Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator

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Published on: February 28, 2012

Elena Salmoirago-Blotcher1, Ira S Ockene

  • 1University of Massachusetts Medical School, 55 Lake Ave Worcester, MA 01655-0002, USA. Elena.Salmoirago-Blotcher@umassmed.edu

BMC Cardiovascular Disorders
|December 31, 2009
PubMed

Insights

Psychosocial interventions show promise for improving anxiety and physical functioning in implantable cardioverter-defibrillator (ICD) patients. However, methodological limitations necessitate cautious interpretation and larger, well-designed future studies.

Area of Science:

  • Cardiology
  • Psychology
  • Health Services Research

Background:

  • Implantable cardioverter-defibrillators (ICDs) save lives but can cause emotional distress in patients.
  • Existing psychosocial interventions aim to mitigate this distress, but their effectiveness is questioned due to methodological flaws.

Purpose of the Study:

  • To critically evaluate the methodology of psychosocial intervention studies in ICD patients.
  • To provide recommendations for future research based on CONSORT guidelines for non-pharmacological interventions.

Main Methods:

  • Systematic electronic search of PubMed, PsycInfo, and Cochrane databases (1980-2008).
  • Inclusion of peer-reviewed experimental studies involving adult populations.

Main Results:

  • Twelve studies were included, featuring small sample sizes and heterogeneous interventions (e.g., cognitive behavioral therapy, exercise).
  • Positive effects were observed for anxiety and depression, with cognitive behavioral therapy being most effective.
  • No significant impact on shocks or arrhythmic events was detected; physical functioning improved in evaluated studies.
  • Common limitations included lack of detail on ICD indication, concomitant medications, treatment fidelity, and patient adherence.

Conclusions:

  • Preliminary evidence suggests psychosocial interventions can benefit anxiety and physical functioning in ICD patients.
  • Methodological limitations require cautious interpretation of current findings.
  • Future research should prioritize large randomized controlled trials (RCTs) addressing the complexities of behavioral intervention evaluation.
Abstract

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