Patients with ICDs require more than a ‘set and forget’ approach

Almost half of patients who have an implantable cardioverter defibrillator experience psychological distress about living with the device, Australian research reveals.

A study presented recently at the European Society of Cardiology Congress found 47% of patients fitted with an implantable cardioverter defibrillators (ICD) for more than 12 months were either anxious or depressed.

Dr Jan Cameron, co-author on the joint US and Australian study, told the limbic anxious or depressed patients were also more likely to rate their overall health as poor and had more concerns about living with an ICD than other patients.

“There needs to more recognition of long-term psychological issues around living with these devices and more programs that address patient concerns,” she said.

Dr Cameron, a senior researcher in the School of Clinical Sciences at Monash Health, said the findings were not surprising given the evidence in other cardiac populations.

“We know patients who have a heart attack have a period of psychological adjustment and some people don’t cope well which is why we have developed cardiac rehabilitation programs. ”

“Typically, patients with an ICD are not referred to these programs although that depends on the underlying reason for the ICD.”

The study found patients with poor adjustment were more likely to be younger and had less social support. They reported more problems with self-care and performing usual activities, and felt they had less control over their heart disease.

They were also twice as likely to think about end of life issues.

Dr Cameron said clinicians should be asking about any worries or concerns early in the process and eliminating any misconceptions about living with an ICD.

“Patient often don’t remember these conversations so this should be revisited at each follow-up appointment especially with regards to any symptoms of anxiety or depression such as difficulty sleeping.

If information and reassurance don’t resolve concerns, then referral to a health psychologist is a consideration.”

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