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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Behavioral interventions in patients with an implantable cardioverter defibrillator: lessons learned and where to go
Mirela Habibović1, Matthew M Burg, Susanne S Pedersen
1CoRPS - Department of Medical and Clinical Psychology, Tilburg University, The Netherlands.
Insights
Behavioral interventions can reduce psychological distress in implantable cardioverter defibrillator (ICD) patients. Future research should focus on large, individualized trials rather than a one-size-fits-all approach.
Area of Science:
- Cardiology
- Psychology
- Behavioral Science
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac death.
- Some patients experience significant psychological distress after ICD implantation.
- Current evidence for addressing this distress is limited.
Purpose of the Study:
- To critically review existing behavioral interventions for ICD patients.
- To identify effective strategies for managing psychological distress.
- To propose future research directions based on current trials.
Main Methods:
- Systematic literature search of PubMed and PsycInfo databases.
- Inclusion of behavioral trials targeting distress in ICD patients (1980-2012).
- Analysis of 17 identified trials.
Main Results:
- Behavioral interventions generally reduced anxiety and depression compared to usual care.
- Effect sizes for anxiety and depression reduction ranged from small to large.
- Limitations include small sample sizes and potential selection bias.
Conclusions:
- Behavioral interventions show promise for reducing distress in ICD patients.
- Larger, individualized intervention trials are needed.
- A "one size fits all" approach is not suitable for all ICD patients.
Background:
The implantable cardioverter defibrillator (ICD) is the first-line treatment for primary and secondary prevention of sudden cardiac death. A subgroup of patients experience psychological distress postimplant, and no clear evidence base exists regarding how best to address patients' needs. The aim of this critical review is to provide an overview of behavioral interventions in ICD patients to date, and to delineate directions for future research using lessons learned from the ongoing RISTA and WEBCARE trials.
Methods:
We searched the PubMed and PsycInfo databases to identify reports of behavioral trials targeting distress and related factors in ICD patients published between 1980 and April 2012.
Results:
We identified 17 trials for the review. Generally, compared to usual care, behavioral interventions were associated with reduced anxiety and depression and improved physical functioning, with effect sizes ranging from small to moderate-large (0.10-1.79 for anxiety; 0.23-1.20 for depression). Important limitations were small sample sizes and potential selection bias, hampering generalizability of the results. In addition to a need for larger trials, experiences from the RISTA and WEBCARE trials suggest that intervention trials tailored to the individual patient may be the way forward.
Conclusions:
Behavioral interventions show promise with respect to reducing distress in ICD patients. Large-scale intervention trials targeted to the individual needs and preferences of patients are warranted, as a "one size fits all" approach is unlikely to work for all ICD patients.
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