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Redhead AP, Turkington D, Rao S, Tynan MM, Bourke JP. Psychopathology in postinfarction patients implanted with cardioverter-defibrillators for secondary prevention. A cross-sectional, case-controlled study. J Psychosom Res 2010; 69:555-63. [PMID: 21109043 DOI: 10.1016/j.jpsychores.2010.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/06/2010] [Accepted: 06/09/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine (1) the incidence of anxiety and depression in patients implanted with defibrillators for secondary arrhythmia protection after myocardial infarction; (2) the effect of comorbidity and receipt of shock therapy on psychosocial maladjustment. METHODS Cross-sectional, one-off, questionnaire-based (HADS; MOS SF-36), case-controlled study of defibrillator recipients (n=100) from a 3-year implant period and three groups of matched controls [pacemaker (n=50), coronary intervention (n=50), atrial fibrillation (n=50)], sharing specific preselected previous health experiences. Spouses of each subgroup (n=106) were also studied. Although a cardiac rehabilitation program was available routinely for postinfarction patients, no specific rehabilitation was provided after defibrillator or pacemaker implant. RESULTS Mean scores for each assessment were similar for each group. Individual patient scores, however, revealed similarly high incidences of anxiety (24-34%) and depression (14-22%) in all groups. Experience of implantable cardioverter-defibrillator (ICD) 'shock(s)' and 'shock storm(s)' (≥ 3 shocks in 24 h) increased anxiety significantly. HADS criteria for anxiety 'caseness' or borderline 'caseness' were met in 63.6% of shock-storm recipients. Abnormal anxiety scores did not differ with interval from index event. Individual HADS scores also identified high incidences of anxiety in all spouse groups (25-48%). CONCLUSIONS Experience of shock storm precipitates pathological levels of anxiety in ICD recipients, and need for an ICD contributes to spouse anxiety. Individual CBT is indicated for patients who experience multiple shocks along with psycho-education for spouses. Anxiolytic and antidepressant medications may be indicated as part of their psychological rehabilitation.
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Salmoirago-Blotcher E, Ockene IS. Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator (ICD) A systematic review. BMC Cardiovasc Disord 2009; 9:56. [PMID: 20040100 PMCID: PMC2809039 DOI: 10.1186/1471-2261-9-56] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 12/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the potentially life-saving benefits of the implantable cardioverter-defibrillator (ICD), a significant group of patients experiences emotional distress after ICD implantation. Different psychosocial interventions have been employed to improve this condition, but previous reviews have suggested that methodological issues may limit the validity of such interventions. AIM To review the methodology of previously published studies of psychosocial interventions in ICD patients, according to CONSORT statement guidelines for non-pharmacological interventions, and provide recommendations for future research. METHODS We electronically searched the PubMed, PsycInfo and Cochrane databases. To be included, studies needed to be published in a peer-reviewed journal between 1980 and 2008, to involve a human population aged 18+ years and to have an experimental design. RESULTS Twelve studies met the eligibility criteria. Samples were generally small. Interventions were very heterogeneous; most studies used cognitive behavioural therapy (CBT) and exercise programs either as unique interventions or as part of a multi-component program. Overall, studies showed a favourable effect on anxiety (6/9) and depression (4/8). CBT appeared to be the most effective intervention. There was no effect on the number of shocks and arrhythmic events, probably because studies were not powered to detect such an effect. Physical functioning improved in the three studies evaluating this outcome. Lack of information about the indication for ICD implantation (primary vs. secondary prevention), limited or no information regarding use of anti-arrhythmic (9/12) and psychotropic (10/12) treatment, lack of assessments of providers' treatment fidelity (12/12) and patients' adherence to the intervention (11/12) were the most common methodological limitations. CONCLUSIONS Overall, this review supports preliminary evidence of a positive effect of psychosocial interventions on anxiety and physical functioning in ICD patients. However, these initial findings must be interpreted cautiously because of important methodological limitations. Future studies should be designed as large RCTs, whose design takes into account the specific challenges associated with the evaluation of behavioural interventions.
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Maryniak A, Szumowski Ł, Orczykowski M, Przybylski A, Walczak F. Anxiety and depression among the patients with frequent implantable cardioverter–defibrillator discharges. Int J Cardiol 2009; 132:e80-1. [DOI: 10.1016/j.ijcard.2007.08.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 08/10/2007] [Indexed: 11/16/2022]
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Pedersen SS, van den Broek KC, Sears SF. Psychological Intervention Following Implantation of an Implantable Defibrillator: A Review and Future Recommendations. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1546-54. [PMID: 18070312 DOI: 10.1111/j.1540-8159.2007.00905.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Susanne S Pedersen
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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Smeulders ESTF, van Haastregt JCM, Dijkman-Domanska BK, van Hoef EFM, van Eijk JT, Kempen GIJM. Nurse- and peer-led self-management programme for patients with an implantable cardioverter defibrillator; a feasibility study. BMC Nurs 2007; 6:6. [PMID: 17880674 PMCID: PMC2096621 DOI: 10.1186/1472-6955-6-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 09/19/2007] [Indexed: 11/16/2022] Open
Abstract
Background The prevalence of cardiovascular disease is increasing. Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, although patients often have difficulty adjusting and regaining control in daily life. In particular, patients who received an implantable cardioverter defibrillator (ICD) experience physical and psychological problems. Interventions to enhance perceived control and acceptance of the device are therefore necessary. This paper describes a small-scale study to explore the feasibility and the possible benefits of a structured nurse- and peer-led self-management programme ('Chronic Disease Self-Management Program' – CDSMP) among ICD patients. Methods Ten male ICD patients (mean age = 65.5 years) participated in a group programme, consisting of six sessions, led by a team consisting of a nurse specialist and a patient with cardiovascular disease. Programme feasibility was evaluated among patients and leaders by measuring performance of the intervention according to protocol, attendance and adherence of the participating ICD patients, and patients' and leaders' opinions about the programme. In addition, before and directly after attending the intervention, programme benefits (e.g. perceived control, symptoms of anxiety and depression, and quality of life) were assessed. Results The programme was conducted largely according to protocol. Eight patients attended at least four sessions, and adherence ranged from good to very good. On average, the patients reported to have benefited very much from the programme, which they gave an overall report mark of 8.4. The leaders considered the programme feasible as well. Furthermore, improvements were identified for general self-efficacy expectancies, symptoms of anxiety, physical functioning, social functioning, role limitations due to physical problems, and pain. Conclusion This study suggests that a self-management programme led by a team consisting of a nurse specialist and a patient with cardiovascular disease seems feasible according to both patients and leaders. The programme may improve general self-efficacy expectancies, symptoms of anxiety, and quality of life (physical functioning, social functioning, role limitations due to physical problems, and pain) as well. Further investigation of the programme's effectiveness among a larger sample of ICD patients or other patient groups with cardiovascular disease, is recommended.
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Affiliation(s)
- Esther STF Smeulders
- Maastricht University, Faculty of Health, Medicine and Life sciences, School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Jolanda CM van Haastregt
- Maastricht University, Faculty of Health, Medicine and Life sciences, School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Barbara K Dijkman-Domanska
- University Hospital Maastricht, Department of Cardiology, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Elisabeth FM van Hoef
- Maastricht University, Faculty of Health, Medicine and Life sciences, School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Jacques ThM van Eijk
- Maastricht University, Faculty of Health, Medicine and Life sciences, School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Gertrudis IJM Kempen
- Maastricht University, Faculty of Health, Medicine and Life sciences, School for Public Health and Primary Care, PO Box 616, 6200 MD Maastricht, The Netherlands
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Bilge AK, Ozben B, Demircan S, Cinar M, Yilmaz E, Adalet K. Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 29:619-26. [PMID: 16784428 DOI: 10.1111/j.1540-8159.2006.00409.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are life-saving devices in treatment of life-threatening arrhythmia. We evaluate the emotional status of Turkish patients with ICD and try to explain factors that affect emotional status of the patients. METHODS Ninety-one patients with previously implanted ICD were included in the study. Follow-up periods, presence of ICD shock, shock frequency, time of the recent shock, age, and gender were noted. Depression and anxiety scores were evaluated according to Hospital Anxiety and Depression (HAD) chart. RESULTS Mean anxiety and depression scores were found as 9.1 +/- 5.3 and 7.2 +/- 5.1, respectively. According to HAD charts, 42 patients (46%) had anxiety and 37 patients (41%) had depression. Depression scores indicated significant difference between subgroups divided on the basis of follow-up periods (P = 0.026) and on the basis of time of recent shock (P = 0.028). There was significant difference in anxiety scores (P = 0.016) between patients with ICD shocks and patients with no shocks. When the patients were divided into subgroups according to shock frequency, both depression (P = 0.024) and anxiety (P = 0.016) scores presented significant difference. In female patients, depression and anxiety scores were found significantly higher compared to male patients (P = 0.046 and P = 0.016, respectively). In multivariate analysis, gender and shock frequency were found as predictors for anxiety scores (P = 0.019 and P = 0.044, respectively). However same analysis revealed no predictive factor for depression score. CONCLUSION Our study indicates presence of depression and anxiety in nearly half of the patients with ICD. Consultation with psychiatry should be a part of the treatment for patients with ICD, especially for those who constitute high-risk groups.
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Affiliation(s)
- Ahmet Kaya Bilge
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Leidy NK, Beusterien K, Sullivan E, Richner R, Muni NI. Integrating the patient's perspective into device evaluation trials. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2006; 9:394-401. [PMID: 17076870 DOI: 10.1111/j.1524-4733.2006.00132.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Innovations in medical device technology have greatly expanded the range of therapeutic options available to physicians and their patients. The understanding of treatment effects from the patient's perspective is an essential component of a comprehensive assessment of any new therapy, including medical devices. The term "patient-reported outcomes" (PROs) has been growing in use to refer to a cluster of variables such as health-related quality of life, symptoms, physical functioning, psychological well-being, treatment satisfaction, and treatment preferences. As in drug trials, the use of PROs in device evaluation has several methodological challenges, ranging from general concerns about interpretation, to more specific issues related to study design and regulatory approval (use of PROs as primary end points, incorporation in labeling, and product promotion). Successful approaches for integrating PROs into device evaluation trials include the careful selection of appropriate, interpretable PRO end points, accounting for possible confounding factors, and the use of alternatives to placebo-controlled trial designs, such as single-arm pre-post, observational, and registry studies, when the use of placebo control groups is not feasible. This article discusses the potential value and difficulties in measuring PROs in device studies.
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Affiliation(s)
- Nancy Kline Leidy
- Center for Health Outcomes Research at United BioSource Corporation, Bethesda, MD 20814, USA.
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Leosdottir M, Sigurdsson E, Reimarsdottir G, Gottskalksson G, Torfason B, Vigfusdottir M, Eggertsson S, Arnar DO. Health-related quality of life of patients with implantable cardioverter defibrillators compared with that of pacemaker recipients. ACTA ACUST UNITED AC 2006; 8:168-74. [PMID: 16627433 DOI: 10.1093/europace/euj052] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS Studies indicate a poorer quality of life (QoL) for implantable cardioverter defibrillator (ICD) patients than for the general population. However, studies comparing the QoL of ICD patients with that of patients with other implantable cardiac devices are scarce. We hypothesized that ICD patients had a poorer QoL than pacemaker patients. METHODS AND RESULTS All ICD patients living in Iceland at the beginning of 2002 (44 subjects), and a comparison group of 81 randomly selected patients with pacemakers were invited to participate. The Icelandic Quality of Life Questionnaire (IQL), the General Health Questionnaire (GHQ), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI) were submitted to measure QoL, psychiatric distress, and symptoms of anxiety and depression. The ICD and pacemaker groups did not differ on IQL, BAI, BDI, or GHQ scores. ICD patients were as a group more fearful of death (P = 0.056) and showed more concerns about returning to work (P = 0.072), although these items fell just short of statistical significance. CONCLUSION Contrary to our expectations, ICD patients had a comparable QoL with pacemaker recipients and were not more likely to suffer from anxiety, depression, or general psychiatric distress. These findings are encouraging in view of expanding ICD indications.
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Affiliation(s)
- Margret Leosdottir
- Department of Medicine, Landspitali University Hospital, Hringbraut, 101 Reykjavik, Iceland
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Yun AJ, Lee PY, Bazar KA. Many diseases may reflect dysfunctions of autonomic balance attributable to evolutionary displacement. Med Hypotheses 2004; 62:847-51. [PMID: 15142634 DOI: 10.1016/j.mehy.2004.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We hypothesize that many ailments are attributable to dysfunctions of autonomic balance. The autonomic system is a primitive, highly-adaptive response system that allows differential allocation of biologic effort under varying conditions. The autonomic system, however, can execute a response that is inappropriate for the system stressor due to evolutionary displacement. Evolutionary displacement is a situation in which a trait that evolved as an adaptive response to certain conditions now faces a new set of conditions. Modern human evolution since the Pleistocene era is characterized by substantial evolutionary displacement, brought on in large part by the accelerating ability of humans to change their own environment. In the setting of evolutionary displacement, previously adaptive systems such as the autonomic system can be rendered unhelpful or even counterproductive. Emergence of chronic conditions, maladaptation of the trauma response, and extension of human lifespan are examples of evolutionary displacements that can induce inappropriate sympathetic bias in hosts. We postulate that many diseases are manifestations of this general phenomenon. Implications for existing and future therapeutic strategies are discussed.
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Affiliation(s)
- A Joon Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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