Top Things to Know: Interventions for Patients and Families with Implantable Cardioverter Defibrillators (ICD)
Published: September 24, 2012
- The number of implantable cardioverter defibrillators (ICDs) being implanted in the United States has grown significantly in the last few years, with estimates reaching in excess of 250,000 per year in 2006, and between 1993 and 2006, ~0.8 million patients received an ICD.
- Approximately 20% of ICD patients have clinically significant psychological distress, chronic anxiety and depression, which can also be heightened or contribute to other symptoms such as sleep disturbances.
- The ultimate goal of this statement is to improve the precision of identification and care of psychosocial distress in pediatric and adult ICD patients to maximize the derived benefit of the ICD.
- Studies found that more than 5 shocks was the threshold to impact the ICD recipient’s psychological states of anxiety and depression; the greater concerns ICD recipients have about their device, the higher the anxiety and depressive symptoms, independent of shocks.
- Patients, family members, and intimate partners’ experiences, challenges, outlooks, and perceptions were reported to determine the concerns from ICDs.
- A problem-based coping method with education and counseling approaches may result with better emotional and functioning outcomes; ongoing education, current ICD patients educating others, and optimal care for psychosocial responses.
- Interventions based on Cognitive Behavioral Theory with group or telephone mode of delivery demonstrated significant improvement s with regard to patient concerns, anxiety, and knowledge; however, there is still a need for further research and clinical interventions.
- Limitations of interventional trials were reported to help identify gaps of evidence that future research should address in this field.
- Recommended list of research questions was created for psychological and quality of life assessments that include determining the clusters of risk factors that consider ICD patients at risk for psychological distress after implantation, for both adults and pediatric patients.
- Recommendations for clinicians were listed, including, but not limited to, discussions with ICD recipients and family members about ICD benefits, limitations, general prognosis, expected trajectory of illness, battery longevity and device replacement, and modes of death in endstage heart failure, if appropriate.
Citation
Dunbar SB, Dougherty CM, Sears SF, Carroll DL, Goldstein NE, Mark DB, McDaniel G, Pressler SJ, Schron E, Wang P, Zeigler VL; on behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Lifelong Congenital Heart Disease and Heart Health in the Young. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: a scientific statement from the American Heart Association. Circulation. 2012: published online before print September 24, 2012, 10.1161/CIR.0b013e31825d59fd.
http://circ.ahajournals.org/lookup/doi/10.1161/CIR.0b013e31825d59fd