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We construct a representation for the first anti-de Sitter curvature correction to the Virasoro-Shapiro amplitude, as an integral over the Riemann sphere. The integrand is that of the Virasoro-Shapiro amplitude in flat space, with the extra insertion of a linear combination of single-valued multiple polylogarithms of weight three. The integral representation implies an elegant, manifestly single-valued representation for the Wilson coefficients of the low-energy expansion.
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We consider graviton scattering in maximal supergravity on anti-de Sitter space (AdS) in d+1 dimensions for d=3, 4, and 6 with no extra compact spacetime factor. Holography suggests that this theory is dual to an exotic maximally supersymmetric conformal field theory (CFT) in d dimensions whose only light single trace operator is the stress tensor. This contrasts with more standard cases like type IIB string theory on AdS_{5}×S^{5} dual to N=4 super-Yang-Mills, where the CFT has light single trace operators for each Kaluza-Klein mode on S^{5}. We compute the one-loop correction to the pure AdS_{d+1} theory in a small Planck length expansion, which is dual to the large central charge expansion in the CFT. We find that this correction saturates the most general nonperturbative conformal bootstrap bounds on this correlator in the large central charge regime for d=3, 4, 6, while the one-loop correction to CFTs with string and M-theory duals all lie inside the allowed region.
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We present the tree-level five-point amplitude of the lowest Kaluza-Klein mode of super-Yang-Mills theory on AdS_{5}×S^{3}, dual to the correlator of the flavor current multiplet in the dual 4d N=2 superconformal field theory. Its color and kinematical structure is particularly simple and resembles that of the flat-space gluon amplitude.
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OBJECTIVE: To derive cluster analysis-based groupings for adults with congenital heart disease (ACHD) when it comes to perceived health, psychological functioning, health behaviours and quality of life (QoL). METHODS: This study was part of a larger worldwide multicentre study called APPROACH-IS; a cross sectional study which recruited 4028 patients (2013-2015) from 15 participating countries. A hierarchical cluster analysis was performed using Ward's method in order to group patients with similar psychological characteristics, which were defined by taking into consideration the scores of the following tests: Sense Of Coherence, Health Behavior Scale (physical exercise score), Hospital Anxiety Depression Scale, Illness Perception Questionnaire, Satisfaction with Life Scale and the Visual Analogue Scale scores of the EQ-5D perceived health scale and a linear analogue scale (0-100) measuring QoL. RESULTS: 3768 patients with complete data were divided into 3 clusters. The first and second clusters represented 89.6% of patients in the analysis who reported a good health perception, QoL, psychological functioning and the greatest amount of exercise. Patients in the third cluster reported substantially lower scores in all PROs. This cluster was characterised by a significantly higher proportion of females, a higher average age the lowest education level, more complex forms of congenital heart disease and more medical comorbidities. CONCLUSIONS: This study suggests that certain demographic and clinical characteristics may be linked to less favourable health perception, quality of life, psychological functioning, and health behaviours in ACHD. This information may be used to improve psychosocial screening and the timely provision of psychosocial care.
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Cardiopatias Congênitas/psicologia , Qualidade de Vida , Adulto , Análise por Conglomerados , Estudos Transversais , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
We present a constructive derivation of all four-point tree-level holographic correlators for eleven dimensional supergravity on AdS_{7}×S^{4}. These correlators correspond to four-point functions of arbitrary one-half BPS operators in the six-dimensional (2,0) theory at large central charge. The crucial observation is that the polar part of the correlators in Mellin space is fully captured by a drastically simpler maximally R-symmetry violating amplitude, while the contact part is fully fixed by superconformal Ward identities and the flat space limit.
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BACKGROUND: The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease. METHODS: This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS: Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed. CONCLUSIONS: This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
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Atenção à Saúde/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Cardiopatias Congênitas/terapia , Medidas de Resultados Relatados pelo Paciente , Adulto , Estudos Transversais , Feminino , Saúde Global , Humanos , MasculinoRESUMO
We consider conformal field theories around points of large twist degeneracy. Examples of this are theories with weakly broken higher spin symmetry and perturbations around generalized free fields. At the degenerate point we introduce twist conformal blocks. These are eigenfunctions of certain quartic operators and encode the contribution, to a given four-point correlator, of the whole tower of intermediate operators with a given twist. As we perturb around the degenerate point, the twist degeneracy is lifted. In many situations this breaking is controlled by inverse powers of the spin. In such cases the twist conformal blocks can be decomposed into a sequence of functions which we systematically construct. Decomposing the four-point correlator in this basis turns crossing symmetry into an algebraic problem. Our method can be applied to a wide spectrum of conformal field theories in any number of dimensions and at any order in the breaking parameter. As an example, we compute the spectrum of various theories around generalized free fields.
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We consider the four-point correlator of the stress-energy tensor multiplet in N=4 super Yang-Mills theory. In the planar limit and at large 't Hooft coupling, such a correlator is given by the corresponding holographic correlation function in IIB supergravity on AdS_{5}×S^{5}. We consider subleading corrections in the number of colors, i.e., order 1/N^{4}, at large 't Hooft coupling. This corresponds to loop corrections to the supergravity result. Consistency conditions, most notably, crossing symmetry, constrain the form of such corrections and lead to a complete determination of the spectrum of leading-twist intermediate operators.
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We present the gravity dual of large N supersymmetric gauge theories on a squashed five-sphere. The one-parameter family of solutions is constructed in Euclidean Romans F(4) gauged supergravity in six dimensions, and uplifts to massive type IIA supergravity. By renormalizing the theory with appropriate counterterms we evaluate the renormalized on-shell action for the solutions. We also evaluate the large N limit of the gauge theory partition function, and find precise agreement.
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Takotsubo Syndrome is an acquired cardiomyopathy characterized by a transient left ventricular antero-apical asynergy or disynergy (apical ballooning), symptoms and electrocardiographic changes are suggestive of an acute coronary syndrome, moderate cardiac enzymatic release and absence of significant atherosclerotic lesions in coronary arteries. It predominantly affects postmenopausal women and it is frequently preceded by situations of physical or psychological stress. The physiopathology is not completely understood but there is consensus that it is triggered by a surge of catecholamines consequent to the aforementioned stress conditions. The study of 32 cases diagnosed at three medical institutions in Córdoba, Argentina, is reported. The mean age was 61 years, and 28 were female. All cases simulated acute coronary syndromes. Congestive heart failure developed in twelve cases (37.5%) and two patients (6.3%) developed cardiogenic shock. The left ventricular function normalized more rapidly than the electrocardiographic changes. The recurrence rate was 25%, the prognosis was benign considering that only one death occurred following a relapse. In general the findings are similar to previously published studies. Recent advances in the comprehension of the physiopathology of this cardiomyopathy gave way to the development of a rational therapeutic approach.
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Cardiomiopatia de Takotsubo/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Argentina , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do TratamentoRESUMO
BACKGROUND: A comprehensive understanding of adult congenital heart disease outcomes must include psychological functioning. Our multisite study offered the opportunity to explore depression and anxiety symptoms within a global sample. OBJECTIVES: In this substudy of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study), the authors we investigated the prevalence of elevated depression and anxiety symptoms, explored associated sociodemographic and medical factors, and examined how quality of life (QOL) and health status (HS) differ according to the degree of psychological symptoms. METHODS: Participants completed the Hospital Anxiety and Depression Scale, which includes subscales for symptoms of anxiety (HADS-A) and depression (HADS-D). Subscale scores of 8 or higher indicate clinically elevated symptoms and can be further categorized as mild, moderate, or severe. Participants also completed analogue scales on a scale of 0 to 100 for QOL and HS. Analysis of variance was performed to investigate whether QOL and HS differed by symptom category. RESULTS: Of 3,815 participants from 15 countries (age 34.8 ± 12.9 years; 52.7% female), 1,148 (30.1%) had elevated symptoms in one or both subscales: elevated HADS-A only (18.3%), elevated HADS-D only (2.9%), or elevations on both subscales (8.9%). Percentages varied among countries. Both QOL and HS decreased in accordance with increasing HADS-A and HADS-D symptom categories (P < 0.001). CONCLUSIONS: In this global sample of adults with congenital heart disease, almost one-third reported elevated symptoms of depression and/or anxiety, which in turn were associated with lower QOL and HS. We strongly advocate for the implementation of strategies to recognize and manage psychological distress in clinical settings. (Patient-Reported Outcomes in Adults With Congenital Heart Disease [APPROACH-IS]; NCT02150603).
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Cardiopatias Congênitas , Qualidade de Vida , Adulto , Humanos , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Masculino , Qualidade de Vida/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologiaRESUMO
The congenital heart disease (CHD) population now comprises an increasing number of older persons in their 6th decade of life and beyond. We cross-sectionally evaluated patient-reported outcomes (PROs) in persons with CHD aged 60 years or older, and contrasted these with PROs of younger patients aged 40-59 years and 18-39 years. Adjusted for demographic and medical characteristics, patients ≥60 years had a lower Physical Component Summary, higher Mental Component Summary, and lower anxiety (Hospital Anxiety and Depression Scale-Anxiety) scores than patients in the two younger categories. For satisfaction with life, older persons had a higher score than patients aged 40-59 years. Registration: ClinicalTrials.gov NCT02150603.
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Cardiopatias Congênitas , Adulto , Humanos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Cardiopatias Congênitas/epidemiologia , Ansiedade/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Envelhecimento , Qualidade de VidaRESUMO
Background Heart failure (HF) is the leading cause of mortality and associated with significant morbidity in adults with congenital heart disease. We sought to assess the association between HF and patient-report outcomes in adults with congenital heart disease. Methods and Results As part of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease-International Study), we collected data on HF status and patient-reported outcomes in 3959 patients from 15 countries across 5 continents. Patient-report outcomes were: perceived health status (12-item Short Form Health Survey), quality of life (Linear Analogue Scale and Satisfaction with Life Scale), sense of coherence-13, psychological distress (Hospital Anxiety and Depression Scale), and illness perception (Brief Illness Perception Questionnaire). In this sample, 137 (3.5%) had HF at the time of investigation, 298 (7.5%) had a history of HF, and 3524 (89.0%) had no current or past episode of HF. Patients with current or past HF were older and had a higher prevalence of complex congenital heart disease, arrhythmias, implantable cardioverter-defibrillators, other clinical comorbidities, and mood disorders than those who never had HF. Patients with HF had worse physical functioning, mental functioning, quality of life, satisfaction with life, sense of coherence, depressive symptoms, and illness perception scores. Magnitudes of differences were large for physical functioning and illness perception and moderate for mental functioning, quality of life, and depressive symptoms. Conclusions HF in adults with congenital heart disease is associated with poorer patient-reported outcomes, with large effect sizes for physical functioning and illness perception. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT02150603.
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Cardiopatias Congênitas , Insuficiência Cardíaca , Adulto , Nível de Saúde , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/terapia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Medidas de Resultados Relatados pelo Paciente , Qualidade de VidaRESUMO
In this international study, we (1) compared patient-reported outcomes (PROs) in adults with congenital heart disease (CHD) who had versus had not been hospitalized during the previous 12 month, (2) contrasted PROs in patients who had been hospitalized for cardiac surgery versus nonsurgical reasons, (3) assessed the magnitude of differences between the groups (i.e., effect sizes), and (4) explored differential effect sizes between countries. APPROACH-IS was a cross-sectional, observational study that enrolled 4,028 patients from 15 countries (median age 32 years; 53% females). Self-report questionnaires were administered to measure PROs: health status; anxiety and depression; and quality of life. Overall, 668 patients (17%) had been hospitalized in the previous 12 months. These patients reported poorer outcomes on all PROs, with the exception of anxiety. Patients who underwent cardiac surgery demonstrated a better quality of life compared with those who were hospitalized for nonsurgical reasons. For significant differences, the effect sizes were small, whereas they were negligible in nonsignificant comparisons. Substantial intercountry differences were observed. For various PROs, moderate to large effect sizes were found comparing different countries. In conclusion, adults with CHD who had undergone hospitalization in the previous year had poorer PROs than those who were medically stable. Researchers ought to account for the timing of recruitment when conducting PRO research as hospitalization can impact results.
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Ansiedade/psicologia , Depressão/psicologia , Nível de Saúde , Cardiopatias Congênitas/fisiopatologia , Hospitalização , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Procedimentos Cirúrgicos Cardíacos , Feminino , Cardiopatias Congênitas/psicologia , Cardiopatias Congênitas/cirurgia , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: Previous studies have found that sense of coherence (SOC) is positively related to quality of life (QoL) in persons with chronic conditions. In congenital heart disease (CHD), the evidence is scant. AIMS: We investigated (i) intercountry variation in SOC in a large international sample of adults with CHD; (ii) the relationship between demographic and clinical characteristics and SOC; (iii) the relationship between cultural dimensions of countries and SOC; and (iv) variation in relative importance of SOC in explaining QoL across the countries. METHODS: APPROACH-IS was a cross-sectional, observational study, with 4028 patients from 15 countries enrolled. SOC was measured using the 13-item SOC scale (range 13-91) and QoL was assessed by a linear analog scale (range 0-100). RESULTS: The mean SOC score was 65.5±13.2. Large intercountry variation was observed with the strongest SOC in Switzerland (68.8±11.1) and the lowest SOC in Japan (59.9±14.5). A lower SOC was associated with a younger age; lower educational level; with job seeking, being unemployed or disabled; unmarried, divorced or widowed; from a worse functional class; and simple CHD. Power distance index and individualism vs collectivism were cultural dimensions significantly related to SOC. SOC was positively associated with QoL in all participating countries and in the total sample, with an explained variance ranging from 5.8% in Argentina to 30.4% in Japan. CONCLUSION: In adults with CHD, SOC is positively associated with QoL. The implementation of SOC-enhancing interventions might improve QoL, but strategies would likely differ across countries given the substantial variation in explained variance.
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Cardiopatias Congênitas , Senso de Coerência , Adulto , Estudos Transversais , Características Culturais , Humanos , Qualidade de VidaRESUMO
BACKGROUND: Atrial arrhythmias (ie, intra-atrial reentrant tachycardia and atrial fibrillation) are a leading cause of morbidity and hospitalization in adults with congenital heart disease (CHD). Little is known about their effect on quality of life and other patient-reported outcomes (PROs) in adults with CHD. OBJECTIVE: The purpose of this study was to assess the impact of atrial arrhythmias on PROs in adults with CHD and explore geographic variations. METHODS: Associations between atrial arrhythmias and PROs were assessed in a cross-sectional study of adults with CHD from 15 countries spanning 5 continents. A propensity-based matching weight analysis was performed to compare quality of life, perceived health status, psychological distress, sense of coherence, and illness perception in patients with and those without atrial arrhythmias. RESULTS: A total of 4028 adults with CHD were enrolled, 707 (17.6%) of whom had atrial arrhythmias. After applying matching weights, patients with and those without atrial arrhythmias were comparable with regard to age (mean 40.1 vs 40.2 years), demographic variables (52.5% vs 52.2% women), and complexity of CHD (15.9% simple, 44.8% moderate, and 39.2% complex in both groups). Patients with atrial arrhythmias had significantly worse PRO scores with respect to quality of life, perceived health status, psychological distress (ie, depression), and illness perception. A summary score that combines all PRO measures was significantly lower in patients with atrial arrhythmias (-3.3%; P = .0006). Differences in PROs were consistent across geographic regions. CONCLUSION: Atrial arrhythmias in adults with CHD are associated with an adverse impact on a broad range of PROs consistently across various geographic regions.
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Fibrilação Atrial/etiologia , Cardiopatias Congênitas/complicações , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Estudos Transversais , Feminino , Saúde Global , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Morbidade/tendênciasRESUMO
BACKGROUND: We compared physical functioning, mental health, and quality of life (QoL) of patients with different subtypes of congenital heart disease (CHD) in a large international sample and investigated the role of functional class in explaining the variance in outcomes across heart defects. METHODS: In the cross-sectional Assessment of Patterns of Patient-Reported Outcome in Adults with Congenital Heart Disease-International Study (APPROACH-IS), we enrolled 4028 adult patients with CHD from 15 countries. Diagnostic groups with at least 50 patients were included in these analyses, yielding a sample of 3538 patients (median age: 32 years; 52% women). Physical functioning, mental health, and QoL were measured with the SF-12 health status survey, Hospital Anxiety and Depression Scale (HADS), linear analog scale (LAS) and Satisfaction with Life Scale, respectively. Functional class was assessed using the patient-reported New York Heart Association (NYHA) class. Multivariable general linear mixed models were applied to assess the relationship between the type of CHD and patient-reported outcomes, adjusted for patient characteristics, and with country as random effect. RESULTS: Patients with coarctation of the aorta and those with isolated aortic valve disease reported the best physical functioning, mental health, and QoL. Patients with cyanotic heart disease or Eisenmenger syndrome had worst outcomes. The differences were statistically significant, above and beyond other patient characteristics. However, the explained variances were small (0.6% to 4.1%) and decreased further when functional status was added to the models (0.4% to 0.9%). CONCLUSIONS: Some types of CHD predict worse patient-reported outcomes. However, it appears that it is the functional status associated with the heart defect rather than the heart defect itself that shapes the outcomes.
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Estado Funcional , Saúde Global/estatística & dados numéricos , Cardiopatias Congênitas , Saúde Mental , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adulto , Assistência ao Convalescente/estatística & dados numéricos , Correlação de Dados , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Cardiopatias Congênitas/classificação , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/psicologia , Cardiopatias Congênitas/terapia , Humanos , Masculino , Desempenho Físico FuncionalRESUMO
We show that the central charge of the Liouville and Toda theories of type A, D, and E can be reproduced by equivariantly integrating the anomaly eight-form of the corresponding six-dimensional N=(0,2) theories, which describe the low-energy dynamics of M5-branes.
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INTRODUCTION: Since the 1980s, stent implantation has evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow-up, lack of adequate follow-up imaging, and retrospective nature of data collection. METHODS: Data was prospectively collected using a multicenter registry congenital cardiovascular interventional study consortium (CCISC). Between 2000 and 2009, 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coarctation. Eligible patients (44%) completed intermediate follow-up (3-18 months) with integrated imaging (cath, CT, MRI), whereas 21% completed long-term follow-up (>18-60 months). Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg, lack of significant recurrent obstruction, and freedom from unplanned repeat intervention. RESULTS: Acute procedural success was 96%. Cumulative intermediate success was 86%, and cumulative long-term success was 77%. Unplanned repeat interventions were required in 4%, and aortic wall complications were seen in 1% of patients (dissection n = 1 and aneurysm n = 3). Other adverse events (n = 15) occurred mainly acutely and included technical complications such as stent malposition (n = 9). At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th centile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication. CONCLUSIONS: This study documented acute, intermediate, and long-term outcome data comparable or superior with other surgical or interventional series. However, even with successful initial stent therapy, patients continue to require long-term follow-up and have associated long-term morbidity, relating to aortic wall complications, systemic hypertension, recurrent obstruction as well as need for repeat intervention.
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Coartação Aórtica/terapia , Procedimentos Endovasculares/instrumentação , Stents , Adolescente , Adulto , Anti-Hipertensivos/uso terapêutico , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico , Coartação Aórtica/fisiopatologia , Argentina , Canadá , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Procedimentos Endovasculares/efeitos adversos , Feminino , Hemodinâmica , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Hipertensão/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Recidiva , Sistema de Registros , Retratamento , Medição de Risco , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are increasingly being used to prevent sudden death in the growing population of adults with congenital heart disease (CHD). However, little is known about their impact on patient-reported outcomes (PROs). OBJECTIVE: The purpose of this study was to assess and compare PROs in adults with CHD with and without ICDs. METHODS: A propensity-based matching weight analysis was conducted to evaluate PROs in an international cross-sectional study of adults with CHD from 15 countries across 5 continents. RESULTS: A total of 3188 patients were included: 107 with ICDs and 3081 weight-matched controls without ICDs. ICD recipients were an average age of 40.1 ± 12.4 years, and >95% had moderate or complex CHD. Defibrillators were implanted for primary and secondary prevention in 38.3% and 61.7%, respectively. Perceived health status, psychological distress, sense of coherence, and health behaviors did not differ significantly among patients with and without ICDs. However, ICD recipients had a more threatening view of their illness (relative % difference 8.56; P = .011). Those with secondary compared to primary prevention indications had a significantly lower quality-of-life score (Linear Analogue Scale 72.0 ± 23.1 vs 79.2 ± 13.0; P = .047). Marked geographic variations were observed. Overall sense of well-being, assessed by a summary score that combines various PROs, was significantly lower in ICD recipients (vs controls) from Switzerland, Argentina, Taiwan, and the United States. CONCLUSION: In an international cohort of adults with CHD, ICDs were associated with a more threatening illness perception, with a lower quality of life in those with secondary compared to primary prevention indications. However, marked geographic variability in PROs was observed.