Enhancing Patient Care by Estimation and Discussion of Risk for ICD Shock

Modern clinical trials have demonstrated that implantable cardioverter defibrillators (ICDs) have been broadly successful in terminating potentially life-threatening arrhythmias in at-risk patients. This success fostered greater attention to the potential negative aspects of the therapy, with particular focus on ICD shocks. Substantial research examining the psychological and quality-of-life effects of shock has followed and been debated,1–3 and have generally shown that the effects of shock are equivocal in relation to generic quality-of-life outcomes, but more detectable when examined in the acute setting (short-term, 30-day window) and using disease-specific measures (e.g., shock anxiety vs general anxiety). Current clinical practice has generally taken a “one size fits all” approach for communicating a patient’s risk for ICD shock. Going beyond reassurance to a more empirically based conversation about individual patients’ risk for shock is now possible with recent clinical trial data. This conceptualization prompts a more clinically meaningful effort to address patient anxiety routinely encountered in cardiology clinics. The purpose of this paper is to integrate recent clinical trial data with psychological and behavioral research to provide a discussion base for a clinical forecast to patients about the nature and probability of ICD shock.