Issues in cardiovascular nursing| Volume 38, ISSUE 2, P109-120, March 2009

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Changes in psychosocial distress in outpatients with heart failure with implantable cardioverter defibrillators

      Patients given implantable cardioverter defibrillators (ICDs) after arrhythmic events or sudden cardiac arrest (SCA) experience psychosocial distress. ICDs now are inserted for the primary prevention of SCA in patients with heart failure; the psychosocial impact of ICDs on patients with heart failure is unknown. Changes in psychosocial status in these ICD recipients were examined. ICD recipients (n = 57) completed depression, anxiety, and social support inventories every 6 months for up to 2 years. Initially, 35% of recipients were depressed and 45% of recipients were anxious. In linear mixed models, depression decreased over time overall but increased in those who experienced ICD shocks. Anxiety decreased in New York Heart Association class III ICD recipients but not in class II ICD recipients. Decreases in social support were related to age: the younger the patient the greater the decrease. A significant proportion of ICD recipients were depressed or anxious, or had diminished social support even after 2 years. Investigation of strategies to improve ICD recipients' psychosocial status is warranted.
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        • American Heart Association
        Heart disease and stroke statistics—2008 update.
        American Hear Association, Dallas, TX2008
        • Levy D.
        • Kenchaiah S.
        • Larson M.G.
        • et al.
        Long-term trends in the incidence of and survival with heart failure.
        N Engl J Med. 2002; 347: 1397-1402
        • McCullough P.A.
        • Philbin E.F.
        • Spertus J.A.
        • et al.
        Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study.
        J Am Coll Cardiol. 2002; 39: 60-69
        • Masse B.M.
        • Shah N.B.
        Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management.
        Am Heart J. 1997; 133: 703-712
        • Wallace R.L.
        • Sears Jr, S.F.
        • Lewis T.S.
        • et al.
        Predictors of quality of life in long-term recipients of implantable cardioverter defibrillators.
        J Cardiopulm Rehabil. 2002; 22: 278-281
        • Zhang J.
        Sudden cardiac death: implantable cardioverter defibrillators and pharmacological treatments.
        Crit Care Nurs Q. 2003; 26: 45-49
        • Myerburg R.J.
        • Interian Jr, A.
        • Mitrani R.M.
        • et al.
        Frequency of sudden cardiac death and profiles of risk.
        Am J Cardiol. 1997; 80: 10F-19F
        • Greenberg H.
        • Case R.B.
        • Moss A.J.
        • et al.
        Analysis of mortality events in the Multicenter Automatic Defibrillator Implantation Trial (MADIT-II).
        J Am Coll Cardiol. 2004; 43: 1459-1465
        • Moss A.J.
        • Hall J.
        • Cannon D.S.
        • et al.
        Improved survival with implanted defibrillator on ventricular arrhythmia.
        N Engl J Med. 1996; 335: 1933-1940
        • Cleland J.G.
        • Daubert J.C.
        • Erdmann E.
        • et al.
        The effect of cardiac resynchronization on morbidity and mortality in heart failure.
        N Engl J Med. 2005; 352: 1539-1549
        • Bardy G.H.
        • Lee K.L.
        • Mark D.B.
        • et al.
        Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.
        N Engl J Med. 2005; 352: 225-237
        • Bristow M.R.
        • Feldman A.M.
        • Saxon L.A.
        Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION) trial.
        J Card Fail. 2000; 6: 276-285
        • Bristow M.R.
        • Saxon L.A.
        • Boehmer J.
        • et al.
        Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure.
        N Engl J Med. 2004; 350: 2140-2150
        • Hunt S.A.
        • Abraham W.T.
        • Chin M.H.
        • et al.
        ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.
        Circulation. 2005; 112: 154-235
        • Centers for Medicare and Medicaid Services
        Medicare expands coverage of Implantable Defibrillators to save lives and develop evidence to maximize benefits.
        (Accessed September 5, 2006)
        • Thomas S.A.
        • Friedmann E.
        • Kelley F.J.
        Living with an implantable cardioverter defibrillator (ICD): a review of the current literature related to psychosocial factors.
        AACN Clin Issues Crit Care Nurs. 2001; 12: 156-163
        • Engle G.L.
        Sudden and rapid death during psychological stress: folklore or folk wisdom?.
        Ann Intern Med. 1971; 74: 771-782
        • Audy R.J.
        Measurement and diagnosis of health.
        Houghton Mifflin, Boston, MA1971
        • Skinner J.E.
        Blockade of frontocardial-brain stem pathway prevents ventricular fibrillation of ischemic heart.
        Am J Physiol. 1981; 240: 156-163
        • Skinner J.E.
        Regulation of cardiac vulnerability by the cerebral defense system.
        J Am Coll Cardiol. 1985; 5: 88B-94B
        • Lown B.
        • Verrier R.L.
        • Corbalan R.
        Psychological stress and thresholds of repetitive ventricular response.
        Science. 1973; 182: 834-836
        • Selye H.
        The stress of life.
        McGraw-Hill, New York1956
        • Thomas S.A.
        • Friedmann E.
        • Wimbush F.
        • et al.
        Psychological factors and survival in the cardiac arrhythmia suppression trial (CAST): a reexamination.
        Am J Crit Care. 1997; 6: 116-126
        • Piotrowicz K.
        • Noyes K.
        • Lyness J.M.
        • et al.
        Physical functioning and mental well-being in association with health outcome in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II.
        Eur Heart J. 2007; 28: 601-607
        • Luttik M.L.
        • Jaarsma T.
        • Moser D.
        • et al.
        The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature.
        J Cardiovasc Nurs. 2005; 20: 162-169
        • Friedmann E.
        • Thomas S.A.
        • Liu F.
        • et al.
        Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality.
        Am Heart J. 2006; 152: 940-948
        • Burke J.L.
        • Hallas C.N.
        • Clark-Carter D.
        • et al.
        The psychosocial impact of the implantable cardioverter defibrillator: a meta-analytic review.
        Br J Health Psychol. 2003; 8: 165-178
        • Dunbar S.B.
        • Jenkins L.S.
        • Hawthrone M.
        • et al.
        Mood disturbance in patients with recurrent ventricular dysrhythmia before insertion of implantable cardioverter defibrillator.
        Heart Lung. 1996; 25: 253-262
        • Luderitz B.
        • Jung W.
        • Deister A.
        • et al.
        Patient acceptance of the implantable cardioverter defibrillator in ventricular tachyarrhythmias.
        Pacing Clin Electrophysiol. 1993; 16: 1815-1821
        • Luyster F.S.
        • Hughes J.W.
        • Waechter D.
        • et al.
        Resource loss predicts depression and anxiety among patients treated with an implantable cardioverter defibrillator.
        Psychosom Med. 2006; 68: 794-800
        • Dubin A.M.
        • Batsford W.P.
        • Lewis R.J.
        • et al.
        Quality-of-life in patients receiving implantable cardioverter defibrillators at or before age 40.
        Pacing Clin Electrophysiol. 1996; 19: 1555-1559
        • Duru F.
        • Buchi S.
        • Klaghofer R.
        • et al.
        How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life?.
        Heart. 2001; 85: 375-379
        • Friedmann E.
        • Thomas S.A.
        • Inguito P.
        • et al.
        Quality of life and psychological status of patients with implantable cardioverter defibrillators.
        J Interv Card Electrophysiol. 2006; 17: 65-72
        • Kamphuis H.C.
        • de Leeuw J.R.
        • Derksen R.
        • et al.
        Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery: a prospective study.
        Europace. 2003; 5: 381-389
        • Schuster P.M.
        • Phillips S.
        • Dillon D.L.
        • et al.
        The psychosocial and physiological experiences of patients with an implantable cardioverter defibrillator.
        Rehabil Nurs. 1998; 23: 30-37
        • Denollet J.
        • Brutsaert D.L.
        Personality disease severity and the risk of long term cardiac events with decreased ejection fraction after myocardial infarction.
        Circulation. 1998; 97: 167-173
        • Goodman M.
        • Hess B.
        Could implantable cardioverter defibrillators provide a human model supporting the learned helplessness theory of depression?.
        Gen Hosp Psychiatry. 1999; 21: 382-385
        • Keren R.
        • Aarons D.
        • Veltri E.P.
        Anxiety and depression in patients with life-threatening ventricular arrhythmias: impact of the implantable cardioverter-defibrillator.
        Pacing Clin Electrophysiol. 1991; 14: 181-187
        • Pauli P.
        • Wiedemann G.
        • Dengler W.
        • et al.
        Anxiety in patients with an automatic implantable cardioverter defibrillator: what differentiates them from panic patients.
        Psychosom Med. 1999; 61: 69-76
        • Carroll D.L.
        • Hamilton G.A.
        Quality of life in implanted cardioverter defibrillator recipients: the impact of a device shock.
        Heart Lung. 2005; 34: 169-178
        • Beck A.T.
        • Steer R.A.
        • Garbin M.G.
        Psychometric properties of the Beck Depression Inventory—25 years of evaluation.
        Clin Psychol Rev. 1988; 8: 77-100
        • Beck A.T.
        • Steer R.A.
        • Ball R.
        • et al.
        Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients.
        J Pers Assess. 1996; 67: 588-597
        • Beck A.T.
        • Steer R.A.
        • Brown G.K.
        BDI-II Beck Depression Inventory manual.
        2nd ed. Harcourt Brace, San Antonio, TX1996
        • Beck A.T.
        • Stear R.A.
        • Brown G.K.
        The Beck Depression Inventory second edition.
        Houghton Mifflin, Boston MA1996
        • Spielberger C.D.
        • Lushene R.E.
        • Gorsuch R.L.
        STAI manual.
        Consulting Psychology Press, Palo Alto, CA1972
        • Frasure-Smith N.
        • Lesperance F.
        • Talajic M.
        The impact of negative emotions on prognosis following myocardial infarction: is it more than depression?.
        Health Psychol. 1995; 14: 388-398
        • Sarason I.G.
        • Sarason B.R.
        • Shearin E.N.
        • et al.
        A brief measure of social support-practical and theoretical implications.
        J Soc Pers Relat. 1987; 4: 497-510
        • Friedmann E.
        • Thomas S.A.
        Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST).
        Am J Cardiol. 1995; 76: 1213-1217
        • Singer J.
        • Willett J.
        Applied longitudinal data analysis: modeling change and event occurrence.
        Oxford University Press, New York2003
        • Hedeker D.
        • Gibbons R.
        Application of random effects pattern mixture models for missing data in longitudinal studies.
        J Psych Methods. 1997; 2: 64-78
        • Gottlieb S.S.
        • Khatta M.
        • Friedmann E.
        • et al.
        The influence of age, gender, and race on the prevalence of depression in heart failure patients.
        J Am Coll Cardiol. 2004; 43: 1542-1549
        • Haveranek E.P.
        • Ware M.G.
        • Lowes B.P.
        Prevalence of depression in congestive heart failure.
        Am J Cardiol. 1999; 84: 348-350
        • Skotzko C.E.
        • Krichten C.
        • Zietowski G.
        • et al.
        Depression is common and precludes accurate assessment of functional status in elderly patients with congestive heart failure.
        J Card Fail. 2000; 6: 300-305
        • Murberg T.A.
        • Bru E.
        • Aarsland T.
        • et al.
        Functional status and depression among men and women with congestive heart failure.
        Int J Psychiatry Med. 1998; 28: 273-291
        • Faris R.
        • Purcell H.
        • Henein M.Y.
        • et al.
        Clinical depression is common and significantly associated with reduced survival in patients with non-ischaemic heart failure.
        Eur J Heart Fail. 2002; 4: 541-551
        • Sola C.L.
        • Bostwick J.M.
        Implantable cardioverter-defibrillators, induced anxiety, and quality of life.
        Mayo Clin Proc. 2005; 80: 232-237
        • Jiang W.
        • Kuchibhatla M.
        • Cuffe M.S.
        • et al.
        Prognostic value of anxiety and depression in patients with chronic heart failure.
        Circulation. 2004; 110: 3452-3456
        • Dougherty C.M.
        Psychological reactions and family adjustment in shock versus no shock groups after implantation of internal cardioverter defibrillator.
        Heart Lung. 1995; 24: 281-291
        • Hamilton G.A.
        • Carroll D.L.
        The effects of age on quality of life in implantable cardioverter defibrillator recipients.
        J Clin Nurs. 2004; 13: 194-200
        • Crossmann A.
        • Pauli P.
        • Dengler W.
        • et al.
        Stability and cause of anxiety in patients with an implantable cardioverter-defibrillator: a longitudinal two-year follow-up.
        Heart Lung. 2007; 36: 87-95
        • Dunbar S.B.
        • Jenkins L.S.
        • Hawthorne M.
        • et al.
        Factors associated with outcomes 3 months after implantable cardioverter defibrillator insertion.
        Heart Lung. 1999; 28: 303-315
        • Reid S.S.
        • McKinley S.
        • Nagy S.
        Outcomes, problems and quality of life with the implantable cardioverter defibrillator.
        Aust J Adv Nurs. 1999; 16: 14-19
        • Thomas S.A.
        • Friedmann E.
        • Kao C.W.
        • et al.
        Quality of life and psychological status of patients with implantable cardioverter defibrillators.
        Am J Crit Care. 2006; 15: 389-398
        • Kamphuis H.C.
        • Verhoeven N.W.
        • Leeuw R.
        • et al.
        ICD: a qualitative study of patient experience the first year after implantation.
        J Clin Nurs. 2004; 13: 1008-1016
        • Anderson J.
        • Bardy G.H.
        Key clinical insights from the sudden cardiac death in heart failure trial.
        J Cardiovasc Nurs. 2006; 21: 463-468
        • Chapa D.W.
        • Lee H-J.
        • Kao C-W.
        • et al.
        Reducing mortality with device therapy in heart failure patients without ventricular arrhythmias: a comparison of three clinical trials.
        Am J Crit Care. 2008; 17
        • Kohn C.S.
        • Petrucci R.J.
        • Baessler C.
        • et al.
        The effect of psychological intervention on patients' long-term adjustment to the ICD: a prospective study.
        Pacing Clin Electrophysiol. 2000; 23: 450-456
        • Dougherty C.M.
        • Thompson E.A.
        • Lewis F.M.
        Long-term outcomes of a telephone intervention after an ICD.
        Pacing Clin Electrophysiol. 2005; 28: 1157-1167
        • Dougherty C.M.
        • Lewis F.M.
        • Thompson E.A.
        • et al.
        Short-term efficacy of a telephone intervention by expert nurses after an implantable cardioverter defibrillator.
        Pacing Clin Electrophysiol. 2004; 27: 1594-1602
        • Pedersen S.S.
        • van Domburg R.T.
        • Theuns D.A.
        • et al.
        Concerns about the implantable cardioverter defibrillator: a determinant of anxiety and depressive symptoms independent of experienced shocks.
        Am Heart J. 2005; 149: 664-669
        • Kuhl E.A.
        • Sears S.F.
        • Conti J.B.
        Using computers to improve the psychosocial care of implantable cardioverter defibrillator recipients.
        Pacing Clin Electrophysiol. 2006; 29: 1426-1433
        • Kuhl E.A.
        • Sears S.F.
        • Conti J.B.
        Internet-based behavioral change and psychosocial care for patients with cardiovascular disease: a review of cardiac disease-specific applications.
        Heart Lung. 2006; 35: 374-382
        • Rainie L.
        • Horrigan J.
        A decade of adoption: how the internet has woven itself into American life.
        (Accessed October 6, 2006)
        • Madden M.
        Internet penetration and impact.
        (Accessed August 4, 2007)
        • Lenert L.
        • Munoz R.F.
        • Stoddard J.
        • et al.
        Design and pilot evaluation of an internet smoking cessation program.
        J Am Med Inform Assoc. 2003; 10: 16-20
        • Nahm E.S.
        • Resnick B.
        • Mills M.E.
        Development and pilot-testing of the perceived health Web Site usability questionnaire (PHWSUQ) for older adults.
        Stud Health Technol Inform. 2006; 122: 38-43
        • Bass D.M.
        • McClendon M.J.
        • Brennan P.F.
        • et al.
        The buffering effect of a computer support network on caregiver strain.
        J Aging Health. 1998; 10: 20-43
        • Brennan P.F.
        • Moore S.M.
        • Smyth K.A.
        ComputerLink: electronic support for the home caregiver.
        ANS Adv Nurs Sci. 1991; 13: 14-27
        • Brennan P.F.
        • Moore S.M.
        • Smyth K.A.
        Alzheimer's disease caregivers' uses of a computer network.
        West J Nurs Res. 1992; 14: 662-673
        • Houston T.K.
        • Cooper L.A.
        • Ford D.E.
        Internet support groups for depression: a 1-year prospective cohort study.
        Am J Psychiatry. 2002; 159: 2062-2068