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Psychosocial outcome after ICD implantation: a current perspective
S S Heller1, M A Ormont, L Lidagoster
1Psychiatric Consultation-Liaison Service, St. Luke's Roosevelt Hospital Center, New York, New York, USA.
Pacing and Clinical Electrophysiology : PACE
|June 20, 1998
Summary
Implantable cardioverter-defibrillator (ICD) placement impacts quality of life, with many patients experiencing depression and reduced sexual function. ICD shocks significantly increase negative emotions like sadness and anxiety.
Area of Science:
- Cardiology
- Psychology
- Quality of Life Research
Background:
- Implantable cardioverter-defibrillator (ICD) placement is associated with psychological distress, including depression and sexual dysfunction.
- Patient quality of life (QoL) following ICD implantation requires comprehensive evaluation beyond mere device efficacy.
Purpose of the Study:
- To investigate the impact of ICD implantation and subsequent defibrillator discharges on various quality-of-life measures.
- To identify specific factors correlating with patient satisfaction and psychological well-being post-ICD.
Main Methods:
- A confidential biopsychosocial questionnaire was administered to 58 patients who had previously undergone ICD implantation.
- Patient-reported outcomes including depression, sexual functioning, anger, worry, and perceived health were assessed.
- Statistical analyses, including correlation and odds ratio calculations, were used to determine relationships between ICD events and QoL.
Main Results:
- Positive attitudes toward ICDs increased post-implantation. Satisfaction correlated with reduced anger, worry about device size, sadness, and better perceived health.
- 20%-58% of patients reported depression, 45% experienced reduced sexual frequency, and 62% had increased health concerns despite successful implantation.
- Experiencing one or more ICD shocks strongly correlated with increased anxiety, sadness, health worry, and reduced engagement in new activities. Multiple shocks amplified these negative emotional and physical concerns.
Conclusions:
- ICD implantation significantly influences patient quality of life, often leading to paradoxical increases in health concerns.
- Defibrillator discharges are strongly associated with negative emotional states, including sadness, anxiety, and nervousness.
- Support groups are highly beneficial for patients, with 96% finding them very helpful.