Premium
Psychosocial Outcome after ICD Implantation: A Current Perspective
Author(s) -
HELLER STANLEY S.,
ORMONT MARIAN A.,
LIDAGOSTER LIDIA,
SCIACCA ROBERT R.,
STEINBERG JONATHAN S.
Publication year - 1998
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1998.tb00179.x
Subject(s) - medicine , psychosocial , perspective (graphical) , current (fluid) , outcome (game theory) , psychiatry , mathematics , mathematical economics , artificial intelligence , computer science , electrical engineering , engineering
Depression and reduced sexual functioning have been identified as problems following ICD placement. We examined these issues, and multiple other quality‐of‐life measures, and their relationship to ICD and ICD discharge. Patients were 64 ± 11 years old, 72% male, and had undergone ICD 20 ± 14 months previously. Fifty‐eight patients responded to a confidential biopsychosocial questionnaire. Positive attitudes toward the procedure increased from 52% before to 76% after implantation. Satisfaction correlated most strongly with less anger (P = 0.002, r = 0.45), less worry about ICD size (P = 0.007, r = 0.38), less sadness (P = 0.01, r = 0.37), and perceived better health (P = 0.01, r = 0.35). Of these ICD patients, 20%–58% reported measures of depression, and sexual frequency was reduced in 45%. Despite successful ICD placement, health concern increased in 62 % of the respondents. Thirty‐nine percent attended support groups; 96% found them very helpful. Mean number of ICD discharges described by responders was 5 ± 11. Fifty percent of our sample reported ≥ 1 shock; equal numbers had 1, 2–5, 6–10, and more than 10 shocks. Sixty‐two percent of men had at least one discharge compared to 13% of women. After controlling for cardiac clinical variables, experiencing ≥ 1 ICD shock was strongly associated with anxiety about family (odds ratio = 7.3), reduced new activities (odds ratio = 6.9), increased sadness (odds ratio = 6.2), and health worry (odds ratio = 5.8). Experiencing ≥ 5 ICD shocks was strongly associated with increased health concern (odds ratio = 13.6), increased sadness (odds ratio = 12.5), increased fatigue (odds ratio = 6.1), current sadness (odds ratio = 5.8), and increased nervousness (odds ratio = 5.3). ICD implantation powerfully affects quality‐of‐life. Postimplantation health concern is paradoxically increased despite improvement in actual health. Negative emotions are associated with defibrillator discharge.