Family Matters: Research and Clinical Management of Psychosocial Issues for ICD Patients and their Partners

Abstract

The success of the implantable cardioverter defi brillator (ICD) in several large -scale randomized trials has established the ICD as the treatment of choice in detecting and treating ventricular arrhythmias (AVID Investigators 1997 ;Moss et al. 2002 ;Bardy et al. 2005 ). Patientreported outcomes encompassing psychosocial and quality of life (QOL) outcomes have generally been positive and desirable. Nonetheless, living successfully with the risk of spontaneous, potentially life -threatening arrhythmias and the resulting, life -saving high -energy shocks presents challenges to a sizable minority of patients and their families. ICDs save lives in at -risk patients, but the ongoing need for comprehensive, biopsychosocial care plans addressing the range of issues for both patients and families has been a challenge in electrophysiology clinics. Researchers have been stimulated by this modern -day scenario to describe, predict, and treat the potential for general psychological distress (i.e., anxiety and depression) and avoidance behaviors in ICD patients. More recent research has added the perspective of ICD family members, such as partners/spouses/ signifi cant others, to better understand the collective adjustment challenges. Preliminary fi ndings indicate that this may be particularly needed as ICD spouses experience signifi cant distress as well. The purpose of this chapter is to review the overall psychosocial and QOL impact of ICDs on patients and their partners. Clinical management strategies and approaches will also be discussed.