Mindfulness based intervention with an attentional comparison group in at risk young adolescents: a pilot randomized controlled trial.

BACKGROUND: Risky behaviors are related to poor outcomes among young adolescents. This study piloted a mindfulness based intervention, Learning 2 Breath Mindfulness Curriculum, focusing on the feasibility of programming and intervention effects on coping, affect, and trait mindfulness among at-risk adolescents. Further, the mindfulness based intervention was compared to an attention intervention. METHODS: Sixth-grade level female students in a boarding school for at-risk youth randomly allocated to either the mindfulness intervention (n = 12) or an attention intervention (n = 11) for six weeks. Outcomes (i.e., primary coping, positive affect, and trait mindfulness) were assessed before and after the interventions. RESULTS: Intervention groups did not differ in demographics or outcomes at baseline. Twenty-two of 23 (95.7%) registered participants attended all of the sessions. Participants completed 86.4% of study tools. Separate repeated measures ANOVAs revealed no significant interactions among group and time for primary coping, positive affect, or mindfulness. However, positive affect did increase [F(1, 17) = 10.675, p = 0.005, partial η 2 = 0.39] over time for both groups and there was a slight increase in trait mindfulness over time (although not statistically significant; p = 0.095, partial η 2 = 0.155]). Primary coping did not change with time. CONCLUSION: The mindfulness intervention utilized in the present study exhibited feasibility in this population. Although preliminary, mindfulness based interventions may contribute to positive affect among at-risk youth in a boarding school. Limitations and future directions are discussed.

Engaging patients with heart failure into the design of health system interventions: Impact on research methods.

The purpose of this study was to engage patients with heart failure (HF) to assess if changes are needed in a research study design, methods and outcomes when transferring interventions used in urban/community hospitals to rural hospital settings. A qualitative structured interview was conducted with eight patients with a diagnosis of HF admitted to two rural hospitals. Patients validated the study design, measures and outcomes, but identified one area that should be added to the study protocol, symptom experience. Results validated that the intervention, methods and outcomes for the planned study were important, but modifications to the study protocol resulted. Patient engagement in the conceptualization of research is essential to guide patient-centered studies.

Inpatient Unit Heart Failure Discharge Volume Predicts All-cause 30-Day Hospital Readmission.

BACKGROUND: All-cause 30-day hospital readmission is a heart failure (HF) quality of care metric. Readmission costs the healthcare system $30.7 million annually. Specific structure, process, or patient factors that predispose patients to readmission are unclear. OBJECTIVE: The aim of this study is to determine whether the addition of unit-level structural factors (attending medical service, patient-to-nurse ratio, and unit HF volume) predicts readmission beyond patient factors. METHODS: A retrospective chart review of 425 patients who resided in Maryland and were discharged home in 2011 with the primary diagnosis of HF from a large, urban academic center was conducted. RESULTS: The patients were predominately (66.6%) black/African American, with mean (SD) age of 62.2 (14.8) years. Men represented 48.2% of the sample; 32% had nonischemic HF, 31.3% had preserved ejection fractions, 25.4% had implantable cardioverter defibrillators, and 15.3% had permanent pacemakers. Average length of stay was 6.0 days. All-cause 30-day hospital readmission rate was 20.2%. Inpatient unit HF discharge volume significantly predicted readmission after controlling for patient factors. CONCLUSIONS: The study found that discharge from inpatient units with higher HF discharge volume was associated with increased risk of readmission. The findings suggest that in caring for patients with severe HF, inpatient unit HF discharge volume may negatively impact care processes, increasing the odds of hospital readmission. It is unclear what specific care processes are responsible. The discharge period is a vulnerable point in care transition that warrants further investigation.

Biopsychosocial predictors of coping strategies of patients postmyocardial infarction.

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event.

The Use of Phone Technology in Outpatient Populations: A Systematic Review.

OBJECTIVE: A systematic review was conducted to identify the types of phone technology used in the adult outpatient population with a focus on Hispanic patients and psychiatric populations. METHODS: A search for articles was conducted on the EMBASE, PubMed and PsycINFO databases. Articles reviewed were peer-reviewed, full-text, English language and published through mid-November 2014. RESULTS: Twenty-one articles were included in this review and grouped according to combinations of phone technology, medical specialty area and population. For all articles, phone technology was defined as telephone, cell, or smart phone. Technology was used in psychiatry with Hispanic population in four articles, in psychiatry with non-Hispanic population in seven articles and in other specialties with Hispanic population in ten articles. Articles were evaluated for quality. Six articles were assessed as strong, eight were moderate and seven were weak in global quality. Interventions included direct communication, text messaging, interactive voice response, camera and smart phone app. Studies with Hispanic populations used more text messaging, while studies in psychiatry favored direct communication. The majority of articles in all groups yielded improvements in health outcomes. CONCLUSION: Few studies have been conducted using phone technology in Hispanic and psychiatric populations. Various phone technologies can be helpful to patients in diverse populations and have demonstrated success in improving a variety of specific and overall healthcare outcomes. Phone technologies are easily adapted to numerous settings and populations and are valuable tools in efforts to increase access to care.

Gender differences in stroke, mortality, and hospitalization among patients with atrial fibrillation: A systematic review.

OBJECTIVE: To conduct a systematic review of gender differences in stroke, mortality, and hospitalization for patients with atrial fibrillation and/or flutter (AF/Afl). METHODS: Full texts, published, peer-reviewed, English language articles from 1999 through July 2014 were examined. Articles with populations of patients with AF/Afl were included if they conducted longitudinal analysis of any of three outcomes: stroke, mortality, and hospitalization, and reported or compared at least one of the outcomes according to gender. RESULTS: Seventeen articles were included: sixteen on stroke, nine on mortality, and one on hospitalization. In nine articles women had more strokes (RRs 0.89-1.9). Findings about gender differences in mortality (RRs 0.69-2.8) and hospitalizations were equivocal. CONCLUSIONS: Few articles examine differences in outcomes between men and women with AF/Afl. Given the prevalence of AF/Afl and health care costs it is vital to determine gender differences to evaluate appropriate therapies to decrease stroke, mortality, and hospitalizations.

A pilot study of a mindfulness based stress reduction program in adolescents with implantable cardioverter defibrillators or pacemakers.

Adolescents with implantable cardioverter defibrillators (ICDs) or pacemakers (PMs) face unique challenges that can cause psychosocial distress. Psychosocial interventions are effective for adults with cardiac devices and could potentially impact adolescents' adjustment to these devices. Mindfulness Based Stress Reduction (MBSR) is a structured psycho-educational program that includes meditation, yoga, and group support and has been studied extensively among adults. This study examined the feasibility of the MBSR program for adolescents with ICDs/PMs, a population previously unexamined in the research literature. The participants completed measures of anxiety and depression (Hospital Anxiety and Depression Scale) and coping (Responses to Stress Questionnaire) at baseline and after the six-session MBSR intervention. Mean age of the cohort (n = 10) was 15 ± 3 years, 6 were male, 6 had a PM, and 4 had an ICD. Feasibility was demonstrated by successful recruitment of 10 participants, 100 % participation and completion. Anxiety decreased significantly following the intervention, with a large effect size, t[9] = 3.67, p < .01, ŋ (2) = .59. Anxiety frequency decreased from baseline to post-intervention (Fisher's exact test p = .024), and 90 % of participants reported decreased anxiety scores post-intervention. Coping skills related negatively to anxiety (r = -.65, p = .04) and depression (r = -.88, p = .001). Post-intervention, the group independently formed their own Facebook group and requested to continue meeting monthly. Although generalizability is limited due to the small sample size, this successful pilot study paves the way for larger studies to examine the efficacy of MBSR interventions in adolescents with high-risk cardiac diagnoses.

Evaluation of a pet-assisted living intervention for improving functional status in assisted living residents with mild to moderate cognitive impairment: a pilot study.

BACKGROUND: In older adults with cognitive impairment (CI), decreased functional status and increased behavioral symptoms require relocation from assisted living (AL) to nursing homes. Studies support positive effects of pets on health/function. PURPOSE: Evaluate the effectiveness of the Pet AL (PAL) intervention to support physical, behavioral, and emotional function in AL residents with CI. METHODS: Cognitively impaired AL residents randomized to 60-90 minute sessions [PAL (n = 22) or reminiscing (n = 18)] twice/week for 12 weeks. PAL interventionist encourages residents to perform skills with the visiting dog; reminiscing interventionist encourages residents to reminisce. Monthly assessment of physical (energy expenditure, activities of daily living), emotional (depression, apathy), and behavioral (agitation) function. RESULTS: In linear mixed models, physical activity depressive symptoms improved more with PAL. CONCLUSION: Evidence supports that the PAL program helps preserve/enhance function of AL residents with CI. Additional study is required to evaluate the duration and predictors of effectiveness of the PAL intervention.

Interventions on mealtime difficulties in older adults with dementia: a systematic review.

OBJECTIVES: To evaluate the effects of interventions on mealtime difficulties in older adults with dementia. DESIGN: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. DATA SOURCES: Pubmed, Medline (OVID), CINAHL (EBSCOHost), EBM Reviews (OVID) and PsychINFO (OVID) were searched between January 2004 and September 2012 by using keywords as dementia, Alzheimer, feed(ing), eat(ing), mealtime(s), oral intake, nutrition, intervention, experimental, quasi-experimental and any matched terms. Other sources included Google Scholar and relevant bibliographies. REVIEW METHODS: Eligibility criteria were established by defining the population, intervention, comparator, outcomes, timing and setting of interest. Studies were reviewed by title and abstract screening, and full-text assessing for eligibility. Data were abstracted from eligible studies using a self-made structured tool. Eligible studies were classified by intervention, accessed for quality using the Quality Assessment Tool for Quantitative Studies, and graded for evidence using the Grading of Recommendations, Assessment, Development and Evaluation Working Group criteria. RESULTS: Twenty-two intervention studies (9 RCTs), including a total of 2082 older adults with dementia and 95 professionals from more than 85 long-term care facilities, were selected, and classified into five types: nutritional supplements, training/education programs, environment/routine modification, feeding assistance and mixed interventions. Eight studies were strong, eleven moderate and three weak in quality. Limitations of body of research included lack of randomization and/or control group, small sample size without power analysis, lack of theory-based interventions and blinding, inadequate statistical analysis and plausible confounding bias. "Nutritional supplements" showed moderate evidence to increase food intake, body weight and BMI. "Training/education programs" demonstrated moderate evidence to increase eating time and decrease feeding difficulty. Both "training/education programs" and "feeding assistance" were insufficient to increase food intake. "Environment/routine modification" indicated low evidence to increase food intake, and insufficient to decrease agitation. Evidence was sparse on nutritional status, eating ability, behavior disturbance, behavioral and cognitive function, or level of dependence. CONCLUSIONS: This review provides updated evidence for clinical practice and points out priorities for nursing research. Current evidence is based on a body of research with moderate quality and existing limitations, and needs to be further explored with more rigorous studies.

Poor social support is associated with increases in depression but not anxiety over 2 years in heart failure outpatients.

BACKGROUND: Heart failure (HF) is a major health problem in the United States, affecting 5.7 million American adults. Psychosocial distress, in particular depression, contributes to morbidity and mortality in patients with HF. Little is known about the interrelationship among disease severity, social support, and depression. OBJECTIVE: The aim of this study was to examine the contributions of social support and disease severity to longitudinal changes in depression and anxiety of outpatients with HF. METHODS: Patients (N = 108) enrolled in the Psychosocial Factors Outcome Study completed the Beck Depression Inventory-II, the State Trait Anxiety Inventory, and the Social Support Questionnaire-6 at study entry and every 6 months for up to 2 years. RESULTS: At baseline, 30% of the patients were depressed and 42% were anxious. Social support amount contributed to changes in depression (P = .044) but not anxiety (P = .856). Depression increased over time for patients who had lower initial social support amount. Depression did not increase for those with higher initial social support amount. Neither New York Heart Association class nor treatment group (placebo or implantable cardioverter defibrillator) interacted with time to predict depression, which indicates that changes in depression were parallel for patients with New York Heart Association class II and class III HF and for those who received implantable cardioverter defibrillators and those who did not. Assessment of patients with HF should include depression and social support. Interventions to enhance social support among patients with HF who have low social support may help alleviate the development of depression. CONCLUSIONS: Reducing psychological distress and increasing social support may improve health outcomes among HF outpatients. It is important for studies of HF to include assessment of depression, anxiety, and social support and evaluate their contributions to health outcomes.

Is health-related quality of life a predictor of hospitalization or mortality among women or men with atrial fibrillation?

BACKGROUND: Little is known about predictors of mortality or hospitalization in women compared with men in patients with atrial fibrillation (AF). Although there are established gender differences in patients with coronary artery disease (CAD), differences have not been established in AF. OBJECTIVES: The aim of this study was to examine clinical and health-related quality of life (HRQOL) predictors of mortality and 1-year hospitalization in women compared with men with AF. METHODS: Limited-use data from the National Institutes of Health/National Heart, Lung, and Blood Institute Atrial Fibrillation Follow-up Investigation of Rhythm Management clinical trial provided the sample of 693 patients with AF, 262 women and 431 men. Clinical predictors examined were heart failure (HF), CAD, left ventricular ejection fraction, diabetes, stroke, and age. Predictors of HRQOL included overall HRQOL (Medical Outcomes Study Short Form-36 physical [PCS] and mental component scores) and cardiovascular HRQOL using Quality of Life Index-Cardiac Version. RESULTS: Mortality did not differ (women, 11.4%; men, 14.5%; χ(2)1 = 0.437, P = .509) according to gender, with mean 3.5-year follow-up. Different variables independently predicted mortality for women and men. For women, diabetes (hazard ratio [HR], 3.415; P = .003), HF (HR, 2.346; P = .027), stroke (HR, 2.41; P = .032), and age (HR, 1.117; P = .002), and for men, CAD (HR, 1.914; P = 02), age (HR, 1.103, P = < .001), worse PCS (HR, 1.089, P = .001), and worse Quality of Life Index-Cardiac Version score (HR, 1.402, P = .025) independently predicted mortality.One-year hospitalization (women, 38.9%; men, 36.4%) did not differ by gender (χ(2)1 = 0.914, P = .339). Different variables independently predicted 1-year hospitalization-for women: diabetes (odds ratio [OR], 2.359; P = .022), worse PCS (OR, 1.070; P = .003), and rhythm control trial arm (OR, 2.111; P = .006); for men: HF (OR, 2.072; P = .007), worse PCS (OR, 1.045; P = .019), living alone (OR, 1.913; P = .036), and rhythm control trial arm (OR, 2.113; P < .001). CONCLUSION: Only clinical status predicted mortality among women; HRQOL and clinical status predicted mortality among men. Both clinical and HRQOL variables predicted hospitalization for women and men. Increased monitoring of HRQOL and interventions designed to target the clinical and HRQOL predictors could impact mortality and hospitalization. Nursing interventions may prove effective for modifying most of the predictors of mortality and hospitalization for women and men with AF.

Does health-related quality of life predict hospitalization or mortality in patients with atrial fibrillation?

BACKGROUND: Poor health-related quality of life (QOL) is related to morbidity and mortality in coronary heart disease and ventricular arrhythmias as well as to mortality in patients with heart failure (HF) and atrial fibrillation (AF). This study examined the contributions of QOL to the prediction of 1-year hospitalization and mortality in patients with AF, independent of HF. METHODS: This study used the public use dataset from the NHLBI/NIH AFFIRM randomized clinical trial. Patients enrolled in the QOL substudy (N = 693) were randomly assigned to rate or rhythm control. QOL was assessed with the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and the Quality of Life Index-Cardiac Version (QLI-CV). Data were analyzed with logistic regression to predict 1-year hospitalization and Cox proportional hazards analysis to predict mortality. RESULTS: In the first year of participation in the study 37% (n = 256) were hospitalized; mortality was 14.3% (n = 93) with mean follow-up of 3.5 years. Patients' mean age was 69.8 ± 8.2 years, were largely male (62%), and white (93%). Patient histories included 70.8% hypertension, 38.2% coronary artery disease (CAD), and 23.7% HF. History of stroke, HF, rhythm control arm, lower SF-36 mental component scores (MCS), and lower SF-36 physical component scores (PCS) predicted hospitalization (P < 0.001). Diabetes, female gender, older age, CAD, hypertension, and lower PCS predicted mortality (P < 0.001). CONCLUSION: QOL adds meaningful information beyond traditional biomedical factors to the prediction of mortality and/or hospitalization of patients with AF. Interventions for improving QOL and helping patients adapt to AF treatments may decrease hospitalization and improve survival.

Longitudinal changes in coping for spouses of post-myocardial infarction patients.

Spouses are the key in the recovery and coping of patients after a myocardial infarction (MI). The purpose of this study was to examine changes in coping for spouses of post-MI patients over time. The study determined the contributions of a spouse's demographic factors and of time since the MI to the changes in coping. A secondary data analysis from the Patients' and Families' Psychological Response to Home Automated External Defibrillator Trial was conducted. On average, older spouses coped better than younger spouses. Coping significantly decreased over time. The spouse's coping decreased for spouses whose baseline coping was higher. Coping decreased more rapidly for spouses of patients who experienced an MI more recently. Patients and spouses need support to improve coping after an MI.

Application of pattern mixture models to address missing data in longitudinal data analysis using SPSS.

BACKGROUND: Longitudinal studies are used in nursing research to examine changes over time in health indicators. Traditional approaches to longitudinal analysis of means, such as analysis of variance with repeated measures, are limited to analyzing complete cases. This limitation can lead to biased results due to withdrawal or data omission bias or to imputation of missing data, which can lead to bias toward the null if data are not missing completely at random. Pattern mixture models are useful to evaluate the informativeness of missing data and to adjust linear mixed model (LMM) analyses if missing data are informative. OBJECTIVES: The aim of this study was to provide an example of statistical procedures for applying a pattern mixture model to evaluate the informativeness of missing data and conduct analyses of data with informative missingness in longitudinal studies using SPSS. METHODS: The data set from the Patients' and Families' Psychological Response to Home Automated External Defibrillator Trial was used as an example to examine informativeness of missing data with pattern mixture models and to use a missing data pattern in analysis of longitudinal data. RESULTS: Prevention of withdrawal bias, omitted data bias, and bias toward the null in longitudinal LMMs requires the assessment of the informativeness of the occurrence of missing data. DISCUSSION: Missing data patterns can be incorporated as fixed effects into LMMs to evaluate the contribution of the presence of informative missingness to and control for the effects of missingness on outcomes. Pattern mixture models are a useful method to address the presence and effect of informative missingness in longitudinal studies.

Changes in depressive symptoms in spouses of post myocardial infarction patients.

PURPOSE: To identify parsimonious models for changes in depression in spouses of post myocardial infarction (MI) patients over 2 years based on the biopsychosocial model. METHODS: A total of 442 community living patients who had experienced an MI and their spouses were included for analysis. Patients and spouses completed psychosocial assessments at baseline, 1 year, and 2 years after enrollment in the Patients' and Families' Psychological Response to Home Automated External Defibrillator Trial. Linear mixed models were used for testing hypotheses. RESULTS: A total of 15.2% (baseline), 11.5% (1-year follow up), and 8.1% (2-year follow up) of spouses were depressed. Spouse biological factors did not influence changes in depression. Among all spouses, two groups of spouses showed increased depression over time: spouses with lower baseline depression scores (p < .001), and spouses of patients who had higher baseline depression scores (p = .001). Among psychologically distressed (anxious or depressed) spouses, three groups of spouses showed increased depression over time: spouses who had lower baseline depression scores (p < .001), spouses who had more social support at baseline (p = .023), and spouses of patients who had higher baseline depression scores (p < .001). CONCLUSION: Spouse and patient baseline depression significantly predicted changes in depression for all spouses and psychologically distressed spouses. Among psychologically distressed spouses, higher baseline social support predicted higher depression scores over time. This study is an important step in understanding longitudinal changes in the psychological status of spouses of MI patients for evaluating the need for interventions. It is crucial that patient couples' psychosocial factors are continuously assessed.

Pets, depression and long term survival in community living patients following myocardial infarction.

Evidence supports the contribution of depression, anxiety, and poor social support to mortality of hospitalized myocardial infarction (MI) patients. The contribution of depression to survival is independent of disease severity. Pet ownership, a non-human form of social support, has also been associated with one year survival of post-MI patients. The current study addresses whether pet ownership contributes independently to long term survival beyond the contributions of depression, anxiety, or low social support in post-MI patients who have already survived at least 6 months. Data from patients (N = 460) enrolled in the "Psychosocial Responses in the Home Automated External Defibrillator Trial (PR-HAT)"were used. Seventeen patients died during a median follow-up of 2.8 years. In Cox proportional hazards regression model that included depression, lack of pet ownership, and the interaction between depression and lack of pet ownership, not owning a pet was the only significant independent predictor of mortality (p = 0.036). The interaction between pet ownership and depression tended to be significant indicating that the effect of pet ownership on survival in this group of people who have supportive spouses/companions living with them may relate to depression.

Changes in anxiety and depression over 2 years in medically stable patients after myocardial infarction and their spouses in the Home Automatic External Defibrillator Trial (HAT): a longitudinal observational study.

OBJECTIVE: To compare the long-term effects of cardiopulmonary resuscitation (CPR) training and CPR/automatic external defibrillator (AED) training on anxiety and depression of patients who were medically stable after myocardial infarction (MI) and of their spouses/companions. DESIGN: Longitudinal. PARTICIPANTS: Post-MI patients (N=460) and their spouses/companions from the Home Automatic External Defibrillator Trial. MAIN OUTCOME MEASURES: Depression (Beck Depression Inventory-II scores) and anxiety (State Trait Anxiety Inventory scores). RESULTS: At study entry, 25% of the patients and 15% of their spouses were depressed and 21% of the patients and 19% of the spouses were anxious. The prevalence of depression and anxiety did not change over time in the patients or their spouses. Average depression and anxiety decreased for patients but not for spouses. An intervention group did not contribute significantly to these changes. Psychological distress, indicated by depression or anxiety of the spouse or the patient, occurred in 191 couples. Among psychologically distressed patients (N=128), depression and anxiety decreased over time; the intervention group did not contribute to these changes. The reduction in anxiety among male patients was greater than in female patients (p=0.012, 95% CI 0.002 to 0.018). Among psychologically distressed spouses (N=118), depression decreased over time independently of the intervention. Changes in spouse anxiety depended on the intervention group (p=0.012, 95% CI 0.001 to 0.012); anxiety decreased significantly in the CPR and remained high in the CPR/AED group. CONCLUSION: There was no evidence that home AEDs caused psychological distress among patients. Even among those who were psychologically distressed when they were assigned to receive either CPR training or CPR/AEDs, home AEDs did not influence changes in patients' depression or anxiety or spouses' depression in comparison with CPR training. Among psychologically distressed spouses, AEDs may keep anxiety higher than it would be otherwise. Interventions to reduce anxiety of spouses who are psychologically distressed may be indicated when their partners receive an AED.

Anxiety and depression in implanted cardioverter-defibrillator recipients and heart failure: a review.

Although implanted cardioverter-defibrillators (ICDs) clearly reduce mortality, their effects on patients' psychological status is equivocal, with a substantial number of patients becoming depressed or anxious after ICD implantation. Significant numbers of ICD recipients, including those with heart failure (HF), remain anxious and depressed 1 year after ICD implantation. ICD recipients who are younger, female, and received ICD shocks are especially vulnerable to psychological distress. Screening for anxiety and depression is appropriate for all ICD recipients. Cognitive behavioral therapy and psychoeducational programs show promise for reducing psychological distress in ICD recipients with HF.

Quality of life predicts one-year survival in patients with implantable cardioverter defibrillators.

PURPOSE: This study examines the contributions of known predictors of survival and quality of life (QOL) to 1-year survival in ICD recipients. METHODS: This study used the data set from the antiarrhythmia versus implanted defibrillator (AVID) controlled clinical trial conducted by the National Institutes of Health, National Heart, Lung, and Blood Institute. The 507 patients randomly assigned to the ICD treatment were included in the analysis. Patients were mostly male (78.3%), with mean age of 64.85 +/- 10.81 and mean left ventricular ejection fraction of 32.2 +/- 13.45%. QOL was measured with the medical outcomes study 36-item short form health survey (SF-36) and quality of life index-cardiac version (QLI-CV). Data were analyzed with descriptive statistics and logistic regression. RESULTS: Fifty-four (10.6%) patients died in the first year after ICD implantation. Angiotensin-converting enzyme inhibitor (ACE) medication, age, and QLI-CV were significant independent predictors of 1-year survival. The odds of survival of a younger patient with ACE medication and good QOL were approximately three times (OR = 3.96) greater than for an older patient, without ACE medication and with poor QOL. CONCLUSION: Quality of life is an important factor predicting 1-year survival in patients with ICDs. ACE medication and younger age also predict 1-year survival independent of QOL and each other.