Examining the psychosocial impact of implantable cardioverter defibrillators: A literature review

Abstract

SummaryBackground: The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life-threatening ventricular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well understood.Hyporhesis: The purposes of this paper are (1) to review the available literature documenting the psychosocial impact of the ICD on patients, (2) to hypothesize possible mechanisms for this psychosocial impact, and (3) to suggest clinical risk profiles and indications for psychological consultation.Methods: Electronic and library searches (e.g., MEDLINE, PsychLit) were used to gather studies examining the psychosocial impact of the ICD. Only studies investigating psychosocial outcomes (e.g., psychological distress, quality of life, social and role functioning), either prospectively or cross-sectionally, were admitted into the review. No literature reviews or secondary sources were included.

2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing

“…ICD shocks have also been associated with independent predictors of mortality in the large ALTITUDE registry of 3809 ICD recipients and in a metaanalysis of ICD trials in which ATP was applied [155,157]. Emotional morbidities associated with ICD shocks are well recognized and include anxiety, depression, and posttraumatic stress disorders [174][175][176]. Phantom shocks can result from fear and/or anxiety and have a reported incidence of 5% in a European study of ICD recipients over 35 months of follow-up [177].…”

Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs)

“…E. Ford & Kamerow, 1989). Similarly, the rates of depression and anxiety in patients with ICDs are high, but comparable to other cardiac disease populations(Sears, Todaro, Lewis, Sotile, & Conti, 1999; W. Whang et al, 2005) found that 14% of a sample of ICD patients were categorized as mildly depressed, while 3.9% were moderately to severely depressed, with depression significantly predicting risk for an ICD shock.…”

“…In particular, more experiences of anxiety, fatigue, and confusion and fewer experiences of energy increased the possibility of an arrhythmia event. Anxiety symptoms may be the most universal yet debilitating experience of the ICD patient; 24–87% of ICD recipients experienced increased anxiety as a result of ICD implantation, with approximately 13–38% meeting criteria for clinically significant anxiety disorders (Sears et al, 1999). Individuals with insomnia may also experience impaired daytime functioning, such as fatigue and excessive daytime sleepiness (K.…”

“…In patients with ICDs, the severity of mood disturbance is found to predict risk for shock (William Whang et al, 2005) and likelihood of cardioversion or tachycardia pacing (Dunbar et al, 1999). Anxiety symptoms may be the most universal yet debilitating experience of the ICD patient; 24–87% of ICD recipients experienced increased anxiety as a result of ICD implantation, with approximately 13–38% meeting criteria for clinically significant anxiety disorders (Magyar-Russell et al, 2011; Sears et al, 1999). …”

Development and feasibility testing of decision support for patients who are candidates for a prophylactic implantable defibrillator: a study protocol for a pilot randomized controlled trial

“…A considerable body of evidence gathered from ICD recipients suggests that psychosocial factors, including depression [33], anxiety [34-37] and personality [38,39] are associated with patient reported outcomes. Patients who receive shocks from the ICD report reductions in health-related quality of life (HRQL) [40,41].…”