Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients: is there a link?

Abstract

Psychological vulnerability, ventricular tachyarrhythmias and mortality in implantable cardioverter defibrillator patients Pedersen, Susanne; Brouwers, Corline; Versteeg, Henneke

Posttraumatic stress and anxiety in patients with an implantable cardioverter defibrillator: Trajectories and vulnerability factors

“…Experienced shocks were not related to increased PTSD or anxiety symptom severity, indicating that demographic and psychological factors rather than experienced shocks are associated with risk of PTSD and anxiety symptoms. This is in line with other studies focusing on the prevalence of anxiety and PTSD symptoms . Current findings show that the prevalence of PTSD symptom severity (3 months: 10.5%; 6 months: 6.8%; 12 months: 6.9%) and anxiety (baseline 12%; 3 months 4%; 6 months 6%; 12 months 9%) decreases over time.…”

“…However, a subgroup of patients experience psychological distress and impaired quality of life post‐ICD implantation, which increase their risk for ventricular tachyarrhythmia and mortality independent of traditional risk factors and despite the state‐of‐the‐art treatment with the ICD …”

Attrition and Adherence in a Web-Based Distress Management Program for Implantable Cardioverter Defibrillator Patients (WEBCARE): Randomized Controlled Trial

“…These patients could be identified using brief and standardized questionnaires that are designed to assess psychological distress. Close monitoring of patients’ psychological needs is warranted as it has been associated with morbidity and mortality [11,12], and may help us to provide the right amount of care that is needed at the right time. Designing behavioral interventions with a collaborative care approach, where a period of “watchful waiting” is employed would perhaps be a way to go.…”

“…However, distress in patients may not necessarily be attributed to the device and ICD therapy, but also to the underlying disease [7,8] and patients’ pre-implantation psychological profile [9]. The importance of monitoring ICD patients for psychological distress is increasingly being recognized [10], likely due to risk for morbidity and mortality associated with patient distress [11,12] and due to preliminary evidence suggesting that distress is still undertreated in this population [13]. One possible explanation for this is the lack of well-designed, validated, randomized controlled trials (RCTs), leaving us with insufficient knowledge for the establishment of a sufficient evidence base to inform clinical practice [14].…”

Study Design and Cohort Description of DEFIB‐WOMEN: A National Danish Study in Patients with an ICD

“…Despite its unequivocal medical benefits, ICD therapy is associated with several challenges to patients, including procedure‐ and device‐related complications (e.g., infection, hematoma, inappropriate shocks, lead dislodgement, and hardware malfunction) and the psychological impact of living with a device . However, the majority of device patients are also faced with challenges imparted by their underlying heart disease and comorbidities, all of which may influence patients’ quality of life and risk of morbidity and mortality …”