Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

Sears, Samuel F.; Conti, Jamie B.

doi:10.1002/clc.4960260303

Cited by 150 publications

(123 citation statements)

References 28 publications

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“…For a more complex discussion of the presentation and management of general anxiety and depression in ICD patients, please refer to Sears and Conti. 26 The Value of a PTSD Diagnosis: Theoretical…”

Section: Prevalence and Clinical Impact Of Ptsdmentioning

confidence: 99%

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Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Sears

Hauf

Kirian

et al. 2011

Circ: Arrhythmia and Electrophysiology

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117

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he implantable cardioverter-defibrillator (ICD) has revolutionized the care of patients at risk for life-threatening arrhythmias. Large-scale clinical trials established mortality benefits for the ICD over usual care or medications 1,2 and led to wider use for both primary and secondary prevention indications. More recent research confirms that the mortality benefits of the ICD extend over 8-year follow-up when compared with usual care. 3 These clinical trial successes, in terms of mortality, have allowed for greater focus on patientcentered outcomes, such as quality of life, device acceptance, psychological well-being, and trauma reactions in research and clinical care. 4 Shock has been a primary focus in this work because of its potentially traumatic impact on the patient experience. Although there is mixed evidence on the effect of single ICD shocks, 5,6 the literature consistently supports the negative impact of Ͼ5 shocks on quality of life and emotional distress. 7,8 ICD shock has been a focus of research interest because it is a unique experience for the ICD patient and can be perceived as a traumatic event. In addition, the existence of concomitant heart disease, angina, congestive heart failure, or previous sudden death may create sensitivity to traumatic stress that warrants improved understanding by attending electrophysiologists. Although psychological distress in ICD patients has been explored, the possibility that some ICD patients have trauma reactions, up to and including posttraumatic stress disorder (PTSD), has garnered increased attention recently. Therefore, the purposes of this report are to highlight the theory and research addressing psychological distress including PTSD in electrophysiology clinics, to discuss clinical management of these sequelae, and to suggest areas of future research and development. Psychosocial Distress of ICD Patients in Electrophysiology ClinicsPrevention and identification of distress in ICD patients represents comprehensive, high-quality care, regardless of the cause (eg, depression, anxiety, trauma), consistent with the biopsychosocial model of care. 9 This model of care entails the conceptualization and treatment of health problems as an interplay between biological factors, psychological factors, and social factors culminating in the manifestation of symptoms. For an electrophysiologist, these ambitious goals can include prevention of distress through cardiac care and education, recognition of distress warranting referral, optimizing quality-of-life (QoL) outcomes, and promoting patient acceptance of the ICD. Clearly, these are not easily accomplished without sufficient awareness, clinical support, and interdisciplinary expertise. Below are some key considerations for daily clinical practice. Prevalence and Impact of Psychosocial DistressGeneral or ICD-specific anxiety as a psychological morbidity has a point prevalence of 13% to 38% of ICD recipients in cross-sectional research. 4 Longitudinal assessment of anxiety has indicated that approximately 35% of pati...

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Section: Prevalence and Clinical Impact Of Ptsdmentioning

confidence: 99%

“…26,32 These risk markers provide the clinician with an initial method of identifying patients who may warrant further assessment of psychosocial distress.…”

Section: Clinical Management Of Psychosocial Distress Identification mentioning

confidence: 99%

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Sears

Hauf

Kirian

et al. 2011

Circ: Arrhythmia and Electrophysiology

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117

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“…17 Recent research has also identified other factors salient to quality of life in ICD recipients in addition to anxiety and depression, as evidenced by the fact that approximately 32% of recent articles have examined these constructs. Recipients of ICDs who are female or young (< 50 years of age) are more likely to develop anxiety, depression, or other distress symptoms.…”

Section: Patient Factors In Implantable Cardioverter Defibrillator Rementioning

confidence: 99%

“…16,18 Patients who experience a greater number of shock discharges, whether cumulatively across time or within short periods of "ICD Storm," (≥ three shocks in 24 h) are also more likely to experience such symptoms that lower quality of life. 17,19,20,21 As ICD recipients have a more optimistic disposition and higher positive expectations for undergoing ICD therapy, their quality of life is either maintained or improves. 22 Also, patients with ICDs who adopt catastrophic cognitions regarding their cardiac functioning experience higher rates of anxiety specific to a fear of being shocked.…”

Section: Patient Factors In Implantable Cardioverter Defibrillator Rementioning

confidence: 99%

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

Stutts

Cross

Conti

et al. 2007

Clinical Cardiology

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SummaryBackground: The implantable cardioverter defibrillator (ICD) is the most effective treatment available for terminating potentially life-threatening ventricular tachycardia and ventricular fibrillation and reducing the risk of mortality. Despite its established health benefits, ICD therapy is accompanied by a unique array of patient and psychological factors meriting ample research attention. The purpose of this paper is to examine research trends and results regarding patient factors in cardiac and ICD research and to discuss key areas for future research.Hypothesis: An increase in articles associated with patient factors in cardiac and ICD research will be shown over time.Methods: The Medical Subject Heading (MeSH) system in PubMed was used to index articles under a range of psychosocial headings for both cardiovascular disease and ICDs to quantify the frequency of articles published across time, the journals most frequently utilized, the most productive institutions, and the most common areas of inquiry.Results: A significant positive relationship was revealed between patient factors in cardiac research (r = 0.96, p < 0.01)

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“…Adults with ICDs have significantly higher levels of depression and anxiety, [1][2][3][4][5] and frequent ICD discharges in adults have been associated with even higher risk for depression and anxiety. 6 However, studies on children and adolescents with ICDs are limited. [7][8][9][10][11] DeMaso and colleagues 12 found changes in scores for anxiety, depression, family functioning, and quality of life (QoL) in pediatric patients with ICDs (20 patients).…”

mentioning

confidence: 99%

Psychiatric Functioning and Quality of Life in Young Patients With Cardiac Rhythm Devices

Webster

Panek²,

Labella

et al. 2014

Pediatrics

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BACKGROUND: Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices. METHODS: A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years). RESULTS: Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population. CONCLUSIONS: Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.

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Understanding implantable cardioverter defibrillator shocks and storms: Medical and psychosocial considerations for research and clinical care

Cited by 150 publications

References 28 publications

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient

Examination of Research Trends on Patient Factors in Patients with Implantable Cardioverter Defibrillators

Psychiatric Functioning and Quality of Life in Young Patients With Cardiac Rhythm Devices

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