127 31 (64,6) 8 (53,3) 39 (61,9) 0,239 neutral 4 (26,7) 6 (12,5) 10 (15,9) 6 (12,5) 4 (26,7) 10 (15,9) satisfied enough 1 (6,7) 6 (12,5) 7 (11,1) 4 (8,3) 3 (20,0) 7 (11,1) very satisfied 7 (14,6) 7 (11,1) 7 (14,6) 7 (11,1) How to move your

arm, where is the implant

Not/little satisfied 5 (10,5) 5 (8,0)

0,092

2 (4,2) 3 (20,0) 5 (8,0) 0,278

neutral 2 (4,2) 2 (3,2) 1 (2,1) 1 (6,7) 2 (3,2)

satisfied enough 2 (13,3) 19 (39,6) 21 (33,3) 17 (35,4) 4 (26,7) 21 (33,3) very satisfied 13 (86,7) 22 (45,8) 35 (55,6) 28 (58,3) 7 (46,7) 35 (55,6) What is the overall

prognosis and how can my condition progress with ICD

Not/little satisfied 2 (13,3) 6 (12,5) 8 (12,7)

0,699

5 (10,4) 4 (20,0) 8 (12,7) 0,293 neutral 4 (26,7) 7 (14,6) 11 (17,5) 10 (20,8) 1 (6,7) 11 (17,5) satisfied enough 5 (33,3) 18 (37,5) 23 (36,5) 15 (31,3) 8 (53,3) 23 (36,5) very satisfied 4 (26,7) 17 (35,4) 21 (33,3) 18 (37,5) 3 (20,0) 21 (33,3) Can ICD Protect

Against Heart Attack?

Not satisfied 4 (26,7) 7 (14,6) 11 (17,5) 0,212

9 (18,8) 2 (13,3) 11 (17,5) 0,894 a little dissatisfied 5 (10,4) 5 (7,9) 4 (8,3) 1 (6,7) 5 (7,9)

neutral 6 (40,0) 10 (20,8) 16 (25,4) 13 (27,1) 3 (20,0) 16 (25,4) satisfied enough 4 (26,7) 15 (31,3) 19 (30,2) 13 (27,1) 6 (40,0) 19 (30,2) very satisfied 1 (6,7) 11 (22,9) 12 (19,0) 9 (18,8) 3 (20,0) 12 (19,0) Impact of the ICD

on the initial condition of the patient

Not satisfied 6 (12,5) 6 (9,5)

0,009

4 (8,3) 2 (13,3) 6 (9,5) 0,950 a little dissatisfied 1 (6,7) 2 (4,2) 3 ( 4,8) 2 (4,2) 1 (6,7) 3 (4,8)

neutral 4 (8,3) 4 (6,3) 3 (6,3) 1 (6,7) 4 (6,3)

satisfied enough 1 (6,7) 19 (39,6) 20 (31,7) 15 (31,3) 5 (33,3) 20 (31,7) very satisfied 13 (86,7) 17 (35,4) 30 (47,6) 24 (50,0) 6 (40,0) 30 (47,6)

How daily life can change

Not satisfied 1 (6,7) 8 (16,7) 9 (14,3)

0,046

7 (14,6) 2 (13,3) 9 (14,3) 0,565 a little dissatisfied 2 (13,3) 2 (4,2) 4 (6,3) 3 (6,3) 1 (6,7) 4 (6,3)

neutral 1 (6,7) 5 (10,4) 6 (9,5) 3 (6,3) 3 (20,0) 6 (9,5) satisfied enough 1 (6,7) 18 (37,5) 19 (30,2) 16 (33,3) 3 (20,0) 19 (30,2) very satisfied 10 (66,7) 15 (31,3) 25 (39,7) 19 (39,6) 6 (40,0) 25 (39,7) Impact of ICD on

driving a car or other activities that you enjoy

Not satisfied 1 (6,7) 7 (14,6) 8 (12,7)

0,021

6 (12,5) 2 (13,3) 8 (12,7) 0,743 a little dissatisfied 2 (13,3) 2 (4,2) 4 (6,3) 3 (6,3) 1 (6,7) 4 (6,3)

neutral 7 (14,6) 7 (11,1) 5 (10,4) 2 (13,3) 7 (11,1) satisfied enough 1 (6,7) 16 (33,3) 17 (27,0) 15 (31,3) 2 (13,3) 17 (27,0) very satisfied 11 (73,3) 16 (33,3) 27 (42,9) 19 (39,6) 8 (53,3) 27 (42,9)

Effect of age on ICD performance

Not satisfied 5 (33,3) 15 (31,3) 20 (31,7) 0,219

14 (29,2) 6 (40,0) 20 (31,7) 0,921 a little dissatisfied 1 (6,7) 4 (8,3) 5 (7,9) 4 (8,3) 1 (6,7) 5 (7,9)

neutral 4 (26,7) 7 (14,6) 11 (17,5) 9 (18,8) 2 (13,3) 11 (17,5) satisfied enough 3 (20,0) 21 (43,8) 24 (38,1) 19 (39,6) 5 (33,3) 24 (38,1) very satisfied 2 (13,3) 1 (2,1) 3 (4,8) 2 (4,2) 1 (6,7) 3 (4,8)

Table 1 continue.

What you need to know about ICD for end-stage heart failure or death

Not satisfied 7 (46,7) 11 (22,9) 18 (28,6) 0,105

14 (29,2) 4 (26,7) 18 (28,6) 0,837 a little dissatisfied 2 (4,2) 2 (3,2) 1 (2,1) 1 (6,7) 2 (3,2)

neutral 5 (33,3) 8 (16,7) 13 (20,6) 11 (22,9) 2 (13,3) 13 (20,6) satisfied enough 2 (13,3) 21 (43,8) 23 (36,5) 17 (35,4) 6 (40,0) 23 (36,5) very satisfied 1 (6,7) 6 (12,5) 7 (11,1) 5 (10,4) 2 (13,3) 7 (11,1) How to care for a

wound after implantation

Not satisfied 5 (10,4) 5 (7,9)

0,004

4 (8,3) 2 (13,3) 6 (9,5) 0,714 a little dissatisfied 2 (4,2) 2 (3,2) 2 (4,2) 2 (13,3) 4 (6,3)

neutral 6 (12,5) 6 (9,5) 8 (16,7) 2 (13,3) 10 (15,9) satisfied enough 4 (26,7) 25 (52,1) 29 (46,0) 20 (41,7) 5 (33,3) 25 (39,7) very satisfied 11 (73,3) 10 (20,8) 21 (33,3) 14 (29,2) 4 (26,7) 18 (28,6) How to manage pain,

symptoms, and medication when you get home

Not/little satisfied 6 (12,5) 6 (9,5)

0,002

5 (10,4) 2 (13,4) 7 (11,1) 0,847 neutral 7 (14,6) 7 (11,1) 5 (10,4) 1 (6,7) 6 (9,5)

satisfied enough 3 (20,0) 24 (50,0) 27 (42,9) 23 (47,9) 6 (40,0) 29 (46,0) very satisfied 12 (80,0) 11 (22,9) 23 (36,5) 15 (31,3) 6 (40,0) 21 (33,3) What does shock

mean when they happen

Not/little satisfied 2 (13.4) 30 (62,5) 32 (50,8) 0,001

23 (47,9) 9 (60,0) 32 (50,8) 0,914 neutral 6 (12,5) 6 (9,5) 5 (10,4) 1 (6,7) 6 (9,5)

satisfied enough 9 (60,0) 5 (10,4) 14 (22,2) 11 (22,9) 3 (20,0) 14 (22,2) very satisfied 4 (26,7) 7 (14,6) 11 (17,5) 9 (18,8) 2 (13,3) 11 (17,5) What to expect for

your family member or you if shock occurs

Not/little satisfied 4 (26,6) 38 (79,9) 42 (66,7) 0,001

32 (66,7) 10 (66,6) 42 (66,7) 0,902 neutral 4 (26,7) 5 (10,4) 9 (14,3) 6 (12,5) 3 (20,0) 9 (14,3) satisfied enough 2 (13,3) 4 (8,3) 6 (9,5) 5 (10,4) 1 (6,7) 6 (9,5) very satisfied 5 (33,3) 1 (2,1) 6 (9,5) 5 (10,4) 1 (6,7) 6 (9,5) Who can be

contacted when a state of shock occurs

Not/little satisfied 2 (13.4) 29 (60.4) 31 (49.2) 0,004

24 (50.0) 7 (46.6) 31 (49.2) 0,729

neutral 3 (6,3) 3 (4,8) 2 (4,2) 1 (6,7) 3 (4,8)

satisfied enough 3 (20,0) 7 (14,6) 10 (15,9) 9 (18,8) 1 (6,7) 10 (15,9) very satisfied 10 (66,7) 9 (18,8) 19 (30,2) 13 (27,1) 6 (40,0) 19 (30,2) The largest number of female respondents rated the

information received about the causes of ICD as satisfactory; among the answers, the female gender prevails at 100.0% compared to 97.9% for the male.

Information about how the ICD works is little or completely dissatisfied with 13.4% of female respondent’s P <0.073.

The information received about the benefits of ICD was noted neutrally by 6.3% of males, and little or completely dissatisfied by 26.7% of females (P <0.003).

Informing the participants about the deficiencies of the ICD, 6.3% of male and 26.7% of female, P <0.019, indicated neutral or worse, not sufficiently satisfactory. From the presented answer to the question of what to do if a shock from ICD occurs, it was revealed that the largest number were not satisfied with the information received, 60.3% (of which 53.3% were female and 64.6 male). 6.3%

of male and 26.7% of female were not satisfied with the information received on how to move the arm, where the implant is located (P <0.278). What the prognosis and course of the disease with ICD and possible progression might be, 17.5% gave a neutral assessment (20.8% prevail among males, compared with 6.7% for females). 12.7% are not satisfied with the information received (female 20.0%

and male 10.4% (P <0.293)). 25.4% rated it as neutral and 25.4% as insufficiently satisfactory in informing the question regarding the possibility of protecting the ICD from heart attack. Of these, 27.1% of male and 20.0% of female gave a neutral assessment, as well as 27.1% of male and 20.0%

of female were not satisfactory enough (P <0.894). The largest number of respondents gave a satisfactory assessment of the information they received about the

impact of ICD on the initial state of the respondent 81.3%

male and 73.3% female. When studying the question of satisfaction with the information received about the effect of ICD on driving a car, traveling, playing sports, having sex, or engaging in other activities, 29.2% of male and 33.3% of female rated it as neutral and worse (P <0.743).

More than a third of respondents, 31.3% of male and 33.4% of female, rated the information received as not satisfactory what to know about ICD for end-stage heart failure or death (P <0.837). On a positive note, 79.2% of male and 80.0% of female are satisfied with the knowledge of how to care for a wound after implantation and manage pain, symptoms and medication after returning home.

A negative trend is a low assessment of satisfaction of only 41.7% of men and 33.3% of female with the knowledge received about what shock means and when they occur (P

<0.914), as well as the information provided about what to expect a family member or to the patient with the occurrence of a state of shock in 20.8% of men and 13.4%

of female. Only 45.9% of men and 46.1% of female (P

<0.729) were satisfied with the knowledge that something can be done to minimize the number of non-critical blows or shock.

Discussion

The role of communication in providing patient-centered care has been proven in various studies, especially for patients with ICD, who may experience negative effects associated with technology. Our results represent the first study in Kazakhstan to examine patient participation in decision-making in therapy. Studies on informing patients

with ICD presented by international authors note the importance of informing patients about the possible positive and negative effects of ICD, such as the occurrence of sudden shock, or about stopping the activity of the ICD [21,26]. Four topics were noted that must be voiced and explained without fail to the patient: the installation of an ICD for heart failure can seriously disrupt the lives of patients; patients had a positive but unrealistic view of the ICD; patients had negative / ambivalent opinions about ICD;

medical decision making included aspects of participatory decision making and informed consent. Patients without ICD felt less benefit and were less supportive of decision making, therefore interventions needed should include the development and validation of processes for making informed decisions about ICD [10,8].

In the study of informing patients about ICD, in general, there is a positive trend among the respondents of the Kyzylorda region in comparison with the city of Almaty.

Accordingly, primary care providers, in conjunction with the inpatient service, should strengthen their efforts to educate patients about ICD, possibly through the development of joint strategies. The study of informing patients about ICD revealed insufficient information among female representatives about the advantages of ICD (P <0.003), and its disadvantages (P <0.019).

In addition, there were no statistically significant results in informing patients about the reasons for receiving ICD (P

<0.156), how the ICD works (P <0.275), about the advantages of ICD and its disadvantages (P <0.188), what to do if shock from ICD occurs (R <0.127), how to move the arm, where the implant is located (P <0.092), prognosis and course of the disease with ICD and possible progression (P

<0.699), the ability to protect the ICD from a heart attack (P

<0.212), the effect of age on ICD performance ( P <0.219) what to know about ICD for end-stage heart failure or death (P <0.105), however, prior to referring patients for ICD surgery, it is very important to focus the attention of healthcare providers on the above issues and educate patients on all points.

Future direction: guidelines for primary care physicians and nurses should be developed, including sections on ICD patient management, information to raise awareness of ICD I patients. Providing regular training on ICD patient management and new types of ICD for primary care specialist is essential to improve patient management. In order to improve medical literacy among patients with coronary artery disease, it is necessary to include the topic of ICD in patient education programs at the primary care level.

Conclusion

The implantation of a cardioverter-defibrillator is one of the effective technologies, however, it is associated with both positive and negative effects. Informing patients about the possible negative consequences, as well as changes in daily life with ICD is important, which is carried out at an insufficient level in Almaty in comparison with the Kyzylorda region.

Contribution of the authors: All authors have made an equal contribution to the writing of the article.

Begisbayev T.S. - this author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation

Begisbayev T.S., Brimzhanova M.D., Akhtaeva N.S., Toleugali Sh.E. - data collection, analysis, methodology, writing original draft.

Kosherbayeva L.K. - scientific management of the study, writing - review & editing.

The Conflict of interest: Authors declare that there are no conflicts of interest.

Authors claim a lack of funding. There is no financial support and sponsorship.

Information about the publication: The results of this study have not been previously published in other journals and are not awaiting review by other publishers.

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1. Kamaliev M.A., Al'muhanova A.B., Bapaeva M., Peremitina A.D. Meditsinskaya effektivnost' posle implantatsii kardioverter-defibrillyatora [Medical efficacy after implantation of a cardioverter defibrillator]. Vestnik KazNMU [Bulletin of KazNMU]. 2018. №03-2018 С 283-284 Corresponding Author

Begisbaev Temirkhan – PhD student,Kazakhstans Medical University "Higher School of Public Health", Almaty, Republic of Kazakhstan.

Mailing address: 19A Gagarina Street, Almaty, Republic of Kazakhstan.

Email: phhtahtaph@gmail.com Phone: +7777 027 08 95

Outline

СӘЙКЕС КЕЛЕТІН ҚҰЖАТТАР