Living with an Implantable Cardioverter Defibrillator (ICD) in Middle East: A Narrative Synthesis
Creators: name: Alahmari, Waleed
name: Mitchell, Gary
Publisher: name: OSF Registries
Year: 2024
Subjects: subject: Medicine and Health Sciences
subject: Health
subject: ICD
subject: Implantable Cardioverter Defibrillator
subject: Middle East
subject: Narrative Review

description: Review Question
What are the experiences for people living with implantable cardioverter defibrillators (ICDs) in the Middle Eastern region.

Review Objective
• To explore experiences of people living with an implantable cardioverter defibrillator (ICDs) in the Middle Eastern region.

Method
A narrative approach will be used for this study to explore and synthesise experiences of people living with an implantable cardioverter defibrillator (ICD) in the Middle Eastern region. The narrative approach offers a flexible framework that allows for an in-depth exploration of qualitative and quantitative studies. The narrative approach is particularly suitable when there is heterogeneity among study designs and outcomes and is often encountered when studying subjective experiences such as patient satisfaction or quality of life.

Eligibility criteria 
All The studies will be selected if they meet the following criteria:
• Primary research studies (including qualitative and quantitative research) on experiences of people living with ICD in Middle East. 
• Adult patients with an ICD (≥ 18 years of age). 
• Studies based on the experiences of people with an ICD, including perspectives from family/carers or professionals.
• Published in English language.
• Published between 1st January 2014 and 31st December 2023.

Exclusion criteria
The studies will be excluded if they do not meet the Inclusion criteria: 
• Secondary studies (including commentaries, discussion pieces or other non-peer reviewed evidence). 
• Studies that do not focus on patients with an ICD.
• Studies done in participant under 18 years of old. 
• Not published in English. 
• Studies Published before January 1st 2014.

Outcome of interest
This review’s primary outcomes of interest are to determine: 
• The experiences for people living with implantable cardioverter defibrillators (ICDs) in the Middle Eastern region and includes psychological impact, quality of life measures, social support needs and cultural factors.

Search strategy
A search strategy will conduct using the electronic databases MEDLINE, CINHAL PubMed, Embase, and APA PsycInfo. Each database provides a well-established multi-disciplinary platform that contains indexed citations and abstracts from a range of peer-reviewed journals concerning medical, nursing, and health care science topics. Covidence software will be used as a review management tool. An extensive search of electronic databases, all titles and abstracts retrieved by electronic searching will be downloaded to a reference management database (Covidence Reference Manager). To ensure a comprehensive search strategy, various search terms comprising Medical Subject Headings (MeSH), database-specific subject headings, and keywords as follow: " patients living with implantable cardioverter defibrillators (ICDs)”, "ICD ", " experiences ", "Cardiovascular patients" keywords “Middle East" "patient with ICD in Middle East ". The search includes the keywords independently, different combinations of the keywords, and a combination of the keywords together. Any duplicates in studies will be removed and all the studies will be considered regardless of the publication date. 

Data extraction 
Following the retrieval of all identified studies and the removal of duplicate publications, the chosen studies will be examined by two reviewers (WA &amp; GM), first based on their title and abstract, and then based on their full text. To find more acceptable studies, the reference lists of chosen articles will be manually searched. Following the selection of eligible studies, prepared tables will be used to manually extract the necessary data. This comprises the data and the year of publication, the first author, the study design, the inclusion and exclusion criteria, and the baseline patient characteristics (number of patients, age, gender, published years, authors, study design, sample size, geographical location, regions, and study limitations). A third reviewer (DF) will manage any conflicts for inclusion.
 
Risk of bias - quality assessment
The quality assessment will involve evaluating aspects such as study design, sample size, data collection methods, data analysis techniques, and reporting transparency. Moreover, the quality assessment will be conducted using established tool. The CASP tool will be used to critically appraise each study's strengths and limitations to ensure that only high-quality and relevant studies are included in the review.

Data Analysis
This method will involve organising findings from included studies and describing patterns across them to explore relationships among the data. WA will utilise a diary to record and reflect on the synthesis process, promoting reflexivity and transparency in the review. The data synthesis will occur in three phases. In the first phase, data extraction will involve systematically summarizing each selected study using the JBI Template Source of Evidence Details. This will facilitate a preliminary synthesis wherein details of each study will be presented in a consistent order, allowing for the identification of potential relationships and differences between them. During the second phase (Phase 2), a thematic analysis of the study findings will take place, and finally, in Phase 3, descriptive themes will be formulated, revised, and transformed into three overarching themes.