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Singh SM, Murray B, Tichnell C, McClellan R, James CA, Barth AS. Anxiety and depression in inherited channelopathy patients with implantable cardioverter-defibrillators. Heart Rhythm O2 2021; 2:388-393. [PMID: 34430944 PMCID: PMC8369306 DOI: 10.1016/j.hroo.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background Implantable cardioverter-defibrillators (ICDs) are an effective treatment in some patients with inherited heart disease, including inherited channelopathies, yet they have also been shown to impact patients' psychological health. Objective We sought to improve understanding of the level of anxiety and depression as well as device acceptance among inherited channelopathy patients with an ICD. Methods Eligible patients seen at Johns Hopkins Hospital were sent a survey, which included the Hospital Anxiety and Depression Scale (HADS), Cardiac Anxiety Questionnaire (CAQ), and the Florida Patient Acceptance Survey (FPAS). Student t tests and χ2 tests were used to identify associations with abnormal anxiety and depression scores. Results Among eligible patients (n = 65), 32 individuals (49%) completed the survey. The rate of device-related complications was 34%, and 41% of patients experienced 1 or more ICD shocks. Twelve patients (38%) had an abnormal HADS anxiety subscore and 5 patients (16%) had an abnormal HADS depression subscore (score ≥ 8). Secondary-prevention ICDs were associated with an abnormal HADS anxiety subscore (P = .03). Experiencing ICD shock(s), device complications, age, sex, and family history of sudden cardiac death were not statistically associated with anxiety or depression. Overall, respondents demonstrated high device acceptance by FPAS (79.9 ± 2.9, maximum total score 100) and moderately high cardiac-specific anxiety by CAQ total score (1.53 ± 0.12). Conclusion A high prevalence of generalized anxiety was identified among inherited channelopathy patients with ICDs. High device acceptance and lack of association with ICD shocks or complications indicate that further research is necessary to understand this increased incidence.
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Affiliation(s)
- Sajya M Singh
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brittney Murray
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Crystal Tichnell
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca McClellan
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cynthia A James
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andreas S Barth
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kindermann I, Wedegärtner SM, Bernhard B, Ukena J, Lenski D, Karbach J, Schwantke I, Ukena C, Böhm M. Changes in quality of life, depression, general anxiety, and heart-focused anxiety after defibrillator implantation. ESC Heart Fail 2021; 8:2502-2512. [PMID: 34047078 PMCID: PMC8318491 DOI: 10.1002/ehf2.13416] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 12/28/2022] Open
Abstract
Aims The Anxiety‐CHF (Anxiety in patients with Chronic Heart Failure) study investigated heart‐focused anxiety (HFA, with the dimensions fear, attention, and avoidance of physical activity), general anxiety, depression, and quality of life (QoL) in patients with heart failure. Psychological measures were assessed before and up to 2 years after the implantation of an implantable cardioverter defibrillator (ICD) with or without cardiac resynchronization therapy defibrillator (CRT‐D). Methods and results One hundred thirty‐two patients were enrolled in this monocentric prospective study (44/88 CRT‐D/ICD, mean age 61 ± 14 years, mean left ventricular ejection fraction 31 ± 9%, and 29% women). Psychological assessment was performed before device implantation as well as after 5, 12, and 24 months. After device implantation, mean total HFA, HFA‐fear, HFA‐attention, general anxiety, and QoL improved significantly. Depression and HFA‐related avoidance of physical activity did not change. CRT‐D patients compared with ICD recipients and women compared with men reported worse QoL at baseline. Younger patients (<median of 63 years) had higher levels of general anxiety and lower levels of HFA‐avoidance at baseline than older patients. After 24 months, groups no longer differed from each other on these scores. Patients with a history of shock or anti‐tachycardia pacing (shock/ATP; N = 19) reported no improvements in psychological measures and had significantly higher total HFA and HFA‐avoidance levels after 2 years than participants without shock/ATP. Conclusions Anxiety and QoL improved after device implantation, and depression and HFA‐avoidance remained unchanged. HFA may be more pronounced after shock/ATP. Psychological counselling in these patients to reduce HFA and increase physical activity should be considered.
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Affiliation(s)
- Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Sonja Maria Wedegärtner
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Benedikt Bernhard
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Julia Ukena
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Denise Lenski
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Julia Karbach
- Department of Psychology, University of Koblenz and Landau, Landau, Germany
| | - Igor Schwantke
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Christian Ukena
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
| | - Michael Böhm
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Kirrbergerstraße 100, Homburg, Saarland, 66421, Germany
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Validity of the newly developed 4-item ANXiety-scale in patients with an implantable cardioverter defibrillator: A 12-month follow-up study. J Psychosom Res 2020; 133:110106. [PMID: 32259765 DOI: 10.1016/j.jpsychores.2020.110106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subclinical anxiety symptoms are associated with risk of impaired mental and physical health status, ventricular tachyarrhythmias and mortality, in patients with an implantable cardioverter defibrillator (ICD). This study evaluates the validity of the brief and new 4-item Anxiety Scale (ANX4) and its predictive value in relation to health status 12-months post ICD implantation. METHODS A total of 288 ICD patients completed the ANX4 questionnaire. Factor analysis was performed to assess the validity of the scale. In a subsample of N = 212 patients, regression analysis was performed to assess questionnaires' predictive value of health status at 12-months follow-up. RESULTS Analyses of the ANX4 revealed a one-factor structure with a high internal consistency (α = 0.894). The ANX4 correlated significantly with existing generic and disease specific measures of anxiety symptoms STAI-S (r = 0.62), GAD-7 (r = 0.58), HADS-A (r = 0.66) and ICD related concerns (ICDC) (r = 0.44). Baseline anxiety symptoms were associated with lower levels of physical (β = -0.276; p < .001) and mental (β = -0.551; p < .001) health status 12-months post ICD implantation, adjusting for demographic and clinical variables. CONCLUSIONS The 4-item ANX4 shows to be a valid measure of anxiety symptoms in ICD patients and predicts physical and mental health status up to 12 months follow-up. Further studies are warranted to replicate these findings, determine the cut-off score for clinical relevant symptoms, and whether the ANX4 can be used in other populations.
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Rosman L, Salmoirago-Blotcher E, Cahill J, Sears SF. Psychosocial Adjustment and Quality of Life in Patients With Peripartum Cardiomyopathy. J Cardiovasc Nurs 2020; 34:20-28. [PMID: 30273257 DOI: 10.1097/jcn.0000000000000518] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Psychological distress can adversely affect heart failure prognosis, yet the immediate and ongoing challenges faced by women diagnosed with peripartum cardiomyopathy (PPCM) are not well studied. OBJECTIVE We examined psychological distress and quality of life in a large, national sample of patients with PPCM and evaluated whether these characteristics differ among newly diagnosed (0-1 year), short-term (2-4 years), and long-term (5-10 years) survivors. METHODS One hundred forty-nine patients with PPCM (mean age, 33.9 ± 5.0 years) recruited from a web-based registry completed questionnaires about generalized anxiety (Generalized Anxiety Disorder-7), cardiac anxiety (Cardiac Anxiety Questionnaire [CAQ]), health status (Medical Outcomes Study Short-Form 12 [SF-12] Health Survey), and PPCM-specific quality-of-life concerns. Group differences were evaluated using multivariate statistics with adjustments for disease severity and psychiatric history. RESULTS Generalized anxiety symptoms higher than the clinical cutoff were reported by 53% of patients with PPCM. Mean scores on the CAQ (1.9 ± 0.7) and CAQ subscale scores (cardiac-specific fear [2.1 ± 0.8], avoidance [1.7 ± 0.9], and heart-focused attention [1.6 ± 0.8]) were elevated in the overall sample. Psychological symptoms and quality-of-life concerns were generally similar across patients except for cardiac avoidance, which was significantly higher in newly diagnosed women after adjustments for disease severity (P = .05) and psychiatric history (P = .01). Peripartum cardiomyopathy-specific quality-of-life concerns were also prevalent; however, group differences were nonsignificant (P = .07). CONCLUSIONS Generalized anxiety, cardiac anxiety, and quality-of-life concerns are prevalent among patients with PPCM at all stages of recovery. Psychological issues may be an underrecognized aspect of women's recovery from PPCM.
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Affiliation(s)
- Lindsey Rosman
- Lindsey Rosman, PhD Research Fellow, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. Elena Salmoirago-Blotcher, MD, PhD Assistant Professor, Department of Medicine, Brown University Medical School & The Miriam Hospital, Providence, Rhode Island. John Cahill, MD Associate Professor, Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina. Samuel F. Sears, PhD Professor, Departments of Cardiovascular Sciences and Psychology, East Carolina University, Greenville, North Carolina
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Rosman L, Whited A, Lampert R, Mosesso VN, Lawless C, Sears SF. Cardiac anxiety after sudden cardiac arrest: Severity, predictors and clinical implications. Int J Cardiol 2014; 181:73-6. [PMID: 25482282 DOI: 10.1016/j.ijcard.2014.11.115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Survival from cardiac arrest is a medical success but simultaneously produces psychological challenges related to perception of safety and threat. The current study evaluated symptoms of cardiac-specific anxiety in sudden cardiac arrest (SCA) survivors and examined predictors of cardiac anxiety secondary to cardiac arrest. METHODS A retrospective, cross-sectional study of 188 SCA survivors from the Sudden Cardiac Arrest Association patient registry completed an online questionnaire that included a measure of cardiac anxiety (CAQ) and sociodemographic, cardiac history, and psychosocial adjustment data. CAQ scores were compared to published means from implantable cardioverter defibrillator (ICD), inherited long QT syndrome (LQTS), and hypertrophic cardiomyopathy (HCM) samples and a hierarchical regression was performed. RESULTS Clinically relevant cardiac anxiety and cardioprotective behaviors were frequently endorsed and 18% of survivors reported persistent worry about their heart even when presented with normal test results. Compared to all other samples, SCA survivors reported significantly higher levels of heart-focused attention (d=0.3-1.1) and greater cardiac fear and avoidance behaviors than LQTS patients. SCA patients endorsed less severe fear and avoidance symptoms than the HCM sample. Hierarchical regression analyses revealed that younger age (p=0.02), heart murmur (p=0.02), history of ICD shock≥1 (p=0.01), and generalized anxiety (p=0.008) significantly predicted cardiac anxiety. The overall model explained 29.2% of the total variance. CONCLUSIONS SCA survivors endorse high levels of cardiac-specific fear, avoidance and preoccupation with cardiac symptoms. Successful management of SCA patients requires attention to anxiety about cardiac functioning and security.
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Affiliation(s)
- Lindsey Rosman
- East Carolina University, Department of Psychology, United States
| | - Amanda Whited
- East Carolina University, Department of Psychology, United States
| | | | | | | | - Samuel F Sears
- East Carolina University, Department of Psychology, United States; East Carolina University, Department of Cardiovascular Sciences, United States.
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Toise SC, Sears SF, Schoenfeld MH, Blitzer ML, Marieb MA, Drury JH, Slade MD, Donohue TJ. Psychosocial and cardiac outcomes of yoga for ICD patients: a randomized clinical control trial. Pacing Clin Electrophysiol 2014; 37:48-62. [PMID: 23981048 PMCID: PMC4524735 DOI: 10.1111/pace.12252] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 01/14/2023]
Abstract
BACKGROUND Because as many as 46% of implantable cardioverter defibrillator (ICD) patients experience clinical symptoms of shock anxiety, this randomized controlled study evaluated the efficacy of adapted yoga (vs usual care) in reducing clinical psychosocial risks shown to impact morbidity and mortality in ICD recipients. METHODS Forty-six participants were randomized to a control group or an 8-week adapted yoga group that followed a standardized protocol with weekly classes and home practice. Medical and psychosocial data were collected at baseline and follow-up, then compared and analyzed. RESULTS Total shock anxiety decreased for the yoga group and increased for the control group, t(4.43, 36), P < 0.0001, with significant differences between these changes. Similarly, consequential anxiety decreased for the yoga group but increased for the control group t(2.86,36) P = 0.007. Compared to the control, the yoga group had greater overall self-compassion, t(-2.84,37), P = 0.007, and greater mindfulness, t(-2.10,37) P = 0.04, at the end of the study. Exploratory analyses utilizing a linear model (R(2) = 0.98) of observed device-treated ventricular (DTV) events revealed that the expected number of DTV events in the yoga group was significantly lower than in the control group (P < 0.0001). Compared to the control, the yoga group had a 32% lower risk of experiencing device-related firings at end of follow-up. CONCLUSIONS Our study demonstrated psychosocial benefits from a program of adapted yoga (vs usual care) for ICD recipients. These data support continued research to better understand the role of complementary medicine to address ICD-specific stress in cardiac outcomes.
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Affiliation(s)
- Stefanie C.F. Toise
- Yale New Haven Hospital, Saint Raphael Campus, New Haven, Connecticut, Greenville, North Carolina
| | - Samuel F. Sears
- Department of Psychology and Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
| | - Mark H. Schoenfeld
- Yale New Haven Hospital, Saint Raphael Campus, New Haven, Connecticut, Greenville, North Carolina
- Yale School of Medicine, New Haven, Connecticut
| | - Mark L. Blitzer
- Yale New Haven Hospital, Saint Raphael Campus, New Haven, Connecticut, Greenville, North Carolina
| | - Mark A. Marieb
- Yale New Haven Hospital, Saint Raphael Campus, New Haven, Connecticut, Greenville, North Carolina
- Yale School of Medicine, New Haven, Connecticut
| | - John H. Drury
- Banner Health Cardiovascular Institute of North Colorado, Greeley, Colorado
| | - Martin D. Slade
- Yale Occupational & Environmental Medicine, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - Thomas J. Donohue
- Yale New Haven Hospital, Saint Raphael Campus, New Haven, Connecticut, Greenville, North Carolina
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Sears SF, Hauf JD, Kirian K, Hazelton G, Conti JB. Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient. Circ Arrhythm Electrophysiol 2011; 4:242-50. [PMID: 21505176 DOI: 10.1161/circep.110.957670] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F. Sears
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jessica D. Hauf
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Kari Kirian
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Garrett Hazelton
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jamie B. Conti
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
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van den Broek KC, Nyklícek I, van der Voort PH, Alings M, Meijer A, Denollet J. Risk of ventricular arrhythmia after implantable defibrillator treatment in anxious type D patients. J Am Coll Cardiol 2009; 54:531-7. [PMID: 19643315 DOI: 10.1016/j.jacc.2009.04.043] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 03/30/2009] [Accepted: 04/26/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We sought to examine the combination of adverse psychological factors (anxiety, depression, and distressed or Type D personality) as a predictor of ventricular arrhythmias in patients with implantable cardioverter-defibrillators (ICDs). BACKGROUND Little is known about the role of psychological factors and their clustering in the occurrence of life-threatening arrhythmias. METHODS In this prospective study, 391 patients with an ICD (81% men, age 62.3 +/- 10.4 years) completed anxiety, depression, and Type D personality scales at the time of implantation. The end point was occurrence of ventricular arrhythmia, defined as appropriate ICD therapies, in the first year after implantation. RESULTS Ventricular arrhythmias occurred in 19% (n = 75) of patients. Increased symptoms of depression (p = 0.81) or anxiety (p = 0.31) did not predict arrhythmias. However, anxious patients with a Type D personality had a significantly increased rate of ventricular arrhythmias (21 of 71; 29.6%) as compared with other ICD patients (54 of 320; 16.9%; hazard ratio [HR]: 1.89; 95% confidence interval [CI]: 1.14 to 3.13; p = 0.013). When controlled for the effects of sex, age, ischemic etiology, left ventricular dysfunction, prolonged QRS duration, and medication, anxious Type D patients (HR: 1.72; 95% CI: 1.03 to 2.89; p = 0.039) and secondary prevention patients (HR: 1.91; 95% CI: 1.14 to 3.20; p = 0.014) were at increased risk of ventricular arrhythmias. CONCLUSIONS Personality modulated the effect of emotional distress; anxiety predicted a 70% increase in risk of arrhythmia in Type D patients but not in other patients. Anxious Type D patients may be identified and offered additional behavioral support after ICD implantation.
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Affiliation(s)
- Krista C van den Broek
- CoRPS (Center of Research on Psychology in Somatic diseases), Tilburg University, Tilburg, The Netherlands.
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