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Dörner M, von Känel R, König N, Pazhenkottil AP, Altwegg R, Nager L, Attanasio V, Guth L, Zirngast S, Menzi A, Zuccarella-Hackl C, Princip M. Mindfulness Is Associated with Lower Depression, Anxiety, and Post-Traumatic Stress Disorder Symptoms and Higher Quality of Life in Patients with an Implantable Cardioverter-Defibrillator-A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1118. [PMID: 38891193 PMCID: PMC11172204 DOI: 10.3390/healthcare12111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Several studies suggested the efficacy of dispositional mindfulness and mindfulness-based interventions in reducing anxiety and depression in cardiovascular diseases. However, data on the impact of mindfulness on the psychological well-being of patients with an implantable cardioverter-defibrillator (ICD) are scarce. In this study, 422 patients with an ICD were prospectively recruited. Logistic regression was applied to determine associations between dispositional mindfulness (Freiburg Mindfulness Inventory), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), adjusting for age, sex, educational status, number of ICD shocks after ICD implantation, and physical activity. The PROCESS regression path analysis modelling tool was used to identify indirect mediating effects of dispositional mindfulness on depression, anxiety, and PTSD symptoms and quality of life (QoL; EuroQol group 5-dimension questionnaire). Participants presented high baseline QoL (mean 1.06 to 1.72) and medium-high mindfulness scores (mean 40.85 points). Higher mindfulness scores were associated with lower levels of anxiety (OR 0.90, 95% CI 0.86 to 0.95, 0.001), depression (OR 0.93, 95% CI 0.88 to 0.98, p = 0.006), and PTSD symptoms (OR 0.94, 95% CI 0.89 to 0.98, p = 0.011). Furthermore, greater mindfulness partially mediated the relationship between anxiety (indirect effect 0.10, 95% CI 0.02 to 0.21), depression (indirect effect 0.08, 95% CI 0.01 to 0.17), or PTSD (indirect effect 0.04, 95% CI 0.01 to 0.17) as independent variables and the QoL as the dependent variable. This study suggests that greater dispositional mindfulness is associated with less anxiety, depression, and PTSD symptoms. Mindfulness might also increase the QoL in ICD patients by mitigating the impact of those with psychological distress.
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Affiliation(s)
- Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Noelle König
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Aju P. Pazhenkottil
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Rahel Altwegg
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Ladina Nager
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Veronica Attanasio
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Lisa Guth
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Sina Zirngast
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Anna Menzi
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Claudia Zuccarella-Hackl
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
| | - Mary Princip
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (R.v.K.); (N.K.); (A.P.P.); (R.A.); (L.N.); (V.A.); (L.G.); (S.Z.); (A.M.); (C.Z.-H.); (M.P.)
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Fakes K, Boyes A, Hall A, Carey M, Leigh L, Brown S, Sanson-Fisher R. Trajectories and Predictors of Raised State Anxiety Among Outpatients Who Have Undergone Medical Imaging Procedures. J Am Coll Radiol 2024; 21:285-294. [PMID: 37453598 DOI: 10.1016/j.jacr.2023.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The aim of this study was to examine the prevalence of raised state anxiety before and after medical imaging procedures, the prevalence of state anxiety trajectories, and factors associated with postprocedural raised state anxiety. METHODS A prospective survey was administered to outpatients undergoing elective medical imaging procedures (CT, radiography, MRI, ultrasound, angiography, or fluoroscopy) recruited from one center. Participants completed a self-report survey preprocedure (time 1) and postprocedure (time 2). State anxiety was measured using the six-item State-Trait Anxiety Inventory. The point prevalence of raised state anxiety (State-Trait Anxiety Inventory score ≥33.16) at time 1 and time 2 was calculated, as was the prevalence of four state anxiety trajectories over time: persistent low anxiety, decreasing anxiety, increasing anxiety, and persistent raised anxiety. Factors predictive of raised state anxiety at time 2 were examined using logistic regression analysis. RESULTS Three hundred fifteen participants completed both surveys. The prevalence of raised state anxiety at time 1 (50%) and time 2 (51%) was similar. Most patients reported persistent raised anxiety (36%) and persistent low anxiety (34%) over time. Fewer patients reported increasing anxiety (15%) and decreasing anxiety (14%). Raised state anxiety (odds ratio, 4.84; 95% confidence interval, 2.48-9.48) and lower reported health status (odds ratio, 2.48; 95% confidence interval, 1.11-5.51) at time 1 were significantly associated with greater odds of raised anxiety at time 2. CONCLUSIONS Raised state anxiety related to medical imaging procedures is common among outpatients. Half of patients either developed or continued to experience raised anxiety after their procedures. Outpatients may benefit from evidence-based methods of alleviating anxiety before their procedures.
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Affiliation(s)
- Kristy Fakes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Allison Boyes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Mariko Carey
- Hunter Medical Research Institute, New Lambton Heights, Australia; Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sandy Brown
- Hunter New England Imaging, John Hunter Hospital/Royal Newcastle Centre, New Lambton Heights, Australia
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Pedersen SS, Carter N, Barr C, Scholten M, Lambiase PD, Boersma L, Johansen JB, Theuns DAMJ. Quality of life, depression, and anxiety in patients with a subcutaneous versus transvenous defibrillator system. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1541-1551. [PMID: 31677279 DOI: 10.1111/pace.13828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/11/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Use of the subcutaneous implantable defibrillator (S-ICD) has increased because the device received US Food and Drug Administration approval in 2012, but we still know little about whether the quality of life (QoL) of patients with an S-ICD versus a transvenous ICD (TV-ICD) is comparable. We compared S-ICD patients with TV-ICD patients on QoL, depression, and anxiety up to 12 months' follow-up. METHODS A matched cohort of S-ICD (N = 167) and TV-ICD patients (N = 167) completed measures on QoL, depression, anxiety, and personality at baseline, 3, 6, and 12 months post implant. Data were analyzed using multivariable modeling with repeated measures. RESULTS In adjusted analyses, we found no statistically significant differences between cohorts on physical and mental QoL and depression (all Ps > .05), while S-ICD patients reported lower anxiety than TV-ICD patients (P = 0.0007). Both cohorts experienced improvements in physical and mental QoL and symptoms of depression and anxiety over time (all Ps < .001), primarily between implant and 3 months. These improvements were similar for both cohorts with respect to physical and mental QoL and anxiety (Ps > .05), while S-ICD patients experienced greater reductions in depressive symptoms (P = .0317). CONCLUSION The QoL and depression levels were similar in patients with an S-ICD and a TV-ICD up to 12 months' follow-up, while S-ICD patients reported lower anxiety levels and a greater reduction in depression over time as compared to TV-ICD patients. This knowledge may be important for patients and clinicians, if the indication for implantation allows both the S-ICD and the TV-ICD, making a choice possible.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Craig Barr
- Department of Cardiology, Russels Hall Hospital, Dudley, UK
| | - Marcoen Scholten
- Department of Cardiology, Thorax Center Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London & Barts Heart Centre, London, UK
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- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Bozyel S, Aktas M, Mutluer FO, Guler TE, Dervis E, Argan O, Celikyurt U, Agir A, Vural A. Reprogramming the tachycardia parameters with long-detection strategy in patients with pre-existing implantable cardioverter-defibrillator. Acta Cardiol 2019; 74:246-251. [PMID: 30058473 DOI: 10.1080/00015385.2018.1488664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: A long-detection interval (LDI) programming has been proved to reduce shock therapy in patients who underwent de novo implantable cardioverter defibrillator (ICD) implantation. We aimed to evaluate effectiveness and safety of this new strategy in old ICD recipients. Methods: We included 147 primary prevention patients with ischaemic and non-ischaemic aetiology. Conventional setting parameters (18 of 24 intervals to detect ventricular arrhythmias (VA's)) were reprogrammed with LDI strategy (30 of 40 intervals to detect VA's). One monitoring zone (between 360 and 330 ms) and two therapy zones were programmed, treating all rhythms of cycle length <330 ms that met the duration criterion of 30/40 intervals and were discriminated as ventricular tachycardia/ventricular fibrillation (VT/VF). The supraventricular tachycardia (SVT) discriminators were used in all patients. Results: At a median follow-up of 24 months, 12.9% (n = 19) of patients received shock therapies (± antitachycardia pacing (ATP)). Appropriate and inappropriate shocks occurred in 7.5 and 5.4% of patients during follow-up, respectively. Only one patient experienced an arrhythmic syncope during the follow-up period. There was no death related to LDI programming. The LDI programming helped to stop unnecessary in 10 patients (6.8%), who otherwise would have been treated in the conventional programming. Conclusions: LDI programming was found safe and effective. Hence, old ICD recipients will benefit from this strategy.
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Affiliation(s)
- Serdar Bozyel
- Department of Cardiology, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey
| | - Mujdat Aktas
- Department of Cardiology, Eregli State Hospital, Zonguldak, Turkey
| | - Ferit Onur Mutluer
- Department of Cardiology, KocUniversity School of Medicine, Istanbul, Turkey
| | - Tumer Erdem Guler
- Department of Cardiology, Derince Training and Research Hospital, Health Sciences University, Kocaeli, Turkey
| | - Emir Dervis
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Onur Argan
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Umut Celikyurt
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Aysen Agir
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Ahmet Vural
- Department of Cardiology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Niewinski P, Jagielski D, Josiak K, Nowak K, Biel B, Tubek S, Walczak T, Szemplinska I, Siennicka A, Banasiak W, Ponikowski P. Seat belts-related behaviors in car drivers with cardiac implantable electronic devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:400-406. [PMID: 30740756 DOI: 10.1111/pace.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Seat belt use is the single most effective means of reducing fatal injuries in road traffic accidents. The presence of a cardiac implantable electronic device (CIED) might influence seat belt-related behaviors due to the physical proximity of the seat belt and left subclavian area in which the device is usually implanted. Understanding the underlying mechanisms of improper seat belt use may improve safety of these patients. METHODS We performed a prospective study using a structured questionnaire with 120 CIED recipients (age, 63.9 ± 10.9 years) attending a pacing outpatient clinic. All study participants were active drivers and predominantly male. The majority of patients (79%) had undergone high-energy device implantation. RESULTS We found that 18% of study participants do not fasten seat belts on a regular basis or use the seat belt in an atypical fashion (such as under the armpit). Moderate or high level of discomfort from the interaction between seat belt and CIED was present in 27%, while more than half (51%) were afraid of seat belt-induced CIED damage. In multifactorial analysis, we found the following independent predictors of improper seat belt use: (1) at least moderate level of discomfort at the CIED site (P = 0.02); (2) fear of CIED damage (P = 0.009); and (3) irregular seat belt use prior to CIED implantation (P = 0.037). CONCLUSIONS Improper seat belt-related behaviors are common in CIED recipients. They arise from previous habits and from CIED-related physical and psychological factors. Patients' education regarding the importance and safety of proper seat belt use is a priority.
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Affiliation(s)
- Piotr Niewinski
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Jagielski
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Krystian Josiak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Nowak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Biel
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Stanislaw Tubek
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Walczak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Iwona Szemplinska
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Agnieszka Siennicka
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Department of Physiology, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Banasiak
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland
| | - Piotr Ponikowski
- Department of Cardiology, Centre for Heart Disease, 4th Military Hospital, Wroclaw, Poland.,Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
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Thylén I, Moser DK, Strömberg A. Octo- and nonagenarians' outlook on life and death when living with an implantable cardioverter defibrillator: a cross-sectional study. BMC Geriatr 2018; 18:250. [PMID: 30342484 PMCID: PMC6195969 DOI: 10.1186/s12877-018-0942-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
Background Elderly individuals are increasingly represented among patients with implantable cardioverter defibrillators (ICD), but data describing life with an ICD are scarse among octo- and nonagenarians. Moreover, few studies have reported those elderly patients’ perspective on timly discussions concerning what shock deactivation involves, preferences on battery replacement, and their attitudes about turning off the ICD nearing end-of-life. Consequently, the aim of the study was to describe outlooks on life and death in octo- and nonagenarian ICD-recipients. Methods Participants were identified via the Swedish Pacemaker- and ICD-registry, with 229 octo- and nonagenarians (82.0 ± 2.2 years, 12% female) completing the survey on one occasion. The survey involved questions on health and psychological measures, as well as on experiences, attitudes and knowledge of end-of-life issues in relation to the ICD. Results The majority (53%) reported their existing health as being good/very good and rated their health status as 67 ± 18 on the EuroQol Visual Analog Scale. A total of 34% had experienced shock(s), 11% suffered from symptoms of depression, 15% had anxiety, and 26% reported concerns related to their ICD. About one third (34%) had discussed their illness trajectory with their physician, with those octo- and nonagenarians being more decisive about a future deactivation (67% vs. 43%, p < .01). A minority (13%) had discussed what turning off shocks would involve with their physician, and just 7% had told their family their wishes about a possible deactivation in the future. The majority desired battery replacement even if they had reached a very advanced age when one was needed (69%), or were seriously ill with a life-threatening disease (55%). When asked about deactivation in an anticipated terminal illness, about one third (34%) stated that they wanted to keep the shocks in the ICD during these circumstances. About one-fourth of the octo- and nonagenarians had insufficient knowledge regarding the ethical aspects, function of the ICD, and practical consequences of withdrawing the ICD treatment in the end-of-life. Conclusions Increasing numbers of elderly persons receive an ICD and geriatric care must involve assessments of life expectancy as well as the patient’s knowledge and attitudes in relation to generator changes and deactivation.
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Affiliation(s)
- Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Division of Nursing Sciences, Linköping University, S-581 83, Linköping, Sweden.
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, USA
| | - Anna Strömberg
- Department of Cardiology and Department of Medical and Health Sciences, Division of Nursing Sciences, Linköping University, S-581 83, Linköping, Sweden.,Sue and Bill Gross School of Nursing, University of California, Irvine, USA
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Rottmann N, Skov O, Andersen CM, Theuns DAMJ, Pedersen SS. Psychological distress in patients with an implantable cardioverter defibrillator and their partners. J Psychosom Res 2018; 113:16-21. [PMID: 30190043 DOI: 10.1016/j.jpsychores.2018.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/15/2018] [Accepted: 07/19/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Adjustment to life with an implantable cardioverter defibrillator (ICD) may be challenging for some patients and their partners, with disease and individual characteristics likely influencing the process. We examined whether perceived social support and clinical patient characteristics are associated with change in couples' symptoms of anxiety and depression in the first year after ICD implantation, and explored whether the associations differ between patients and partners. METHOD A cohort of consecutively implanted patients (n = 286; 21% women) and their partners completed questionnaires on social support and symptoms of anxiety and depression prior to ICD implantation and 12 months later. Information on demographic and clinical characteristics were captured from patients' medical records or purpose-designed questions. Data were analyzed using multilevel models accounting for the interdependency of scores within couples with adjustment for possible confounders. RESULTS Higher ratings of perceived social support prior to ICD implantation were associated with greater reductions in couples' symptoms of anxiety and depression, whereas having received an ICD shock was associated with less improvement. Secondary prevention indication for ICD implantation and symptomatic heart failure were associated with less improvement in anxiety symptoms. These associations applied to both patients' and partners' levels of distress. CONCLUSION The patient's heart disease affects both patients' and partners' psychological adjustment in the first year after ICD implantation. Interventions are warranted that address this issue not only in patients but also in partners. Targeting social support as a resource for both could be one avenue to pursue.
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Affiliation(s)
- Nina Rottmann
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark; The Danish Knowledge Center for Rehabilitation and Palliative Care, Department of Oncology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Nyborg, Denmark; National Research Center for Cancer Rehabilitation, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Ole Skov
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Christina Maar Andersen
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Dominic A M J Theuns
- Thoraxcenter, Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Susanne S Pedersen
- Unit of Medical Psychology, Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
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Pedersen SS, Knudsen C, Dilling K, Sandgaard NCF, Johansen JB. Living with an implantable cardioverter defibrillator: patients' preferences and needs for information provision and care options. Europace 2018; 19:983-990. [PMID: 27267553 DOI: 10.1093/europace/euw109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/24/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The clinical management and care of patients with an implantable cardioverter defibrillator (ICD) has shifted from face-to-face in-clinic visits to remote monitoring. Reduced interactions between patients and healthcare professionals may impede patients' transition to adapting post-implant. We examined patients' needs and preferences for information provision and care options and overall satisfaction with treatment. Methods and results Patients implanted with a first-time ICD or defibrillator with cardiac resynchronization therapy (n = 389) within the last 2 years at Odense University Hospital were asked to complete a purpose-designed and standardized set of questionnaires. The level of satisfaction with information provision was high; only 13.1% were dissatisfied. Psychological support for patients (39.9%), their relatives (43.1%), and deactivation of the ICD towards end of life (47.8%) were among the top five topics that patients reported to have received no information about. The top five care options that patients had missed were talking to the same healthcare professional (75.2%), receiving ongoing feedback via remote monitoring (61.1%), having a personal conversation with a staff member 2-3 weeks post-implant (59.6%), having an exercise tolerance test (52.5%), and staff asking how patients felt while hospitalized (50.4%). Patients with a secondary prevention indication and cardiac arrest survivors had specific needs, including a wish for a psychological consult post-discharge. Conclusion Despite a high satisfaction level with information provision, particular topics are not broached with patients (e.g. device activation) and patients have unmet needs that are not met in current clinical practice.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Charlotte Knudsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Karen Dilling
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Prevalence and risk markers of early psychological distress after ICD implantation in the European REMOTE-CIED study cohort. Int J Cardiol 2017; 240:208-213. [DOI: 10.1016/j.ijcard.2017.03.124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/13/2017] [Accepted: 03/27/2017] [Indexed: 11/19/2022]
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Perini AP, Kutyifa V, Veazie P, Daubert JP, Schuger C, Zareba W, McNitt S, Rosero S, Tompkins C, Padeletti L, Moss AJ. Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy. Am Heart J 2017. [PMID: 28625384 DOI: 10.1016/j.ahj.2017.03.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pacing (ATP) on anxiety and quality of life (QoL) in ICD patients are poorly understood. METHODS We evaluated changes in QoL from baseline to 9-month follow-up using the EQ-5D questionnaire in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) (n=1,268). We assessed anxiety levels using the Florida Shock Anxiety Scale (1-10 score) in patients with appropriate or inappropriate shocks or ATP compared to those with no ICD therapy during the first 9 months postimplant. The analysis was stratified by number of ATP or shocks (0-1 vs ≥2) and adjusted for covariates. RESULTS In MADIT-RIT, 15 patients (1%) had ≥2 appropriate shocks, 38 (3%) had ≥2 appropriate ATPs. Two or more inappropriate shocks were delivered in 16 patients (1%); ≥2 inappropriate ATPs, in 70. In multivariable analysis, patients with ≥2 appropriate shocks had higher levels of shock-related anxiety than those with ≤1 appropriate shock (P<.01). Furthermore, ≥2 inappropriate shocks produced more anxiety than ≤1 inappropriate shock (P=.005). Consistently, ≥2 appropriate ATPs resulted in more anxiety than ≤1 (P=.028), whereas the number of inappropriate ATPs showed no association with anxiety levels (P=.997). However, there was no association between QoL and appropriate or inappropriate ATP/shock (all P values > .05). CONCLUSIONS In MADIT-RIT, ≥2 appropriate or inappropriate ICD shocks and ≥2 appropriate ATPs are associated with more anxiety at 9-month follow-up despite no significant changes in the assessment of global QoL by the EQ-5D questionnaire. Innovative ICD programming reducing inappropriate therapies may help deal with patient concerns about the device.
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11
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Pedersen SS, Mastenbroek MH, Carter N, Barr C, Neuzil P, Scholten M, Lambiase PD, Boersma L, Johansen JB, Theuns DA. A Comparison of the Quality of Life of Patients With an Entirely Subcutaneous Implantable Defibrillator System Versus a Transvenous System (from the EFFORTLESS S-ICD Quality of Life Substudy). Am J Cardiol 2016; 118:520-6. [PMID: 27353211 DOI: 10.1016/j.amjcard.2016.05.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
The first clinical results from the Evaluation of Factors Impacting Clinical Outcome and Cost Effectiveness of the subcutaneous implantable cardioverter defibrillator (EFFORTLESS S-ICD) Registry on the entirely S-ICD system are promising, but the impact of the S-ICD system on patients' quality of life (QoL) is not known. We evaluated the QoL of patients with an S-ICD against an unrelated cohort with a transvenous (TV)-ICD system during 6 months of follow-up. Consecutively implanted patients with an S-ICD system were matched with patients with a TV-ICD system on a priori selected variables including baseline QoL. QoL was measured with the Short-Form Health Survey at baseline, 3, and 6 months after implant and compared using multivariable modeling with repeated measures. Patients with an S-ICD (n = 167) versus a TV-ICD system (n = 167) did not differ significantly on physical (p = 0.8157) and mental QoL scores (p = 0.9080) across baseline, 3, and 6 months after implantation in adjusted analyses. The evolution in physical (p = 0.0503) and mental scores (p = 0.3772) during follow-up was similar for both cohorts, as indicated by the nonsignificant interaction effect for ICD system by time. Both patients with an S-ICD system and a TV-ICD system experienced significant improvements in physical and mental QoL between time of implant and 3 months (both p's <0.0001) and between time of implant and 6 months (both p's <0.0001) but not between 3 and 6 months (both p's >0.05). In conclusion, these first results show that the QoL of patients with an S-ICD versus TV-ICD system is similar and that patients with either system experience improvements in QoL on the short term.
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12
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Mastenbroek MH, Pedersen SS, van der Tweel I, Doevendans PA, Meine M. Results of ENHANCED Implantable Cardioverter Defibrillator Programming to Reduce Therapies and Improve Quality of Life (from the ENHANCED-ICD Study). Am J Cardiol 2016; 117:596-604. [PMID: 26732419 DOI: 10.1016/j.amjcard.2015.11.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/25/2022]
Abstract
Novel implantable cardioverter defibrillator (ICD) discrimination algorithms and programming strategies have significantly reduced the incidence of inappropriate shocks, but there are still gains to be made with respect to reducing appropriate but unnecessary antitachycardia pacing (ATP) and shocks. We examined whether programming a number of intervals to detect (NID) of 60/80 for ventricular tachyarrhythmia (VT)/ventricular fibrillation (VF) detection was safe and the impact of this strategy on (1) adverse events related to ICD shocks and syncopal events; (2) ATPs/shocks; and (3) patient-reported outcomes. The "ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life" study (ENHANCED-ICD study) was a prospective, safety-monitoring study enrolling 60 primary and secondary prevention patients at the University Medical Center Utrecht. Patients implanted with any type of ICD with SmartShock technology and aged 18 to 80 years were eligible to participate. In all patients, a prolonged NID 60/80 was programmed. The cycle length for VT/fast VT/VF was 360/330/240 ms, respectively. Programming a NID 60/80 proved safe for ICD patients. Because of the new programming strategy, unnecessary ICD therapy was prevented in 10% of ENHANCED-ICD patients during a median follow-up period of 1.3 years. With respect to patient-reported outcomes, levels of distress were highest and perceived health status lowest at the time of implantation, which both gradually improved during follow-up. In conclusion, the ENHANCED-ICD study demonstrates that programming a NID 60/80 for VT/VF detection is safe for ICD patients and does not negatively impact their quality of life.
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13
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Thylén I, Moser DK, Strömberg A, Dekker RA, Chung ML. Concerns about implantable cardioverter-defibrillator shocks mediate the relationship between actual shocks and psychological distress. Europace 2015; 18:828-35. [PMID: 26324839 DOI: 10.1093/europace/euv220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/15/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS Although most implantable cardioverter-defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not yet been investigated. Our objective was to examine whether the relationship between receipt of defibrillating shocks and psychological distress was mediated by patients' concerns related to their ICD. METHODS AND RESULTS All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3067 completing the survey (55% response rate). Their mean age was 66 ± 11 years, and 80% were male. One-third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression [odds ratio (OR) 1.58 and OR 3.04, respectively]. The association between receipt of shocks and psychologically distress was mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety, and 54% of the relationship between shocks and symptoms of depression. CONCLUSION Implantable cardioverter-defibrillator-related concerns have a bigger impact on psychological distress than receipt of an actual shock. Assessing ICD-related concerns in clinical practice can identify patients at risk for psychological distress. Further research on assessment of, and interventions targeting, ICD-related concerns is warranted.
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Affiliation(s)
- Ingela Thylén
- Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Debra K Moser
- College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA University of Ulster, Newtownabbey, UK
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden Department of Cardiology, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Rebecca A Dekker
- College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Misook L Chung
- College of Nursing, University of Kentucky, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
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Mastenbroek MH, Denollet J, Versteeg H, van den Broek KC, Theuns DA, Meine M, Zijlstra WP, Pedersen SS. Trajectories of patient-reported health status in patients with an implantable cardioverter defibrillator. Am J Cardiol 2015; 115:771-7. [PMID: 25623734 DOI: 10.1016/j.amjcard.2014.12.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
To date, no study has assessed the course of patient-reported health status in patients with an implantable cardioverter defibrillator (ICD). Studying health status trajectories and their baseline determinants would permit the identification of patients at risk for poor health outcomes after ICD implantation. A combined cohort of 1,222 patients with an ICD (79% men; age = 61.4 [11.2] years) completed the 12-Item Short-Form Health Survey at baseline and 2 to 3 months and 12 to 14 months after implantation. Latent class analyses were used to identify trajectories and predictors of health status over time. Most health status trajectories showed a stable pattern after short-term follow-up, with differences between trajectories being mainly related to differences in absolute levels of health status. Seven trajectories were identified for physical health status. Being unemployed, symptomatic heart failure, ICD shock, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer physical health status. For mental health status, 6 trajectories were identified. Younger age, low educational level, symptomatic heart failure, renal failure, no use of ACE inhibitors, psychotropic medication, negative affectivity, and type D personality were identified as independent determinants of poorer mental health status. In conclusion, the population with an ICD seems to be heterogeneous in terms of patient-reported physical and mental health status. Patients with an ICD who present with poor health status and a distressed personality profile should be timely identified and monitored as they may benefit from cardiac rehabilitation in combination with behavioral intervention.
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15
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Lauck SB, Sawatzky R, Johnson JL, Humphries K, Bennett MT, Chakrabarti S, Kerr CR, Tung S, Yeung-Lai-Wah JA, Ratner PA. Sex Is Associated With Differences in Individual Trajectories of Change in Social Health After Implantable Cardioverter-Defibrillator. Circ Cardiovasc Qual Outcomes 2015; 8:S21-30. [DOI: 10.1161/circoutcomes.114.001607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Social health is a dimension of quality of life, and refers to people’s involvement in, and satisfaction with social roles, responsibilities, and activities. The implantable cardioverter-defibrillator is associated with changes in overall quality of life, but little is known about sex differences in individual trajectories of change in social health.
Methods and Results—
We prospectively measured changes in 3 subscales of the SF-36v2 generic health questionnaire (role physical, role emotional, and social functioning), 2 Patient-Reported Outcomes Measurement Information System short forms (satisfaction with participation in social roles and satisfaction with participation in discretionary social activities), and the Florida Patient Acceptance Survey before and at 1, 2, and 6 months after implantation. Individual growth models of temporal change were estimated. The scores of the 6 indicators improved with time. The unconditional model demonstrated significant (fixed effects:
P
<0.05; covariance parameters:
P
<0.10) residual variability in the individual trajectories. In the conditional model, men and women differed significantly in their rates of change in the scores of 3 of the 6 measures. Although men’s mean scores exceeded women’s mean scores on all indicators at baseline (range of relative mean difference: 11.0% to 17.8%), the rate of women’s change resulted in a reversal in relative standing at 6 months after implantation, with the mean scores of women exceeding the men’s by 4.5% to 5.6%.
Conclusions—
Men and women differed in their trajectories of change in social health, both in terms of their starting points (ie, baseline scores) and their rates of change.
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Affiliation(s)
- Sandra B. Lauck
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Richard Sawatzky
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Joy L. Johnson
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Karin Humphries
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Matthew T. Bennett
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Santabhanu Chakrabarti
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Charles R. Kerr
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Stanley Tung
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - John A. Yeung-Lai-Wah
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
| | - Pamela A. Ratner
- From the University of British Columbia, Vancouver, Canada (S.B.L., J.L.J., K.H., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W., P.A.R.) and Trinity Western University, Langley, Canada (R.S.); Department of Cardiology and Cardiac Programs, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada (S.B.L., M.T.B., S.C., C.R.K., S.T., J.A.Y.L.W); and Providence Health Care, Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada (R.S.)
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Manzoni GM, Castelnuovo G, Compare A, Pagnini F, Essebag V, Proietti R. Psychological effects of implantable cardioverter defibrillator shocks. A review of study methods. Front Psychol 2015; 6:39. [PMID: 25698991 PMCID: PMC4316692 DOI: 10.3389/fpsyg.2015.00039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/08/2015] [Indexed: 11/13/2022] Open
Abstract
Background: The implantable cardioverter defibrillator (ICD) saves lives but clinical experience suggests that it may have detrimental effects on mental health. The ICD shock has been largely blamed as the main offender but empirical evidence is not consistent, perhaps because of methodological differences across studies. Objective: To appraise methodologies of studies that assessed the psychological effects of ICD shock and explore associations between methods and results. Data Sources: A comprehensive search of English articles that were published between 1980 and 30 June 2013 was applied to the following electronic databases: PubMed, EMBASE, NHS HTA database, PsycINFO, Sciencedirect and CINAHL. Review Methods: Only studies testing the effects of ICD shock on psychological and quality of life outcomes were included. Data were extracted according to a PICOS pre-defined sheet including methods and study quality indicators. Results: Fifty-four observational studies and six randomized controlled trials met the inclusion criteria. Multiple differences in methods that were used to test the psychological effects of ICD shock were found across them. No significant association with results was observed. Conclusions: Methodological heterogeneity of study methods is too wide and limits any quantitative attempt to account for the mixed findings. Well-built and standardized research is urgently needed.
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Affiliation(s)
- Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Verbania, Italy ; Department of Psychology, Catholic University of Milan Milano, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS Verbania, Italy ; Department of Psychology, Catholic University of Milan Milano, Italy
| | - Angelo Compare
- Department of Psychology, University of Bergamo Bergamo, Italy
| | - Francesco Pagnini
- Department of Psychology, Catholic University of Milan Milano, Italy
| | - Vidal Essebag
- McGill University Health Center Montreal, QC, Canada
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Versteeg H, Roest AM, Denollet J. Persistent and fluctuating anxiety levels in the 18 months following acute myocardial infarction: the role of personality. Gen Hosp Psychiatry 2015; 37:1-6. [PMID: 25524723 DOI: 10.1016/j.genhosppsych.2014.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the varying courses of anxiety symptoms in the first 18 months after a myocardial infarction (MI) and to examine the importance of personality in determining elevated anxiety. METHODS Four hundred eighty-six MI patients completed the State-Trait Anxiety Inventory during hospitalization and at 2-, 12- and 18-months post-MI. At baseline, patients also completed the DS14 Type D personality scale, Anxiety Sensitivity Index and Beck Depression Inventory, and clinical and sociodemographic information was collected. RESULTS Growth mixture modeling analysis identified four anxiety trajectories. The majority of patients reported stable anxiety scores over time, indicative of either persistent high (17%) or low (71%) anxiety. Patients in the other two smaller groups initially reported moderate levels of anxiety that fluctuated during follow-up. Type D personality [odds ratio (OR)=5.34; 95% confidence interval (CI): 2.26-12.63], negative affectivity (OR=3.24; 95% CI: 1.29-8.14) and anxiety sensitivity (OR=3.35; 95% CI: 1.69-6.62) were the most prominent determinants of persistent high anxiety, independent of depression, sociodemographic and clinical factors. CONCLUSIONS The course of anxiety in the first 18 months after MI is relatively stable for the majority of patients. Patients with Type D personality, negative affectivity and anxiety sensitivity are at an increased risk for persisting elevated anxiety and should be identified and offered appropriate treatment.
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Affiliation(s)
- Henneke Versteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands; Department of Cardiology, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Annelieke M Roest
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Hanzeplein 1, 9173 GZ Groningen, The Netherlands.
| | - Johan Denollet
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
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18
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Larsen JM, Riahi S, Johansen JB, Nielsen JC, Petersen HH, Haarbo J, Pedersen SS. The patient perspective on the Riata defibrillator lead advisory: A Danish nationwide study. Heart Rhythm 2014; 11:2148-55. [DOI: 10.1016/j.hrthm.2014.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 11/24/2022]
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19
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Dinkel A, Kremsreiter K, Marten-Mittag B, Lahmann C. Comorbidity of fear of progression and anxiety disorders in cancer patients. Gen Hosp Psychiatry 2014; 36:613-9. [PMID: 25213227 DOI: 10.1016/j.genhosppsych.2014.08.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The relation between fear of progression (FoP) and anxiety disorders remains unclear. Therefore, we investigated the comorbidity between clinical FoP and psychiatric anxiety disorders. METHOD In this cross-sectional study, 341 cancer patients undergoing acute inpatient care participated. A structured clinical interview (Structured Clinical Interview for DSM-IV Axis I) was used to identify Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition anxiety disorders and hypochondriasis. Patients completed measures of FoP (Fear of Progression Questionnaire), worries (Penn State Worry Questionnaire, Worry Domains Questionnaire), depression [Patient Health Questionnaire (PHQ): Depression], anxiety (PHQ: General Anxiety Disorder) and somatic symptoms (PHQ: Somatic Symptoms). We cross-tabulated FoP with the presence of anxiety disorders and studied associated variables. RESULTS Of all patients studied, 17.6% suffered from an anxiety disorder. With regard to comorbidity, 68.3% suffered neither from clinical FoP nor from any anxiety disorder, 13.4% had not been diagnosed with an anxiety disorder but experienced clinical FoP, and 11.6% only suffered from an anxiety disorder. The remaining 6.7% suffered from FoP that was comorbid with an anxiety disorder. Patients with a pure FoP did not differ from patients with a pure anxiety disorder on nearly all symptom measures. Only a few associations between the comorbidity pattern and sociodemographic and clinical variables emerged. CONCLUSION Clinical FoP appears to be a distinct phenomenon. It does not differ from anxiety disorders in its psychological and somatic burdens.
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Affiliation(s)
- Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Katrin Kremsreiter
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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20
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Sanghera R, Sanders R, Husby M, Bentsen JG. Development of the subcutaneous implantable cardioverter-defibrillator for reducing sudden cardiac death. Ann N Y Acad Sci 2014; 1329:1-17. [DOI: 10.1111/nyas.12550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rick Sanghera
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Richard Sanders
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Michael Husby
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - James G. Bentsen
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
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Abstract
BACKGROUND Research on the emotional processes associated with Type D personality is important for its further conceptualization. We examined the associations of Type D personality with social and general anxiety symptoms in a large community sample. PURPOSE The aim of the current study was to disentangle the associations of Type D personality and its components with social anxiety and general anxiety in a large sample from the general population. METHODS A random sample of 2,475 adults from the general population filled out questionnaires to assess Type D personality (DS-14), social anxiety (SIAS(10), SPS(11), BFNE-II), and general anxiety (HADS-A, GAD-7). RESULTS Type D individuals were characterized by increased levels of both social and general anxiety. The social inhibition (SI) component of Type D personality was most strongly associated with social interaction anxiety (r = .63), while negative affectivity (NA) was strongly associated with general anxiety (GAD-7: r = .70; HADS-A: r = .66). Within social anxiety, SI was more strongly associated with facets of social interaction anxiety than with social phobia. Multiple regression analysis showed that the synergistic interaction of NA and SI was a predictor of social anxiety (SIAS(10): β = .32, p < .0005; SPS(11): β = .27, p < .0005; BFNE-II: β = .11, p = .007) independent of demographics and the scores on the individual Type D components. This interaction was not a significant predictor of general anxiety. Logistic regression using the dichotomous Type D classification demonstrated a 9.1-fold (95%CI, 7.0-11.8) increased odds of a score in the highest quartile of social interaction anxiety and a 7.6-fold (95%CI, 5.8-9.8) increased odds of high social phobia. Odds ratios for clinically relevant levels of general anxiety were 8.3 (95%CI, 5.5-12.5) for GAD-7 and 6.5 (95%CI, 3.4-12.6) for HADS-A. CONCLUSION In the general population, Type D individuals were characterized by both social and general anxiety. The SI component of Type D is strongly associated with social interaction anxiety and the synergistic interaction of NA and SI was associated with high social anxiety, above and beyond the main NA and SI effects.
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Thylén I, Dekker RL, Jaarsma T, Strömberg A, Moser DK. Characteristics associated with anxiety, depressive symptoms, and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients. J Psychosom Res 2014; 77:122-7. [PMID: 25077853 DOI: 10.1016/j.jpsychores.2014.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Although most patients with implantable cardioverter defibrillators (ICDs) adjust well, some have considerable psychological distress. Factors associated with psychological adjustment in ICD-recipients are still not well understood. Our purpose was to describe quality-of-life (QoL) and prevalence of self-reported symptoms of anxiety and depression in a large national cohort of ICD-recipients, and to determine socio-demographic, clinical, and ICD-related factors associated with these variables. METHODS A cross-sectional, correlational design was used. All eligible adult ICD-recipients in the Swedish ICD- and Pacemaker Registry were invited to participate. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS), and QoL with the EuroQol-5D. RESULTS A total of 3067 ICD-recipients (66±11years, 80% male) were included. The mean HADS score was 3.84±3.70 for anxiety symptoms and 2.99±3.01 for symptoms of depression. The mean EQ-5D index score was 0.82±0.21. The probability of symptoms of anxiety and depression was associated with younger age, living alone, and a previous history of myocardial infarction or heart failure. Additionally, female ICD-recipients had a higher probability of symptoms of anxiety. A higher level of ICD-related concerns was most prominently related to symptoms of anxiety, depressive symptoms and poorer QoL, while number of shocks, ICD-indication and time since implantation were not independently related. CONCLUSIONS In this large cohort of ICD-recipients, the association of ICD-related concerns with symptoms of anxiety, depressive symptoms, and poor QoL suggests that ICD specific factors should be addressed in order to improve outcomes.
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Affiliation(s)
- Ingela Thylén
- Department of Cardiology and Department of Medicine and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping, Sweden.
| | - Rebecca L Dekker
- College of Nursing, University of Kentucky, Lexington, United States.
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Anna Strömberg
- Department of Cardiology and Department of Medicine and Health Sciences, Division of Nursing Sciences, Linköping University, Linköping, Sweden.
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, United States.
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Morken IM, Norekvål TM, Bru E, Larsen AI, Karlsen B. Perceptions of healthcare professionals’ support, shock anxiety and device acceptance among implantable cardioverter defibrillator recipients. J Adv Nurs 2014; 70:2061-2071. [PMID: 24506575 DOI: 10.1111/jan.12364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 09/13/2013] [Accepted: 01/11/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Ingvild M. Morken
- Department of Cardiology; Stavanger University Hospital; Norway
- Department of Health Studies; University of Stavanger; Norway
| | - Tone M. Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Norway
- Norwegian Centre for Learning Environment and Behavioural Research in Education; University of Stavanger; Norway
| | - Alf I. Larsen
- Department of Cardiology; Stavanger University Hospital; Norway
- Institute of Medicine; University of Bergen; Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Norway
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Hoogwegt MT, Pedersen SS, Theuns DAMJ, Kupper N. Relation between emotional distress and heart rate variability in patients with an implantable cardioverter-defibrillator. Psychophysiology 2013; 51:187-96. [PMID: 24423136 DOI: 10.1111/psyp.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/07/2013] [Indexed: 11/29/2022]
Abstract
We investigated the relationship between Type D personality, depression, and anxiety, and heart rate variability (HRV) in 64 patients with an implantable cardioverter-defibrillator (ICD). HRV was obtained via 24-h Holter monitoring, and 24-h, 30-min daytime rest and 30-min nighttime sleep HRV were analyzed. In adjusted analyses, significant associations (standard deviation of normal-to-normal [NN] intervals [SDNN]: p = .043; standard deviation of NN intervals over 5-min periods [SDANN]: p = .010) and a trend (HRV triangular index: p = .09) were found for Type D personality, and trends were found for depression (lower RMSSD: p = .10; lower pNN50: p = .09). During daytime rest, similar results were found for anxiety and depression. During sleep, only noteworthy adjusted associations were found for depression (lower root mean square of successive differences in NN intervals [RMSSD]: p = .06; lower pNN50: p = .043). A Benjamini-Hochberg correction for multiple testing led to reduction of the number of significant relationships, but there was still support for lower autonomic control patients with Type D personality and depression. Future research with larger sample sizes is warranted.
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Affiliation(s)
- Madelein T Hoogwegt
- CoRPS-Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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In reply to the Letter to the editor of Dr. Kawada: "Depression and 7-year mortality for patients treated with percutaneous coronary intervention". Int J Cardiol 2013; 168:2880-1. [PMID: 23642816 DOI: 10.1016/j.ijcard.2013.03.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/19/2013] [Accepted: 03/29/2013] [Indexed: 11/20/2022]
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LANG SASKIA, BECKER RÜDIGER, WILKE STEFANIE, HARTMANN MECHTHILD, HERZOG WOLFGANG, LÖWE BERND. Anxiety Disorders in Patients with Implantable Cardioverter Defibrillators: Frequency, Course, Predictors, and Patients’ Requests for Treatment. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:35-47. [DOI: 10.1111/pace.12276] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/24/2013] [Accepted: 08/12/2013] [Indexed: 12/31/2022]
Affiliation(s)
- SASKIA LANG
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - RÜDIGER BECKER
- Department of Cardiology; University of Heidelberg; Heidelberg Germany
| | - STEFANIE WILKE
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - MECHTHILD HARTMANN
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - WOLFGANG HERZOG
- Department of General Internal Medicine and Psychosomatics; University of Heidelberg; Heidelberg Germany
| | - BERND LÖWE
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek; Hamburg Germany
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27
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Morken IM, Bru E, Norekvål TM, Larsen AI, Idsoe T, Karlsen B. Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients. J Clin Nurs 2013; 23:450-60. [DOI: 10.1111/jocn.12200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Ingvild M Morken
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Department of Health Studies; University of Stavanger; Stavanger Norway
| | - Edvin Bru
- Department of Health Studies; University of Stavanger; Stavanger Norway
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
| | - Tone M Norekvål
- Department of Heart Disease; Haukeland University Hospital; Bergen Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Alf I Larsen
- Department of Cardiology; Stavanger University Hospital; Stavanger Norway
- Institute of Medicine; University of Bergen; Bergen Norway
| | - Thormod Idsoe
- Centre for Behavioural Research; University of Stavanger; Stavanger Norway
- Norwegian
Institute of Public Health; Oslo Norway
| | - Bjørg Karlsen
- Department of Health Studies; University of Stavanger; Stavanger Norway
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28
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Shortening the S-STAI: consequences for research and clinical practice. J Psychosom Res 2013; 75:167-72. [PMID: 23915774 DOI: 10.1016/j.jpsychores.2013.03.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Several authors proposed a shortened version of the State scale of the State-Trait Anxiety Inventory (S-STAI) to obtain a more efficient measurement instrument. Psychometric theory shows that test shortening makes a total score more vulnerable to measurement error, and this may result in inaccurate and biased research results and an increased risk of making incorrect decisions about individuals. This study investigated whether the reliability and the measurement precision of shortened versions of the S-STAI are adequate for psychological research and making decisions about individuals in clinical practice. METHODS Secondary data analysis was used to compare reliability and measurement precision between twelve shortened S-STAI versions and the full-length 20-item S-STAI version. Data for the 20-item version came from a longitudinal study performed previously in the Netherlands and included 377 patients and 375 of their family members. This was our master data set. A literature study was conducted to identify shortened S-STAI versions that are used in research and clinical practice. Data for each shortened version were obtained from the master data set by selecting the relevant items from the 20-item version. All analyses were done by means of classical test theory statistics. RESULTS The effect of test shortening on total-score reliability was small, the effect on measurement precision was large, and the effect on individual diagnosis and assessment of individual change was ambiguous. CONCLUSION We conclude that shortened versions of the S-STAI seem to be acceptable for research purposes, but may be problematic in clinical practice.
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Williams J, Roth A, Vatthauer K, McCrae CS. Cognitive behavioral treatment of insomnia. Chest 2013; 143:554-565. [PMID: 23381322 DOI: 10.1378/chest.12-0731] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Chronic insomnia (symptoms for ≥ 6 months) is the most common sleep disorder, affecting 6% to 10% of adults in the general population, with even higher rates in patients with comorbid conditions (eg, hypertension, 44%; cardiac disease, 44.1%; breathing problems, 41.5%). Traditionally, chronic insomnia occurring with another condition has been considered secondary and rarely received direct treatment because treatment of the primary condition was expected to improve the insomnia. However, this approach often failed because chronic insomnia is maintained by behaviors, cognitions, and associations that patients adopt as they attempt to cope with poor sleep but that end up backfiring (eg, increasing caffeine, spending more time in bed, trying harder to sleep). Cognitive behavioral treatment of insomnia (CBTi) targets those behaviors, cognitions, and associations and is effective across a variety of populations, including those with medical and psychologic comorbidities. Thus, in 2005, a National Institutes of Health expert consensus panel on chronic insomnia recommended dropping the term "secondary insomnia" in favor of the term "comorbid insomnia." Because CBTi does not carry the risks associated with some sleep medications (eg, dependency, polypharmacy, cognitive and psychomotor impairment), it is an attractive option for patients with other conditions. Through the Society of Behavioral Sleep Medicine (www.behavioralsleep.org) and the American Board of Sleep Medicine (www.absm.org), it is possible to find practitioners with expertise in CBTi (as well as other aspects of behavioral sleep medicine) and other behavioral sleep resources. Given the currently limited number of trained practitioners, exploration of alternative delivery methods (eg, briefer protocols, self-help, Internet) to improve access to this highly effective treatment and expanded training in these treatments are warranted.
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Affiliation(s)
- Jacob Williams
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Alicia Roth
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Karlyn Vatthauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Christina S McCrae
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL.
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Pedersen SS, Hoogwegt MT, Jordaens L, Theuns DA. Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12months post implantation. Int J Cardiol 2013; 166:215-20. [DOI: 10.1016/j.ijcard.2011.10.092] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 09/18/2011] [Accepted: 10/18/2011] [Indexed: 11/15/2022]
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31
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Hoogwegt MT, Kupper N, Jordaens L, Pedersen, SS, Theuns DA. Comorbidity burden is associated with poor psychological well-being and physical health status in patients with an implantable cardioverter-defibrillator. ACTA ACUST UNITED AC 2013; 15:1468-74. [DOI: 10.1093/europace/eut072] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Habibović M, Burg MM, Pedersen SS. Behavioral interventions in patients with an implantable cardioverter defibrillator: lessons learned and where to go from here? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:578-90. [PMID: 23438053 DOI: 10.1111/pace.12108] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/27/2012] [Accepted: 01/03/2013] [Indexed: 01/21/2023]
Abstract
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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Affiliation(s)
- Mirela Habibović
- CoRPS - Department of Medical and Clinical Psychology, Tilburg University, The Netherlands
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33
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VAN DEN Broek KC, Heijmans N, VAN Assen MALM. Anxiety and depression in patients with an implantable cardioverter defibrillator and their partners: a longitudinal study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:362-71. [PMID: 23252886 DOI: 10.1111/pace.12055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 09/11/2012] [Accepted: 10/23/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the relation between emotional distress of patients with an implantable cardioverter defibrillator (ICD) and distress of their partners. This longitudinal study aimed to determine the association between patient and partner distress, and to explain distress in patients and partners using demographic, clinical, and psychological characteristics of patients and partners. METHODS In total, 343 patients (84% male, mean age = 63.2 ± 9.2 years) and partners (18% male, mean age = 60.3 ± 9.4 years) completed self-report measures on anxiety and depressive symptoms at the time of implantation and at 2, 12, and 18 months follow-up. Type D personality (DS14; nonexpression of negative emotions) was assessed at baseline. Clinical information was gathered from medical records. Multilevel modeling was applied. RESULTS The correlations between distress in patients and partners were positive (range r = 0.19-0.43; all P's < 0.001). Generally, partners experienced more anxiety and patients more depression. Patient and partner characteristics explained about half of the variance of distress of patients and partners. As expected, psychological characteristics had the strongest effect on distress. Patient anxiety was associated with patient depression and Type D, and to the corresponding distress variable of the partner (anxiety). Similar results were found for patient depression, partner anxiety, and partner depression. CONCLUSION Distress of ICD patients is associated with distress of their partners. Future studies need to investigate mechanisms of these patient-partner dynamics, such as communication and behavioral issues. It may be timely to not only focus emotional support on patients, but also on their partners.
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Affiliation(s)
- Krista C VAN DEN Broek
- Department of Medical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
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Trajectories of Perceived Emotional and Physical Distress in Patients with an Implantable Cardioverter Defibrillator. Int J Behav Med 2012; 21:149-59. [DOI: 10.1007/s12529-012-9275-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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MORKEN INGVILDM, ISAKSEN KJETIL, KARLSEN BJØRG, NOREKVÅL TONEM, BRU EDVIN, LARSEN ALFINGE. Shock Anxiety among Implantable Cardioverter Defibrillator Recipients with Recent Tachyarrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1369-76. [DOI: 10.1111/j.1540-8159.2012.03505.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pelle AJ, Loerbroks A, Widdershoven JW, Denollet J. Heart failure and comorbid diabetes mellitus or chronic obstructive pulmonary disease: effects on mood in outpatients. Int J Cardiol 2011; 154:216-7. [PMID: 22078992 DOI: 10.1016/j.ijcard.2011.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/18/2011] [Indexed: 11/29/2022]
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Damen NL, Pelle AJ, van Geuns RJM, van Domburg RT, Boersma E, Pedersen SS. Intra-individual changes in anxiety and depression during 12-month follow-up in percutaneous coronary intervention patients. J Affect Disord 2011; 134:464-7. [PMID: 21676467 DOI: 10.1016/j.jad.2011.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 05/16/2011] [Accepted: 05/16/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Only a paucity of studies focused on intra-individual changes in anxiety and depression over time and its correlates in cardiac patients, which may contribute to the identification of high-risk patients and point to targets for intervention. We examined changes in anxiety and depression over a 12-month period and the demographic and clinical correlates of change scores using an intra-individual approach in patients treated with percutaneous coronary intervention (PCI). METHODS Consecutive PCI patients (N=715) completed the Hospital Anxiety and Depression Scale (HADS) at baseline and at 12 months post-PCI. Individual change scores were calculated and in secondary analysis, three categories of change were identified (i.e., stable, improved, and deteriorated anxiety or depression). RESULTS The mean individual change was -.16 (± 3.0) for anxiety and -.02 (± 2.8) for depression. In linear regression analysis, baseline anxiety levels (B = -.25, 95%CI[-.30 to -.20], p = <.001) and baseline depression levels (B = -.28, 95%CI[-.33 to -.22], p =< .001) were significant correlates of individual change scores. Secondary analysis showed that anxiety remained stable in 76.4% (546/715) of patients, while depression remained stable in 81.4% (582/715) of patients. CONCLUSIONS The findings of the current study showed that levels of anxiety and depression remained stable in the majority of PCI patients from the index PCI to 12 months post-PCI. Future studies using an intra-individual approach are warranted to further examine individual changes in anxiety and depression over time in CAD, and PCI in particular, as a means to bridge the gap between research and clinical practice.
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Affiliation(s)
- Nikki L Damen
- Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands
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Norton S, Sacker A, Young A, Done J. Distinct psychological distress trajectories in rheumatoid arthritis: findings from an inception cohort. J Psychosom Res 2011; 71:290-5. [PMID: 21999971 DOI: 10.1016/j.jpsychores.2011.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 04/21/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE As with other chronic physical illness, rates of depressive disorder are high in rheumatoid arthritis (RA). The aim of the current study was to identify distinct trajectories of psychological distress over 10 years in a cohort of RA patients recruited very early in the course of the disease. METHODS Psychological distress as measured by the Hospital Anxiety and Depression Scale total score was assessed annually in a subgroup of 784 patients enrolled in a multi-centre RA inception cohort (Early RA Study). A latent growth mixture modelling (GMM) approach was used to identify distinct psychological distress patterns. RESULTS Four distinct psychological distress trajectories were observed: low-stable (68%), high-stable (12%), high-decreasing (9%) and low-increasing (11%). Symptoms of pain, stiffness and functional impairment were significantly associated with levels of psychological distress at the time of diagnosis and after 3 years; serological markers of disease activity (ESR and CRP) were not. CONCLUSIONS Although the majority of individuals developing RA experience little or no impact of the effects of the disease on their psychological well-being, a significant proportion experience high levels of distress at some point which may be related to their subjective appraisal of their condition. Assessment and treatment of psychological distress should occur synchronously with somatic symptoms.
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Affiliation(s)
- Sam Norton
- Centre for Lifespan & Chronic Illness Research, University of Hertfordshire, UK.
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Pedersen SS, Schiffer AA. The distressed (Type D) personality. A risk marker for poor health outcomes in ICD patients. Herzschrittmacherther Elektrophysiol 2011; 22:181-188. [PMID: 21710200 DOI: 10.1007/s00399-011-0139-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The distressed (Type D) personality is an emerging risk marker for poor health outcomes in patients with cardiovascular disease. Patients with this personality disposition are typified by a general propensity to experience psychological distress. The contribution focuses on the impact of Type D personality on psychological distress, quality of life, ventricular tachyarrhythmias, and mortality in implantable cardioverter-defibrillator (ICD) patients and examines the relative influence of this vulnerability factor compared to ICD shocks and markers of disease severity in relation to these outcomes.
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Affiliation(s)
- S S Pedersen
- CoRPS - Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, Warandelaan 2, 90153, 5000, LE Tilburg, The Netherlands.
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[Changes in depression, anxiety, and vital exhaustion in patients after ICD implantation. Comparison of clinical subgroups]. Herzschrittmacherther Elektrophysiol 2011; 22:174-9. [PMID: 21773789 DOI: 10.1007/s00399-011-0144-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The psychological strain of an implantable cardioverter-defibrillator (ICD) is infrequently explored in prospective studies, which have until now generally focused on the dimensions anxiety and depression. Furthermore, vital exhaustion (VE; ICD10 F 48.0) is known as a very good predictor for negative outcome in patients with coronary heart disease. The influence of VE on patients with an ICD is presented and analyzed in a prospective study. METHODS A total of 249 patients with an ICD completed a set of questionnaires (HADS, EQ-5D, VE) at baseline and at the 1-year follow-up. RESULTS The patients with high levels of depression, anxiety, and VE after ICD implantation did not show spontaneous remission after 1 year. DISCUSSION As expected, the implanatation of an ICD is associated with high acceptance and increased life quality in about 3/4 of patients. However, there is a subgroup of patients (20-30%) who have difficulties and the measured dimensions remain at elevated levels after implantation, thus, indicating that these patients probably need competent psychological help.
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Cross NJ, McCrae CS, Smith KM, Conti JB, Sears SF. Comparison of actigraphic and subjective measures of sleep in implantable cardioverter defibrillator and coronary artery disease patients. Clin Cardiol 2011; 33:753-9. [PMID: 21184559 DOI: 10.1002/clc.20827] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cardiac patients frequently have insomnia symptoms that may pose risk for future cardiac events. Poor sleep relates to hyperarousal, anxiety and depression, and the incidence of hypertension and myocardial infarction. HYPOTHESIS The authors hypothesized that implantable cardioverter defibrillator (ICD) patients would have poorer sleep than coronary artery disease (CAD) patients related to hypervigilance for device functioning and shock discharge. METHODS Authors investigated sleep efficiency and sleep latency in a sample of 60 patients (n = 30 CAD and n = 30 ICD) without obstructive sleep apnea at the University of Florida & Shands Hospital. For 14 days, participants completed a sleep diary. Additionally, half of the total sample also used actigraphy to objectively measure their sleep. Measures of somatic hypervigilance and psychosocial distress were administered. RESULTS Using actigraphy, mean sleep efficiency was poorer (69.76%) in CAD patients compared with ICD patients (82.80%). This difference was highly significant, F₁,₂₇ = 16.840, P < 0.001. CAD patients also had shorter mean total sleep times per sleep diaries compared with ICD patients (336.19 minutes or 5.60 hours, 430.65 minutes or 7.18 hours, respectively), F₁,₂₇ = 15.908, P < 0.001. CONCLUSIONS The finding that ICD patients slept more efficiently than CAD patients is surprising given that CAD patients had higher ejection fractions and no concerns about ICD shocks. This difference cannot be accounted for by differences in hypervigilance, depression, anxiety, or physical activity. Results suggest that CAD patients may have more sleep problems and may warrant increased research attention.
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Affiliation(s)
- Natalie J Cross
- Department of Veterans Affairs, Greenville Community Based Outpatient Clinic, North Carolina, USA.
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NEWMAN DAVID, CRYSTAL EUGENE. The Marriage of True Minds: The Partner of the ICD Patient as a New Focus for Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1427-9. [DOI: 10.1111/j.1540-8159.2010.02886.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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