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Schulz SM, Ritter O, Zniva R, Nordbeck P, Wacker C, Jack M, Groschup G, Deneke T, Puppe F, Ertl G, Angermann C, Störk S, Pauli P. Efficacy of a web-based intervention for improving psychosocial well-being in patients with implantable cardioverter-defibrillators: the randomized controlled ICD-FORUM trial. Eur Heart J 2021; 41:1203-1211. [PMID: 30957867 PMCID: PMC9597328 DOI: 10.1093/eurheartj/ehz134] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/28/2018] [Accepted: 02/25/2019] [Indexed: 11/16/2022] Open
Abstract
Aims Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. Methods and results This multicentre, randomized controlled trial (RCT) enrolled 118 ICD patients with increased anxiety or depression [≥6 points on either subscale of the Hospital Anxiety and Depression Scale (HADS)] or reduced QoL [≤16 points on the Satisfaction with Life Scale (SWLS)] from seven German sites (mean age 58.8 ± 11.3 years, 22% women). The primary outcome was a composite assessing change in heart-focused fear, depression, and mental QoL 6 weeks after randomization to WBI or UC, stratified for age, gender, and indication for ICD placement. Web-based intervention consisted of 6 weeks’ access to a structured interactive web-based programme (group format) including self-help interventions based on cognitive behaviour therapy, a virtual self-help group, and on-demand support from a trained psychologist. Linear mixed-effects models analyses showed that the primary outcome was similar between groups (η
p
2 = 0.001). Web-based intervention was superior to UC in change from pre-intervention to 6 weeks (overprotective support; P = 0.004, η
p
2 = 0.036), pre-intervention to 1 year (depression, P = 0.004, η
p
2 = 0.032; self-management, P = 0.03, η
p
2 = 0.015; overprotective support; P = 0.02, η
p
2 = 0.031), and 6 weeks to 1 year (depression, P = 0.02, η
p
2 = 0.026; anxiety, P = 0.03, η
p
2 = 0.022; mobilization of social support, P = 0.047, η
p
2 = 0.018). Conclusion Although the primary outcome was neutral, this is the first RCT showing that WBI can improve psychosocial well-being in ICD patients. ![]()
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Affiliation(s)
- Stefan M Schulz
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, BY, 97070 Würzburg, Germany.,Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Wallstraße 3, RP, 55122 Mainz, Germany
| | - Oliver Ritter
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Cardiologoephrology and Pulmology, Brandenburg Medical School, University Hospital Brandenburg, Hochstraße 29, BB, 14770 Brandenburg an der Havel, Germany
| | - Richard Zniva
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Peter Nordbeck
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, BY, 97080 Würzburg, Germany
| | - Christian Wacker
- Division of Cardiology, Department of Medicine, ANregiomed-Hospital Rothenburg ob der Tauber, Ansbacher Straße 131, BY, 91541 Rothenburg ob der Tauber, Germany
| | - Mary Jack
- Hospital Bad Wörishofen, Tannenbaum 2, BY, 86825 Bad Wörishofen, Germany
| | - Guido Groschup
- Division of Rhythmology, Department of Medicine I, City Hospital Aschaffenburg, Am Hasenkopf 1, BY, 63739 Aschaffenburg, Germany
| | - Thomas Deneke
- Department of Cardiology, Cardiovascular Centre GmbH, Schlossplatz 1, BY, 97616 Bad Neustadt a. d. Saale, Germany
| | - Frank Puppe
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Chair of Computer Science VI, University of Würzburg, Am Hubland, BY, 97074 Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Christiane Angermann
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Division of Cardiology, Department of Medicine I, University Hospital Würzburg, Oberdürrbacher Straße 6, BY, 97080 Würzburg, Germany
| | - Paul Pauli
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Am Schwarzenberg 15, BY, 97078 Würzburg, Germany.,Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Marcusstraße 9-11, BY, 97070 Würzburg, Germany
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2
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Khalsa SS, Clausen AN, Shahabi L, Sorg J, Gonzalez SE, Naliboff B, Shivkumar K, Ajijola OA. Cardiac sympathetic denervation and mental health. Auton Neurosci 2021; 232:102787. [PMID: 33631539 DOI: 10.1016/j.autneu.2021.102787] [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: 03/06/2020] [Revised: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. METHODS 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. RESULTS A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. CONCLUSION The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States of America; Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States of America.
| | - Ashley N Clausen
- Department of Behavioral Health, Kansas City VA Medical Center, Kansas City, MO, United States of America; Department of Psychiatry and Behavioral Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Leila Shahabi
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Julie Sorg
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sarah E Gonzalez
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Bruce Naliboff
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Kalyanam Shivkumar
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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3
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O'Donovan CE, Skinner JR, Broadbent E. The trajectory of anxiety and depression in people presenting to a cardiac inherited disease service: a longitudinal study. Psychol Health 2020; 36:1260-1274. [PMID: 33090029 DOI: 10.1080/08870446.2020.1836181] [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: 10/23/2022]
Abstract
OBJECTIVE Little is known about the psychological experiences of individuals being investigated for cardiac inherited diseases (CID). This study aimed to assess the prevalence, trajectory and associated variables of anxiety and depression in this population. DESIGN This was a longitudinal study with 116 individuals being investigated for a CID; 85 (73%) completed follow-up. MAIN OUTCOME MEASURES Questionnaires were administered at the first appointment, post-disclosure of genetic results, and six-months later. Questionnaires measured demographic and psychological variables. The NZCID Registry provided clinical and genetic information. RESULTS Thirty-seven (43%) individuals reported clinical and subclinical levels of anxiety and/or depression at least once. Anxiety and depression at follow up were associated with anxiety (p < .001) and depression (p < .001) at baseline. Elevated anxiety and depression scores at any point were also associated with more reporting of somatic symptoms (p < .001), poorer social support (p < .01) and greater intolerance for uncertainty (p < .001). There were five different trajectories of anxiety and depression: stable-low, stable-high, increasing, decreasing and fluctuating. CONCLUSION A significant minority of individuals being investigated for a CID experience anxiety and depression. Ongoing screening for anxiety, depression, social support and somatic symptoms could help identify those individuals.
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Affiliation(s)
- Claire E O'Donovan
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Shakibfar S, Yazdchi M, Aliakbaryhosseinabadi S. Effectiveness of CRT-D Versus ICD on Prevention of Electrical Storm: Big Data from the USA .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:302-304. [PMID: 31945901 DOI: 10.1109/embc.2019.8857530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with implantable cardioverter-defibrillator (ICD) are at the risk of electrical storm (ES) occurrence associated with mortality and poor quality of life. Cardiac resynchronization therapy with defibrillator (CRT-D) minimizes inappropriate ICD shocks. However, limited reports exist on the impact of CRT-D versus traditional ICD on ES occurrences in real-life cohorts. We evaluated the implanted-device characteristics associated with ES events in a large data based on daily stored device-summaries obtained from remote monitoring data in US.Between 2004 and 2016, 19,935 US patients were implanted. Survival analyses with Cox regression for device-shock therapy were performed between patients who experienced at least one ES and those without ES. CRT-D devices (bi-ventricular) were implanted in 5522 (28%) patients during this period, and their ES events over time were compared to ICD recipients implanted with RV lead. Primary endpoint was the first ES event.ES occurred with the rate of 7.26% for all patients during the period. Cox regression analyses revealed significantly an increase risk in ES occurrences (the p-value <; 0.05 and hazard ratio >> 1) with shock therapy. CRT-D implant led to lower ES risk comparing with patients received traditional ICD (RV only).
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5
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Miller JL, Thylén I, Elayi SC, Etaee F, Fleming S, Czarapata MM, Lennie TA, Moser DK. Multi-morbidity burden, psychological distress, and quality of life in implantable cardioverter defibrillator recipients: Results from a nationwide study. J Psychosom Res 2019; 120:39-45. [PMID: 30929706 DOI: 10.1016/j.jpsychores.2019.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The prevalence of multi-morbidity in implantable cardioverter defibrillator (ICD) recipients is approximately 25%. Multi-morbidity is associated with poor health and psychological outcomes in this population and may affect ICD recipients' quality-of-life (QOL). The purpose of this study was to determine the prevalence of psychological distress (anxiety, depressive symptoms, and Type-D personality) in ICD recipients with varying levels of comorbidities, and to examine the association between multi-morbidity burden and QOL in this population. METHODS All adults listed in the Swedish ICD and Pacemaker Registry in 2012 with an ICD implanted for at least one year were invited to participate in this study. Binary logistic regression was used to predict QOL using the EQ-5D mean index dichotomized based on median QOL scores. Multi-morbidity burden scores were based on quartile groupings. RESULTS A total of 2658 ICD recipients participated in the study (with a mean age of 65, 20.6% female, mean implant duration of 4.7 years, with 35.4% implanted for primary prevention of sudden cardiac arrest). Greater multi-morbidity burden, female sex, not working outside the home, history of ICD shock, negative ICD experience, higher levels of ICD-related concerns, and the presence of anxiety, depression, or Type D personality were associated with worse QOL in ICD recipients. Predictors differed by multi-morbidity burden level. CONCLUSIONS Multi-morbidity burden and psychological distress is an essential factor related to QOL. This issue should be discussed with potential ICD recipients prior to implant. Further exploration of increased recognition and treatment of psychological distress in ICD recipients is warranted.
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Affiliation(s)
- Jennifer L Miller
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| | - Ingela Thylén
- Department of Cardiology, Department of Medical Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Samy C Elayi
- University of Florida, Jacksonville, FL, United States
| | - Farshid Etaee
- Division of Cardiology, University of Kentucky College of Medicine, Gill Heart Institute, 800 Rose St, Lexington, KY 40536, United States.
| | - Steve Fleming
- University of Kentucky College of Public Health, Lexington, KY, United States
| | - Mary M Czarapata
- Division of Cardiology, University of Kentucky College of Medicine, Gill Heart Institute, 800 Rose St, Lexington, KY 40536, United States
| | - Terry A Lennie
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
| | - Debra K Moser
- University of Kentucky College of Nursing, RICH Heart Program, Lexington, KY, United States
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6
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Nielsen KM, Zwisler A, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Jakobsen JC, Berg SK. Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Cochrane Database Syst Rev 2019; 2:CD011828. [PMID: 30746679 PMCID: PMC6953352 DOI: 10.1002/14651858.cd011828.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND An effective way of preventing sudden cardiac death is the use of an implantable cardioverter defibrillator (ICD). In spite of the potential mortality benefits of receiving an ICD device, psychological problems experienced by patients after receiving an ICD may negatively impact their health-related quality of life, and lead to increased readmission to hospital and healthcare needs, loss of productivity and employment earnings, and increased morbidity and mortality. Evidence from other heart conditions suggests that cardiac rehabilitation should consist of both exercise training and psychoeducational interventions; such rehabilitation may benefit patients with an ICD. Prior systematic reviews of cardiac rehabilitation have excluded participants with an ICD. A systematic review was therefore conducted to assess the evidence for the use of exercise-based intervention programmes following implantation of an ICD. OBJECTIVES To assess the benefits and harms of exercise-based cardiac rehabilitation programmes (exercise-based interventions alone or in combination with psychoeducational components) compared with control (group of no intervention, treatment as usual or another rehabilitation programme with no physical exercise element) in adults with an ICD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and four other databases on 30 August 2018 and three trials registers on 14 November 2017. We also undertook reference checking, citation searching and contacted study authors for missing data. SELECTION CRITERIA We included randomised controlled trials (RCTs) if they investigated exercise-based cardiac rehabilitation interventions compared with no intervention, treatment as usual or another rehabilitation programme. The trial participants were adults (aged 18 years or older), who had been treated with an ICD regardless of type or indication. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. The primary outcomes were all-cause mortality, serious adverse events and health-related quality of life. The secondary outcomes were exercise capacity, antitachycardia pacing, shock, non-serious adverse events, employment or loss of employment and costs and cost-effectiveness. Risk of systematic errors (bias) was assessed by evaluation of predefined bias risk domains. Clinical and statistical heterogeneity were assessed. Meta-analyses were undertaken using both fixed-effect and random-effects models. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS We identified eight trials published from 2004 to 2017 randomising a total of 1730 participants, with mean intervention duration of 12 weeks. All eight trials were judged to be at overall high risk of bias and effect estimates are reported at the end of the intervention with a follow-up range of eight to 24 weeks.Seven trials reported all-cause mortality, but deaths only occurred in one trial with no evidence of a difference between exercise-based cardiac rehabilitation and control (risk ratio (RR) 1.96, 95% confidence interval (CI) 0.18 to 21.26; participants = 196; trials = 1; quality of evidence: low). There was also no evidence of a difference in serious adverse events between exercise-based cardiac rehabilitation and control (RR 1.05, 95% CI 0.77 to 1.44; participants = 356; trials = 2; quality of evidence: low). Due to the variation in reporting of health-related quality of life outcomes, it was not possible to pool data. However, the five trials reporting health-related quality of life at the end of the intervention, each showed little or no evidence of a difference between exercise-based cardiac rehabilitation and control.For secondary outcomes, there was evidence of a higher pooled exercise capacity (peak VO2) at the end of the intervention (mean difference (MD) 0.91 mL/kg/min, 95% CI 0.60 to 1.21; participants = 1485; trials = 7; quality of evidence: very low) favouring exercise-based cardiac rehabilitation, albeit there was evidence of substantial statistical heterogeneity (I2 = 78%). There was no evidence of a difference in the risk of requiring antitachycardia pacing (RR 1.26, 95% CI 0.84 to 1.90; participants = 356; trials = 2; quality of evidence: moderate), appropriate shock (RR 0.56, 95% CI 0.20 to 1.58; participants = 428; studies = 3; quality of evidence: low) or inappropriate shock (RR 0.60, 95% CI 0.10 to 3.51; participants = 160; studies = 1; quality of evidence: moderate). AUTHORS' CONCLUSIONS Due to a lack of evidence, we were unable to definitively assess the impact of exercise-based cardiac rehabilitation on all-cause mortality, serious adverse events and health-related quality of life in adults with an ICD. However, our findings do provide very low-quality evidence that patients following exercise-based cardiac rehabilitation experience a higher exercise capacity compared with the no exercise control. Further high-quality randomised trials are needed in order to assess the impact of exercise-based cardiac rehabilitation in this population on all-cause mortality, serious adverse events, health-related quality of life, antitachycardia pacing and shock.
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Affiliation(s)
- Kim M Nielsen
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Ann‐Dorthe Zwisler
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Jesper H Svendsen
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
| | - Jane Lindschou
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchSouth Cloisters, St Luke's Campus, Heavitree RoadExeterUKEX2 4SG
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
| | - Selina K Berg
- Copenhagen University Hospital, RigshospitaletDepartment of Cardiology, The Heart CentreBlegdamsvej 9CopenhagenDenmark2100
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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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8
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Pedersen SS, Skovbakke SJ, Wiil UK, Schmidt T, dePont Christensen R, Brandt CJ, Sørensen J, Vinther M, Larroudé CE, Melchior TM, Riahi S, Smolderen KGE, Spertus JA, Johansen JB, Nielsen JC. Effectiveness of a comprehensive interactive eHealth intervention on patient-reported and clinical outcomes in patients with an implantable cardioverter defibrillator [ACQUIRE-ICD trial]: study protocol of a national Danish randomised controlled trial. BMC Cardiovasc Disord 2018; 18:136. [PMID: 29969990 PMCID: PMC6029360 DOI: 10.1186/s12872-018-0872-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Denmark and other countries, there has been a shift in the management of patients with an implantable cardioverter defibrillator (ICD) with remote device monitoring largely replacing in-hospital visits. Less patient-nurse and patient-physician interaction may lead to gaps in patients' quality of care and impede patients' adaptation to living successfully with the ICD. A comprehensive eHealth intervention that include goal-setting, monitoring of symptoms of depression, anxiety, and quality of life, psychological treatment, information provision, supportive tools, online dialogues with nursing staff and access to an online community network, may help fill these gaps and be particularly beneficial to patients who suffer from anxiety and depression. This study will evaluate the effectiveness of the ACQUIRE-ICD care innovation, a comprehensive and interactive eHealth intervention, on patient-reported and clinical outcomes. METHODS The ACQUIRE-ICD study is a multicenter, prospective, two-arm, unblinded randomised controlled superiority trial that will enroll 478 patients implanted with a first-time ICD or ICD with cardiac synchronisation therapy (CRT-D) from the six implanting centers in Denmark. The trial will evaluate the clinical effectiveness and cost-effectiveness of the ACQUIRE-ICD care innovation, as add-on to usual care compared with usual care alone. The primary endpoint, device acceptance, assessed with the Florida Patient Acceptance Survey, is evaluated at 12 months' post implant. Secondary endpoints, evaluated at 12 and 24 months' post implant, include patient-reported outcomes, return to work, time to first ICD therapy and first hospitalisation, mortality and cost-effectiveness. DISCUSSION The effectiveness of a comprehensive and interactive eHealth intervention that relies on patient-centred and personalised tools offered via a web-based platform targeted to patients with an ICD has not been assessed so far. The ACQUIRE-ICD care innovation promotes and facilitates that patients become active participants in the management of their disease, and as such addresses the need for a more patient-centered disease-management approach. If the care innovation proves to be beneficial to patients, it may not only increase patient empowerment and quality of life but also free up time for clinicians to care for more patients. TRIAL REGISTRATION The trial has been registered on https://clinicaltrials.gov/ct2/show/NCT02976961 on November 30, 2016 with registration number [ NCT02976961 ].
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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
- OPEN, Odense Patient data Explorative Networ, Odense University Hospital, Odense, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Uffe K. Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Jan Sørensen
- Danish Center for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Michael Vinther
- Department of Cardiology B, Rigshospitalet, Copenhagen, Denmark
| | | | - Thomas M. Melchior
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kim G. E. Smolderen
- Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO USA
| | - John A. Spertus
- Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, MO USA
| | - Jens B. Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens C. Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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9
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Ng CY, Mela T. A Primer on Cardiac Devices: Psychological and Pharmacological Considerations. Psychiatr Ann 2016. [DOI: 10.3928/00485713-20161107-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Posttraumatic stress and quality of life with the totally subcutaneous compared to conventional cardioverter-defibrillator systems. Clin Res Cardiol 2016; 106:317-321. [PMID: 27878381 DOI: 10.1007/s00392-016-1055-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND For prevention of sudden cardiac death, the transvenously implantable cardioverter-defibrillator therapy (tv-ICD) is well accepted. The subcutaneous system (S-ICD®) is promising in terms of reducing ICD complications. Nevertheless, the impact of the novel generator position on patients' quality of life (QoL) is yet unknown. OBJECTIVE This study aimed at comparing QoL and posttraumatic stress with both systems. METHODS 60 S-ICD® and 60 case-controlled tv single-chamber ICD patients were asked to respond to three standardized questionnaires. PDS [screening for posttraumatic stress disorders (PTSD)] and PHQ-D (detection of the most predominant psychological disorders) were used to screen for potential mental comorbidities. The SF-12 questionnaire was used to evaluate physical and mental well-being. Groups were compared in terms of QoL and PTSD. RESULTS n = 42 (70%) pairs were analyzed (n = 30 male, mean age 44.6 ± 12.2 years). Prior appropriate (p = 0.06) or inappropriate episodes (p = 0.24), ejection fraction (p = 0.28), or underlying cardiac disease did not differ significantly between groups. PDS revealed a PTSD in n = 6 tv-ICD and n = 6 S-ICD® patients (14.3%) equally. In the PHQ-D questionnaire, n = 4 tv-ICD and n = 2 S-ICD® patients fulfilled criteria for a major depression (p = 0.68). Panic disorders (n = 2 tv, n = 0 S-ICD®, p = 0.5), and anxiety disorders (n = 3 S-ICD®, n = 0 tv-ICD, p = 0.24) did not differ between groups. The physical well-being score was 39.9 ± 12.5 in patients with a tv-ICD compared to 46.6 ± 9.9 in S-ICD® patients (p = 0.01). The mental well-being score was comparable in both groups (tv-ICD 51.8 ± 10.8 vs. S-ICD® 51.9 ± 10.4, p = 0.95). CONCLUSIONS Our case-control study revealed equal or even better physical well-being of patients with the S-ICD®. PTSD occurred in almost 15% of ICD patients irrespective of the type of system.
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Caleshu C, Kasparian NA, Edwards KS, Yeates L, Semsarian C, Perez M, Ashley E, Turner CJ, Knowles JW, Ingles J. Interdisciplinary psychosocial care for families with inherited cardiovascular diseases. Trends Cardiovasc Med 2016; 26:647-53. [DOI: 10.1016/j.tcm.2016.04.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 12/21/2022]
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Sawatari H, Ohkusa T, Rahamawati A, Ishikawa K, Tsuchihashi-Makaya M, Ohtsuka Y, Nakai M, Miyazono M, Hashiguchi N, Chishaki H, Sakurada H, Mukai Y, Inoue S, Sunagawa K, Chishaki A. Left Ventricular Ejection Fraction Predicts Severity of Posttraumatic Stress Disorder in Patients With Implantable Cardioverter-Defibrillators. Clin Cardiol 2016; 39:263-8. [PMID: 27153459 DOI: 10.1002/clc.22521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/07/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICD) have provided effective therapy for fatal arrhythmia. However, ICD patients are known to develop psychological problems, such as posttraumatic stress disorder (PTSD), if they have experienced potentially fatal arrhythmia and ICD shocks. Little is known about the factors influencing PTSD in ICD patients. HYPOTHESIS Echocardiographic cardiac-function parameters might relate to psychological problems, especially PTSD, in ICD patients. METHODS A total of 128 outpatients with ICD implantation completed the Impact of Event Scale Revised (IES-R) questionnaire as a measurement of PTSD. Demographic and clinical characteristic data were collected from medical records. RESULTS The mean age of the ICD patients was 59 ± 16 years; 103 were male; and the mean left ventricular ejection fraction (LVEF) by echocardiography was 52.4% ± 18.3%. In the ICD patients, female sex and impaired LVEF were related to lower IES-R scores or led to PTSD (P = 0.01 and P = 0.03, respectively). Impaired LVEF also worsened 2 symptoms of PTSD, intrusion (P = 0.02) and hyperarousal (P = 0.03). In patients with LVEF <35%, there was a significant negative correlation between LVEF level and IES-R score (P = 0.045). CONCLUSIONS This study showed that LVEF was related to the severity of PTSD, especially in the ICD patients with LVEF of <35%. We should pay more attention to ICD patients with severely impaired left ventricular function to prevent psychological problems.
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Affiliation(s)
- Hiroyuki Sawatari
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Ohkusa
- Center for Clinical and Translational Research, Kyushu University, Fukuoka, Japan
| | - Anita Rahamawati
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Katsuhiko Ishikawa
- Institutional Research Office for Education, Education Promotion Center, Prefectural University of Kumamoto, Kumamoto, Japan
| | | | - Yuko Ohtsuka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
| | - Mori Nakai
- Tokyo Metropolitan Health and Medical Treatment Corporation Ookubo Hospital, Tokyo, Japan
| | - Mami Miyazono
- School of Nursing, Fukuoka Prefectural University, Fukuoka, Japan
| | - Nobuko Hashiguchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroaki Chishaki
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan
| | - Harumizu Sakurada
- Tokyo Metropolitan Health and Medical Treatment Corporation Ookubo Hospital, Tokyo, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shujiro Inoue
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Sunagawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akiko Chishaki
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Healthcare Management, College of Healthcare Management, Fukuoka, Japan
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Knowledge of Implantable Cardioverter Defibrillator Purpose and Function Among Nurses in the United States. J Cardiovasc Nurs 2016; 32:304-310. [PMID: 27111820 DOI: 10.1097/jcn.0000000000000339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nurses play a crucial role in patient education and adaptation to having an implantable cardioverter defibrillator (ICD). OBJECTIVE The aim of this study was to assess cardiology nurses' knowledge and confidence in providing education and support to ICD recipients. METHODS A cross-sectional descriptive survey was used to assess nurses' knowledge and experience caring for ICD recipients in 2 academic medical centers in the Pacific Northwest, using an instrument developed in 2004 in the United Kingdom. RESULTS Nurses (N = 74) worked on cardiology units or clinics, primarily held a baccalaureate degree or higher (85%), and had 16 years or more of nursing experience and 6 to 10 years of cardiology experience. The overall average knowledge score was 77%, with knowledge about modern ICD technology averaging 55%. Nurses' confidence, using 10-point scale, in preparing patients to receive an ICD implant was 6.32 ± 2.56, for preparing patients for discharge was 6.14 ± 2.43, and for providing education about ICD shocks was 6.63 ± 2.50. Nurses were most knowledgeable about factors that affect patient retention of knowledge and ICD-related environmental hazards. Nurses lacked knowledge about the basic ICD components, purpose of cardiac resynchronization, and dual-chamber ICDs. Factors associated with higher knowledge scores included past experience caring for a patient with an ICD and working in an electrophysiology outpatient clinic. CONCLUSIONS The ICD knowledge of US nurses in 2015 was similar to that reported in the United Kingdom in 2004, with limited knowledge about the complexities of modern ICD devices. Such deficits in knowledge may affect the quality of education provided to ICD recipients in preparing them to live safely with an ICD.
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Miller JL, Thylén I, Moser DK. Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:149-59. [PMID: 26856629 DOI: 10.1111/pace.12786] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 10/20/2015] [Accepted: 11/10/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Most patients cope well with an implantable cardioverter defibrillator (ICD), but psychological distress and ICD-related concerns have been reported in about 20% of ICD recipients. Many previous studies have not distinguished between genders. METHODS In this nationwide study we compared quality of life, anxiety, and depression symptoms between the genders in ICD recipients, and determined predictors of each of these variables in men and women. All adult Swedish ICD recipients were invited by mail to participate and 2,771 patients (66 ± 12 years) completed standardized measures of quality of life, symptoms of anxiety, and depression. Time since implantation ranged from 1 year to 23 years with a mean of 4.7 ± 3.9. RESULTS Women reported worse quality of life (mean index 0.790 vs 0.825) and higher prevalence of anxiety (20.5% vs 14.7%) than did men (P < 0.001 for both comparisons), while there were no differences in symptoms of depression (8.8% vs 8.2%). CONCLUSIONS Most ICD recipients report a good quality of life, without emotional distress, but among the minority with distress, women fare worse than men.
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Affiliation(s)
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Protogerou C, Fleeman N, Dwan K, Richardson M, Dundar Y, Hagger MS. Moderators of the effect of psychological interventions on depression and anxiety in cardiac surgery patients: A systematic review and meta-analysis. Behav Res Ther 2015; 73:151-64. [DOI: 10.1016/j.brat.2015.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/21/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
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Nielsen KM, Zwisler AD, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Berg SK. Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Hippokratia 2015. [DOI: 10.1002/14651858.cd011828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Kim M Nielsen
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Ann-Dorthe Zwisler
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Rod S Taylor
- University of Exeter Medical School; Institute of Health Research; Exeter UK EX2 4SG
| | - Jesper H Svendsen
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Jane Lindschou
- Department 7812, Rigshospitalet, Copenhagen University Hospital; Copenhagen Trial Unit, Centre for Clinical Intervention Research; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Lindsey Anderson
- University of Exeter Medical School; Institute of Health Research; Exeter UK EX2 4SG
| | - Selina K Berg
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology, The Heart Centre; Blegdamsvej 9 Copenhagen Denmark 2100
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Ladwig KH, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, Fritzsche K, Haass M, Jordan J, Jünger J, Kindermann I, Köllner V, Kuhn B, Scherer M, Seyfarth M, Völler H, Waller C, Herrmann-Lingen C. Position paper on the importance of psychosocial factors in cardiology: Update 2013. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc09. [PMID: 24808816 PMCID: PMC4012565 DOI: 10.3205/000194] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered. Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
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Affiliation(s)
- Karl-Heinz Ladwig
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-2, Helmholtz-Zentrum München, Neuherberg, Germany ; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Rechts der Isar der TU München, Germany
| | - Florian Lederbogen
- Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Medizinische Fakultät Mannheim, Germany
| | - Christian Albus
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln, Germany
| | | | - Martin Borggrefe
- I. Medizinische Klinik für Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim, Germany
| | - Denise Fischer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Kurt Fritzsche
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Germany
| | - Markus Haass
- Innere Medizin II: Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Jochen Jordan
- Herz-, Thorax- und Rheumazentrum, Abteilung für Psychokardiologie, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Jana Jünger
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Germany
| | - Ingrid Kindermann
- Innere Medizin III (Kardiologie/Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Volker Köllner
- Medizinische Fakultät, Universität des Saarlandes, Blieskastel, Germany
| | - Bernhard Kuhn
- Fachpraxis für Innere Medizin, Kardiologie, Angiologie und Notfallmedizin, Heidelberg, Germany
| | - Martin Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Melchior Seyfarth
- Medizinische Klinik 3 (Kardiologie), Helios-Klinikum Wuppertal-Herzzentrum, Universität Witten/Herdecke, Wuppertal, Germany
| | - Heinz Völler
- Fachklinik für Innere Medizin, Abteilung Kardiologie, Klinik am See, Rüdersdorf, Germany
| | - Christiane Waller
- Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Germany
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Post‐traumatic stress disorder and its risk factors in Japanese patients living with implantable cardioverter defibrillators: A preliminary examination. J Arrhythm 2014. [DOI: 10.1016/j.joa.2013.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Webster G, Panek KA, Labella M, Taylor GA, Gauvreau K, Cecchin F, Martuscello M, Walsh EP, Berul CI, DeMaso DR. Psychiatric functioning and quality of life in young patients with cardiac rhythm devices. Pediatrics 2014; 133:e964-72. [PMID: 24664095 PMCID: PMC3966499 DOI: 10.1542/peds.2013-1394] [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] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Less is known about depression, anxiety and quality of life (QoL) in children and adolescents with pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) than is known in adults with these devices. METHODS A standardized psychiatric interview diagnosed anxiety/depressive disorders in a cross-sectional study. Self-report measures of anxiety, depression and post-traumatic stress disorder were obtained. Medical disease severity, family functioning and QoL data were collected. A total of 166 patients were enrolled (52 ICD, 114 PM; median age 15 years). RESULTS Prevalence of current and lifetime psychiatric disorders was higher in patients with ICDs than PMs (Current: 27% vs. 11%, P = .02; Lifetime: 52% ICD vs. 34% PM, P = .01). Patients with ICDs had more anxiety than a healthy population (25% vs. 7%, P < .01). Patients with ICDs and PMs had similar levels of depression as a healthy population (ICD 10%, PM 4%, reference 4%, P = .29). In multivariate analysis including a medical disease score, demographics, exposure to beta-blockers, activity limitations, hospitalizations, shocks and procedures, the type of device (PM versus ICD) did not predict psychiatric diagnoses when age at implantation and the severity of medical disease were controlled for. Patients with ICDs and PMs had lower physical QoL scores (ICD 45, PM 47.5, Norm 53, P ≤ .03), but similar psychosocial functioning scores (ICD 49, PM 51, Norm 51, P ≥ .16) versus a normal reference population. CONCLUSIONS Anxiety is highly prevalent in young patients with ICDs, but the higher rates can be attributed to medical disease severity and age at implantation instead of type of device.
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Affiliation(s)
- Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Madelyn Labella
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | | | - Kimberlee Gauvreau
- Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Cecchin
- Division of Cardiology, NYU Langone Medical Center, New York University, New York, New York; and
| | - Maria Martuscello
- Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edward P. Walsh
- Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles I. Berul
- Division of Cardiology, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - David R. DeMaso
- Departments of Psychiatry, and,Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Habibović M, Cuijpers P, Alings M, van der Voort P, Theuns D, Bouwels L, Herrman JP, Valk S, Pedersen S. Attrition and adherence in a WEB-Based Distress Management Program for Implantable Cardioverter defibrillator Patients (WEBCARE): randomized controlled trial. J Med Internet Res 2014; 16:e52. [PMID: 24583632 PMCID: PMC3961745 DOI: 10.2196/jmir.2809] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/11/2013] [Accepted: 12/10/2013] [Indexed: 11/26/2022] Open
Abstract
Background WEB-Based Distress Management Program for Implantable CARdioverter defibrillator Patients (WEBCARE) is a Web-based randomized controlled trial, designed to improve psychological well-being in patients with an implantable cardioverter defibrillator (ICD). As in other Web-based trials, we encountered problems with attrition and adherence. Objective In the current study, we focus on the patient characteristics, reasons, and motivation of (1) completers, (2) those who quit the intervention, and (3) those who quit the intervention and the study in the treatment arm of WEBCARE. Methods Consecutive first-time ICD patients from six Dutch referral hospitals were approached for participation. After signing consent and filling in baseline measures, patients were randomized to either the WEBCARE group or the Usual Care group. Results The treatment arm of WEBCARE contained 146 patients. Of these 146, 34 (23.3%) completed the treatment, 88 (60.3%) dropped out of treatment but completed follow-up, and 24 (16.4%) dropped out of treatment and study. Results show no systematic differences in baseline demographic, clinical, or psychological characteristics between groups. A gradual increase in dropout was observed with 83.5% (122/146) completing the first lesson, while only 23.3% (34/146) eventually completed the whole treatment. Reasons most often given by patients for dropout were technical problems with the computer, time constraints, feeling fine, and not needing additional support. Conclusions Current findings underline the importance of focusing on adherence and dropout, as this remains a significant problem in behavioral Web-based trials. Examining possibilities to address barriers indicated by patients might enhance treatment engagement and improve patient outcomes. Trial Registration Clinicaltrials.gov: NCT00895700; http://www.clinicaltrials.gov/ct2/show/NCT00895700 (Archived by WebCite at http://www.webcitation.org/6NCop6Htz).
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Affiliation(s)
- Mirela Habibović
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
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Berg SK, Pedersen PU, Zwisler AD, Winkel P, Gluud C, Pedersen BD, Svendsen JH. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator. Findings from the COPE-ICD randomised clinical trial. Eur J Cardiovasc Nurs 2014; 14:34-44. [PMID: 24504872 DOI: 10.1177/1474515114521920] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS The aim of this randomised clinical trial was to assess a comprehensive cardiac rehabilitation intervention including exercise training and psycho-education vs 'treatment as usual' in patients treated with an implantable cardioverter defibrillator (ICD). METHODS In this study 196 patients with first time ICD implantation (mean age 57.2 (standard deviation (SD)=13.2); 79% men) were randomised (1:1) to comprehensive cardiac rehabilitation vs 'treatment as usual'. Altogether 144 participants completed the 12 month follow-up. The intervention consisted of twelve weeks of exercise training and one year of psycho-educational follow-up focusing on modifiable factors associated with poor outcomes. Two primary outcomes, general health score (Short Form-36 (SF-36)) and peak oxygen uptake (VO₂), were used. Post-hoc analyses included SF-36 and ICD therapy history. RESULTS Comprehensive cardiac rehabilitation significantly increased VO2 uptake after exercise training to 23.0 (95% confidence interval (CI) 20.9-22.7) vs 20.8 (95% CI 18.9-22.7) ml/min/kg in the control group (p=0.004 (multiplicity p=0.015)). Comprehensive cardiac rehabilitation significantly increased general health; at three months (mean 62.8 (95% CI 58.1-67.5) vs 64.4 (95% CI: 59.6-69.2)) points; at six months (mean 66.7 (95% CI 61.5-72.0) vs 61.9 (95% CI 56.1-67.7) points); and 12 months (mean 63.5 (95% CI 57.7-69.3) vs 62.1 (95% CI 56.2-68.0)) points (p <0.05). Explorative analyses showed a significant difference between groups in favour of the intervention group. No significant difference was seen in ICD therapy history. CONCLUSION Comprehensive cardiac rehabilitation combining exercise training and a psycho-educational intervention improves VO₂-uptake and general health. Furthermore, mental health seems improved. No significant difference was found in the number of ICD shocks or anti-tachycardia pacing therapy.
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Affiliation(s)
| | - Preben U Pedersen
- Centre of Clinical Guidelines - Clearinghouse, Faculty of Medicine and Technology, Aalborg University, Denmark
| | - Ann-Dorthe Zwisler
- The Heart Centre Unit 2151, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Per Winkel
- Centre for Clinical Intervention Research Unit 3344, Copenhagen University Hospital, Denmark
| | - Christian Gluud
- Centre for Clinical Intervention Research Unit 3344, Copenhagen University Hospital, Denmark
| | | | - Jesper H Svendsen
- Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), University of Copenhagen, Denmark
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Matchett M, Sears SF, Hazelton G, Kirian K, Wilson E, Nekkanti R. The implantable cardioverter defibrillator: its history, current psychological impact and future. Expert Rev Med Devices 2014; 6:43-50. [DOI: 10.1586/17434440.6.1.43] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jordan J, Titscher G, Peregrinova L, Kirsch H. Manual for the psychotherapeutic treatment of acute and post-traumatic stress disorders following multiple shocks from implantable cardioverter defibrillator (ICD). PSYCHO-SOCIAL MEDICINE 2013; 10:Doc09. [PMID: 24403967 PMCID: PMC3884562 DOI: 10.3205/psm000099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND In view of the increasing number of implanted cardioverter defibrillators (ICD), the number of people suffering from so-called "multiple ICD shocks" is also increasing. The delivery of more than five shocks (appropriate or inappropriate) in 12 months or three or more shocks (so called multiple shocks) in a short time period (24 hours) leads to an increasing number of patients suffering from severe psychological distress (anxiety disorder, panic disorder, adjustment disorder, post-traumatic stress disorder). Untreated persons show chronic disease processes and a low rate of spontaneous remission and have an increased morbidity and mortality. Few papers have been published concerning the psychotherapeutic treatment for these patients. OBJECTIVE The aim of this study is to develop a psychotherapeutic treatment for patients with a post-traumatic stress disorder or adjustment disorder after multiple ICD shocks. DESIGN Explorative feasibility study: Treatment of 22 patients as a natural design without randomisation and without control group. The period of recruitment was three years, from March 2007 to March 2010. The study consisted of two phases: in the first phase (pilot study) we tested different components and dosages of psychotherapeutic treatments. The final intervention programme is presented in this paper. In the second phase (follow-up study) we assessed the residual post-traumatic stress symptoms in these ICD patients. The time between treatment and follow-up measurement was 12 to 30 months. POPULATION Thirty-one patients were assigned to the Department of Psychocardiology after multiple shocks. The sample consisted of 22 patients who had a post-traumatic stress disorder or an adjustment disorder and were willing and able to participate. They were invited for psychological treatment. 18 of them could be included into the follow-up study. METHODS After the clinical assessment at the beginning and at the end of the inpatient treatment a post-treatment assessment with questionnaires followed. In this follow-up measurement, minimum 12 months after inpatient treatment, posttraumatic stress was assessed using the "Impact of Event Scale" (IES-R). SETTING Inpatient treatment in a large Heart and Thorax Centre with a Department of Psychocardiology (Kerckhoff Heart Centre). RESULTS From the 18 patients in the follow-up study no one reported complaints of PTSD. 15 of them reported a high or even a very high decrease of anxiety and avoidance behaviour. CONCLUSIONS The fist step of the treatment development seems to be successful. It shows encouraging results with an acceptable dosage. The second step of our work is in process now: we evaluate the treatment manual within other clinical institutions and a higher number of psychotherapists. This leads in the consequence to a controlled and randomised comparison study.
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Affiliation(s)
- Jochen Jordan
- Department of Psychocardiology, Kerckhoff Clinic Heart and Thorax Center, Bad Nauheim, Germany
| | | | - Ludmila Peregrinova
- Department of Psychocardiology, Kerckhoff Clinic Heart and Thorax Center, Bad Nauheim, Germany
| | - Holger Kirsch
- Evangelische Hochschule (University of Applied Sciences), Darmstadt, Germany
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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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Conijn JM, Emons WHM, van Assen MALM, Pedersen SS, Sijtsma K. Explanatory, Multilevel Person-Fit Analysis of Response Consistency on the Spielberger State-Trait Anxiety Inventory. MULTIVARIATE BEHAVIORAL RESEARCH 2013; 48:692-718. [PMID: 26741059 DOI: 10.1080/00273171.2013.815580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Self-report measures are vulnerable to concentration and motivation problems, leading to responses that may be inconsistent with the respondent's latent trait value. We investigated response consistency in a sample (N = 860) of cardiac patients with an implantable cardioverter defibrillator and their partners who completed the Spielberger State-Trait Anxiety Inventory on five measurement occasions. For each occasion and for both the state and trait subscales, we used the l (p) z person-fit statistic to assess response consistency. We used multilevel analysis to model the between-person and within-person differences in the repeated observations of response consistency using time-dependent (e.g., mood states) and time-invariant explanatory variables (e.g., demographic characteristics). Respondents with lower education, undergoing psychological treatment, and with more post-traumatic stress disorder symptoms tended to respond less consistently. The percentages of explained variance in response consistency were small. Hence, we conclude that the results give insight into the causes of response inconsistency but that the identified explanatory variables are of limited practical value for identifying respondents at risk of producing invalid test results. We discuss explanations for the small percentage of explained variance and suggest alternative methods for studying causes of response inconsistency.
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Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S, Dougherty CM, Fridlund B, Kautz DD, Mårtensson J, Mosack V, Moser DK. Sexual counselling for individuals with cardiovascular disease and their partners: a consensus document from the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Eur Heart J 2013; 34:3217-35. [PMID: 23900695 DOI: 10.1093/eurheartj/eht270] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
After a cardiovascular event, patients and their families often cope with numerous changes in their lives, including dealing with consequences of the disease or its treatment on their daily lives and functioning. Coping poorly with both physical and psychological challenges may lead to impaired quality of life. Sexuality is one aspect of quality of life that is important for many patients and partners that may be adversely affected by a cardiac event. The World Health Organization defines sexual health as '… a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences ….'(1(p4)) The safety and timing of return to sexual activity after a cardiac event have been well addressed in an American Heart Association scientific statement, and decreased sexual activity among cardiac patients is frequently reported.(2) Rates of erectile dysfunction (ED) among men with cardiovascular disease (CVD) are twice as high as those in the general population, with similar rates of sexual dysfunction in females with CVD.(3) ED and vaginal dryness may also be presenting signs of heart disease and may appear 1-3 years before the onset of angina pectoris. Estimates reflect that only a small percentage of those with sexual dysfunction seek medical care;(4) therefore, routine assessment of sexual problems and sexual counselling may be of benefit as part of effective management by physicians, nurses, and other healthcare providers.
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Knackstedt C, Arndt M, Mischke K, Marx N, Nieman F, Kunert HJ, Schauerte P, Norra C. Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy. Heart Vessels 2013; 29:364-74. [PMID: 23732755 DOI: 10.1007/s00380-013-0372-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.
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Affiliation(s)
- Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands,
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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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Anxiety and risk of ventricular arrhythmias or mortality in patients with an implantable cardioverter defibrillator. Psychosom Med 2013. [PMID: 23197843 DOI: 10.1097/psy.0b013e3182769426] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences anxiety after device implantation. The purpose of the present study was to evaluate whether anxiety is predictive of ventricular arrhythmias and all-cause mortality 1 year post ICD implantation. METHODS A total of 1012 patients completed the state version of the State-Trait Anxiety Inventory at baseline. The end points were ventricular arrhythmias and mortality the first year after ICD implantation. RESULTS Within the first year after ICD implantation, 19% of patients experienced a ventricular arrhythmia, and 4% died. Anxiety was associated with an increased risk of ventricular arrhythmias (hazard ratio [HR] = 1.017; 95% confidence interval [CI] = 1.005-1.028; p = .005) and mortality (HR = 1.038; 95% CI = 1.014-1.063; p = .002) in adjusted analysis. Patients with anxiety (highest tertile) had a 1.9 increased risk for ventricular arrhythmias (95% CI = 1.329-2.753; p =.001) and a 2.9 increased risk for mortality (95% CI = 1.269-6.677; p = .01) compared with patients with low anxiety (lowest tertile). Among 257 patients with cardiac resynchronization therapy, anxiety was associated with mortality (HR = 5.381; 95% CI = 1.254-23.092; p = .02) after adjusting for demographic and clinical covariates. CONCLUSIONS Anxiety was associated with an increased risk of ventricular arrhythmias and mortality 1 year after ICD implantation, independent of demographic and clinical covariates. Monitoring and treatment of anxiety may be warranted in a selected subgroup of high-risk patients with an ICD.
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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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Opić P, Utens EMWJ, Moons P, Theuns DAMJ, van Dijk APJ, Hoendermis ES, Vliegen HW, de Groot NMS, Witsenburg M, Schalij M, Roos-Hesselink JW. Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot. Clin Res Cardiol 2012; 101:509-19. [PMID: 22314278 PMCID: PMC3377899 DOI: 10.1007/s00392-012-0420-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 01/23/2012] [Indexed: 11/08/2022]
Abstract
Objective To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF). Methods Included were 26 ToF-patients with an ICD (age 44 ± 12 years), and two control groups consisting of 28 ToF-patients without an ICD (age 40 ± 10 years) and a group of 35 ICD-patients of older age without ToF (age 72.0 ± 8 years). This last control group was chosen to represent the “older general ICD population” with acquired heart disease seen at the out-patient clinic. Psychosocial functioning encompassed daily functioning, subjective health status, quality of life, anxiety, depression, coping and social support. Results ToF-patients with ICD showed diminished psychosocial functioning in comparison to ToF-patients without ICD. This was reflected by diminished subjectively perceived physical functioning (p = 0.01), general health perception (p < 0.01) and a lower satisfaction with life (p = 0.02). In comparison to older ICD-patients, ToF-patients with ICD showed less satisfaction with life (p = 0.03), experienced more anxiety (p = 0.01) and showed less favourable coping styles, although physical functioning was better for ToF-patients with ICD than for older ICD-patients (p = 0.01). More inappropriate shocks were found in ToF-patients with ICD compared to the older ICD-patients. Conclusion In patients with ToF, ICD implantation had a major impact on psychosocial functioning which should be taken into account when considering ICD implantation in these young patients. To help improve psychosocial functioning, psychological counselling attuned to the specific needs of these patients may be useful.
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Affiliation(s)
- Petra Opić
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Implantable cardioverter defibrillator shocks are prospective predictors of anxiety. Heart Lung 2012; 42:105-11. [PMID: 23110854 DOI: 10.1016/j.hrtlng.2012.08.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the temporal contingency of anxiety and implantable cardioverter defibrillator (ICD) therapy (anti-tachycardia-pacing and shocks to prevent ventricular tachycardia and/or fibrillation). BACKGROUND It is under debate whether anxiety is a precursor and/or consequence of ICD-therapy. METHODS In a prospective longitudinal study, fifty-four patients undergoing first-time ICD-implantation were assessed for anxiety, frequency of ICD-shocks and anti-tachycardia-pacing up to two days before ICD-implantation (T0) and twelve months later (T1). RESULTS Anxiety at T0 did not predict frequency of ICD-shocks at T1, but ICD-shocks significantly predicted increased anxiety at T1. In contrast, anxiety at T0 and T1 was unrelated to frequency of anti-tachycardia-pacing. Effects remained stable when we controlled for potentially confounding variables (e.g. age, sex, cardiac health and depression at T0). CONCLUSION Our findings indicate that repeated ICD-shocks are a cause of anxiety in ICD-patients rather than a consequence, thus shock frequency should be minimized.
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Habibović M, Versteeg H, Pelle AJ, Theuns DA, Jordaens L, Pedersen SS. Poor health status and distress in cardiac patients: the role of device therapy vs. underlying heart disease. ACTA ACUST UNITED AC 2012; 15:355-61. [DOI: 10.1093/europace/eus295] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Magrì D, Piccirillo G, Quaglione R, Dell'armi A, Mitra M, Velitti S, Di Barba D, Lizio A, Maisto D, Barillà F. Effect of Acute Mental Stress on Heart Rate and QT Variability in Postmyocardial Infarction Patients. ISRN CARDIOLOGY 2012; 2012:912672. [PMID: 22844616 PMCID: PMC3403409 DOI: 10.5402/2012/912672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 05/16/2012] [Indexed: 01/08/2023]
Abstract
Emotionally charged events are associated with an increased risk of sudden cardiac death (SCD). In this study we assessed RR and QT variability index (QTVI) at baseline during anger recall test (AR). We calculated QTVI from a 5-min ECG recording and from a 10-beats segment around the presumed maximum sympathetic activation in thirty post-myocardial infarction patients under β-blocker therapy and 10 controls underwent. In all groups, the low-frequency component of RR and SBP increased during AR. In all recordings, the QTVI calculated on a 5-min ECG recording and the QTVI10 beats were higher in patients than in controls (P < 0.05). The QTVI during AR remained unchanged from baseline within each group. Conversely, during AR, the QTVI10 beats in controls diminished significantly (P < 0.05) from baseline whereas in patients remained unchanged. The inability to buffer an acute stress-induced increase in sympathetic activity could explain why events charged with acute stress are associated with an increased risk of ventricular arrhythmias in this setting of patients and support the role of cognitive behavior stress management strategies.
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Affiliation(s)
- Damiano Magrì
- Dipartimento di Medicina Clinica e Molecolare, Azienda Ospedaliera S. Andrea, "Sapienza" Università degli Studi di Roma, 00185 Rome, Italy
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Pavy B, Iliou MC, Vergès-Patois B, Brion R, Monpère C, Carré F, Aeberhard P, Argouach C, Borgne A, Consoli S, Corone S, Fischbach M, Fourcade L, Lecerf JM, Mounier-Vehier C, Paillard F, Pierre B, Swynghedauw B, Theodose Y, Thomas D, Claudot F, Cohen-Solal A, Douard H, Marcadet D. French Society of Cardiology guidelines for cardiac rehabilitation in adults. Arch Cardiovasc Dis 2012; 105:309-28. [DOI: 10.1016/j.acvd.2012.01.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 01/23/2012] [Indexed: 12/18/2022]
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Abstract
Implantable cardioverter-defibrillators (ICD) are increasingly used for the prevention of potentially lethal cardiac arrhythmias due to their confirmed superior medical efficiency. Nevertheless, ICD-patients often suffer from psychosocial problems, e.g., anxiety and depression. These issues are rarely addressed in routine medical follow-up care. Due to the limited mobility of many ICD-patients, Internet-based care may be ideal for delivering psychosocial care to patients in their homes. Our pilot study and case studies illustrate prospects and challenges of this approach. We developed icd-forum.de, a 6-week internet-based prevention program that provides a platform for information, a virtual self-help group, and a professionally moderated chat room in order to help decrease anxiety and to improve quality of life. A critical evaluation in the context of other published studies on the subject allows recommendations for the implementation of future internet-based psychosocial programs for ICD-patients to be deduced. It is the authors' opinion that such programs offer advantages specifically for heart failure patients and they recommend their broader use. Prior to this, conclusive evaluation studies are needed.
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Affiliation(s)
- S M Schulz
- Lehrstuhl für Psychologie I, Universität Würzburg, Marcusstr. 9-11, 97070, Würzburg, Deutschland.
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Abstract
PURPOSE Evaluating rehabilitation programmes from the patient's perspective is much needed, as the patients are the most important stakeholders in the health care system. A comprehensive rehabilitation programme, COPE-ICD programme, consists of exercise training and nursing consultations during a one year period post ICD implantation. The purpose of this paper is to describe the experience and meaning of participating in a comprehensive ICD-specific rehabilitation programme. METHODS Qualitative interviews were conducted with 10 patients representing the participating population, and later transcribed. The analysis was inspired by Ricoeur's theory of interpretation, which consists of three levels: naive reading, structured analysis and critical interpretation and discussion. RESULTS The overall concept was that participating in the COPE-ICD programme meant feeling inspired and secure through individualized care. Four themes emerged: Knowledge: patients gained much needed understanding; Physical attention: patients interpreted body signals and adjusted their exercise behaviour; Trust: patients regained trust, felt secure and dared to live again; Strategies of living: patients' coping was supported through reflection and professional dialogue, and they dealt with the risk of shock or death. CONCLUSION Participating in an ICD-specific rehabilitation programme can make patients feel inspired and secure through individualized care. They discover that they have to rethink some of their strategies of living and they gain support in the reflection and coping needed for that. Patients gain insight and they develop a special physical attention whereby they continue healthy activities through interpreting body signals and adjusting exercise behaviour. They learn to trust their body again.
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Day SM. Anxiety in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Implantable Cardioverter Defibrillators. ACTA ACUST UNITED AC 2012; 5:2-4. [DOI: 10.1161/circgenetics.111.962639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Sharlene M. Day
- From the Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI
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VERSTEEG HENNEKE, STARRENBURG ANNEMIEKE, DENOLLET JOHAN, PALEN JOBVANDER, SEARS SAMUELF, PEDERSEN SUSANNES. Monitoring Device Acceptance in Implantable Cardioverter Defibrillator Patients Using the Florida Patient Acceptance Survey. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:283-93. [DOI: 10.1111/j.1540-8159.2011.03299.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jacob S, Panaich SS, Zalawadiya SK, McKelvey G, Abraham G, Aravindhakshan R, Sears SF, Conti JB, Marsh HM. Phantom shocks unmasked: clinical data and proposed mechanism of memory reactivation of past traumatic shocks in patients with implantable cardioverter defibrillators. J Interv Card Electrophysiol 2011; 34:205-13. [PMID: 22183617 DOI: 10.1007/s10840-011-9640-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 11/02/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD), despite an unequivocal clinical benefit, are known to have a complex psychosocial impact on the patients. ICD shocks and the resultant psychobiological changes are known to contribute to increased levels of anxiety, depression, and post-shock stress symptoms in these patients. Phantom shock is a patient-reported perception of an ICD shock in the absence of any actual shock; however, its pathophysiological understanding is poor. METHODS A retrospective chart review of the University hospital ICD patients' database from June 2006 to April 2010 was conducted. A total of 38 patients with documented phantom shocks as cases and 76 age- and sex-matched patients with no phantom shocks as controls were selected from the database. Patient characteristics were analyzed for their potential association with the occurrence of phantom shocks. RESULTS Phantom shock patients had higher prevalence of documented depression (31.6%), anxiety (23.7%), and cocaine use (42.1%). Additionally, patients who had previous ICD shock storms were more likely to have phantom shocks (39.5%; p = 0.001). More importantly, no phantom shocks were reported in patients who did not receive defibrillation threshold testing or past ICD shock storms. CONCLUSIONS Phantom shocks are primarily observed in ICD patients who had prior exposure to traumatic device shocks and are more common in patients with a history of depression, anxiety, or substance abuse. A pathophysiological mechanism is proposed as a guide to potential prevention.
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Affiliation(s)
- Sony Jacob
- Division of Cardiology/Electrophysiology, Wayne State University School of Medicine, Detroit, MI, USA.
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van den Broek KC, Tekle FB, Habibović M, Alings M, van der Voort PH, Denollet J. Emotional distress, positive affect, and mortality in patients with an implantable cardioverter defibrillator. Int J Cardiol 2011; 165:327-32. [PMID: 21963213 DOI: 10.1016/j.ijcard.2011.08.071] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/19/2011] [Accepted: 08/21/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about the relationship between emotional distress and mortality in patients with an implantable cardioverter defibrillator (ICD). Our aim was to examine the predictive value of general negative and positive affect, and depressive symptoms (including its components somatic symptoms and cognitive-affective symptoms) for mortality. METHODS ICD patients (N=591, 81% male, mean age=62.7 ± 10.1 years) completed the Global Mood Scale to measure the independent dimensions negative and positive mood, and the Beck Depression Inventory to measure depressive symptoms. Covariates consisted of demographic and clinical variables. RESULTS During the median follow-up of 3.2 years, 96 (16.2%) patients died. After controlling for covariates, negative affect was significantly related to all-cause mortality (HR=1.034, p=0.002), whereas positive affect was not (HR=1.007, p=0.61). Depressive symptoms were also independently associated with an increased mortality risk (HR=1.031, p=0.030) and somatic symptoms of depression in particular (HR=1.130, p=0.003), but cognitive-affective symptoms were not associated with mortality (HR=0.968, p=0.29). When entering both significant psychological predictors in a covariate-adjusted model, negative mood remained significant (HR=1.039, p=0.009), but somatic symptoms of depression did not (HR=0.988, p=0.78). Similar results were found for cardiac-related death. Of covariates, increased age, CRT, appropriate shocks were positively related to death. CONCLUSIONS Negative affect in general was related to mortality, but reduced positive affect was not. Depression, particularly its somatic symptoms, was also related to mortality, while cognitive-affective symptoms were not. Future research may further focus on the differential predictive value of emotional distress factors, as well as on mechanisms that relate emotional distress factors to mortality.
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Affiliation(s)
- Krista C van den Broek
- CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
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Uncertainty is a major concern for patients with implantable cardioverter defibrillators. Heart Lung 2011; 40:420-8. [DOI: 10.1016/j.hrtlng.2011.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 02/10/2011] [Accepted: 02/10/2011] [Indexed: 11/22/2022]
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Ethical Dilemmas and End-of-Life Choices for Patients with Implantable Cardiac Devices: Decisions Regarding Discontinuation of Therapy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:385-92. [DOI: 10.1007/s11936-011-0136-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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von Känel R, Baumert J, Kolb C, Cho EYN, Ladwig KH. Chronic posttraumatic stress and its predictors in patients living with an implantable cardioverter defibrillator. J Affect Disord 2011; 131:344-52. [PMID: 21195483 DOI: 10.1016/j.jad.2010.12.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 12/01/2010] [Accepted: 12/01/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with an implantable cardioverter defibrillator (ICD) show clinically relevant depression and anxiety, but little is known about their levels of posttraumatic stress. We assessed chronic posttraumatic stress attributable to a traumatic cardiac event and its predictors in patients at two time points after ICD placement. METHODS We investigated 107 consecutively enrolled patients (57 ± 14 years, 62% men) on average 24 ± 21 months after ICD placement (baseline) and again 41 ± 18 months later (follow-up). All patients completed the Impact of Event Scale-Revised (IES-R) to self-rate the severity of posttraumatic stress (range 0-110). The 30% of patients with the highest IES-R scores (≥ 25) at baseline were defined as PTSD cases; the same threshold was applied to define PTSD caseness at follow-up. RESULTS Posttraumatic stress increased from baseline to follow-up (19 ± 22 vs. 25 ± 19, p < 0.001); 19% of patients had PTSD at both assessments, 12% at baseline only, and 18% at follow-up only. Female gender as well as greater peritraumatic dissociation and depression predicted greater posttraumatic stress at baseline (p-values ≤ 0.041). Greater baseline posttraumatic stress, helplessness, alexithymia, and ≥ 5 shocks during follow-up all predicted greater posttraumatic stress at follow-up (p-values ≤ 0.029). Female gender, helplessness, and depression predicted PTSD at baseline (p-values ≤ 0.022); low education and posttraumatic stress at baseline predicted PTSD at follow-up (p-values ≤ 0.003). CONCLUSIONS Between 2 and 5.5 years post-ICD placement chronic posttraumatic stress slightly increased and nearly one-fifth of patients had newly developed PTSD. The identified psychological predictors of long-term chronicity of posttraumatic stress might particularly inform behavioral interventions for ICD recipients.
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Affiliation(s)
- Roland von Känel
- Division of Psychosomatic Medicine, Department of General Internal Medicine, Inselspital, Bern University Hospital and University of Bern, Switzerland
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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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Sears SF, Hauf JD, Kirian K, Hazelton G, Conti JB. Posttraumatic Stress and the Implantable Cardioverter-Defibrillator Patient. Circ Arrhythm Electrophysiol 2011; 4:242-50. [PMID: 21505176 DOI: 10.1161/circep.110.957670] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F. Sears
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jessica D. Hauf
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Kari Kirian
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Garrett Hazelton
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
| | - Jamie B. Conti
- From the Department of Psychology, East Carolina University, Greenville, NC (S.F.S., J.D.H., K.K., G.H.); the Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC (S.F.S.); and the Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, FL (J.B.C.)
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A randomized controlled trial of cognitive behavior therapy tailored to psychological adaptation to an implantable cardioverter defibrillator. Psychosom Med 2011; 73:226-33. [PMID: 21321256 DOI: 10.1097/psy.0b013e31820afc63] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate a eight-session cognitive behavior therapy (CBT) intervention tailored to adaptation in implantable cardioverter defibrillator (ICD) patients; and to test for treatment group by gender interaction effects. METHODS Patients receiving their first ICD implant were randomized to CBT or usual cardiac care. Primary outcomes measured at baseline, 6-month, and 12-month follow-ups were symptoms of anxiety and depression (Hospital Anxiety and Depression Scale), posttraumatic stress disorder symptoms (Impact of Events Scale-Revised), and phobic anxiety (Crown-Crisp Experiential Index). Secondary outcomes were quality of life (Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary) and ICD shocks or antitachycardia pacing therapies. RESULTS Of 292 eligible patients, 193 consented and were randomized to CBT (n = 96) or usual cardiac care (n = 97). Eighty percent were male; mean age was 64.4 years (standard deviation = 14.3); and 70% received an ICD for secondary prevention. No baseline differences were observed between the treatment conditions; however, women scored worse than men on all psychological and quality of life variables (p < .05). Eighty-three percent completed follow-up. Repeated-measures analyses of covariance revealed significantly greater improvement with CBT on posttraumatic stress disorder total and avoidance symptoms for men and women combined (p < .05) and significantly greater improvement in depressive symptoms and Short Form-36 Mental Component Summary only in women (p < .01). No differences were observed between treatment conditions on ICD therapies over follow-up. CONCLUSION A CBT intervention to assist adaptation to an ICD enhanced psychological functioning over the first year post implant.
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