Psychopathology in patients with ICDs over time: results of a prospective study

The effects of implantable cardioverter defibrillators (ICDs) and ICD shocks on psychological state have previously been studied. However, it is still unclear how health-related quality-of-life changes over time using standardized assessments. We sought to characterize the effects of ICDs and ICD shocks on psychological outcomes.

Three hundred-eight patients receiving ICDs were prospectively identified. Baseline QOL assessments including standardized psychological surveys [Hospital Anxiety and Depression Scale (HADS), Impact of Events Scale-Revised (IES-R), and Short Form 36 Health Survey (SF-36)] were obtained within 2 months of device implantation and at 6 and 12 months, respectively. Outcomes including ICD shocks were followed over the 12-month study period.

The number of patients meeting criteria for anxiety or posttraumatic stress disorder (PTSD) at baseline (78/223, 35%) was higher than at 6 (34/223, 15%) or 12 (34/223, 15%) months (P < 0.01). There was a significant improvement over time in HADS (P < 0.001) and IES-R (PTSD) scores (P < 0.001). Amongst the 20 patients who received ICD shocks, no significant differences were observed in IES-R, SF-36, or HADS scores when compared with those who did not receive shocks at any time point. Patients who experienced electrical storms (N = 5) had significantly higher baseline PTSD scores (29.6 +/- 11.4 vs 14.6 +/- 11.6, P < 0.01).

Patients receiving ICDs have significant rates of baseline psychopathology after implantation. However, psychological assessment scores tend to improve with time. ICD shocks do not appear to significantly impact psychological state. These results suggest the importance of close screening and referral for possible psychopathology in patients receiving ICDs, especially in the peri-implant period.