Does ICD Indication Affect Quality of Life and Levels of Distress?

Abstract

The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening arrhythmias, with ICD indications having recently been extended to include primary prophylaxis. Despite the medical benefits of the ICD, there is an ongoing debate as to the impact of the ICD on patients' lives, particularly whether primary prophylaxis implantation may impact adversely on patient-centered outcomes such as quality of life (QoL) and distress. We examined the evidence for a role of ICD indication on these patient-centered outcomes. A literature search was conducted on PubMed and Web of Science from 2002 to present, focusing on indication for ICD therapy and patient-centered outcomes (i.e., anxiety, depression, disease-specific, or general QoL). We identified five studies (seven articles) concerning the impact of indication on patient-centered outcomes. Sample sizes varied from 91-426 patients across studies, five of seven articles used a prospective design, and follow-up ranged from 2-12 months. No study reported an effect for indication on patient-centered outcomes. There is no evidence to suggest that patients receiving an ICD for primary prophylaxis have subsequent poorer QoL and greater distress than patients receiving an ICD for secondary prophylaxis. This knowledge may help cardiologists in the clinical management of patients, in particular when discussing ICD implantation with patients.

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

“…Although Pedersen and colleagues 37 concluded that there is currently no evidence that adult patients who receive ICDs for primary prevention of SCA have poorer QOL or greater distress than those receiving ICDs for secondary prevention, this may not be the case in pediatric ICD recipients. The issue is prominent for those pediatric/ adolescent patients with anatomically normal hearts and genetically determined diseases that put them at risk for SCA, particularly when it comes to sports participation.…”

“…2,3,35,36 Equivalent QOL outcomes generally have been demonstrated between primary and secondary prevention indications. 37,38 QOL outcomes remain an area of intense research, because refinement of measures including generic and disease-specific parameters, evaluation of clinically and statistically significant differences, survivor and missing data sample biases, and evolving sophistication of the technology may change our understanding of the QOL outcomes and patient experiences with ICDs over time.…”

Phantom shocks unmasked: clinical data and proposed mechanism of memory reactivation of past traumatic shocks in patients with implantable cardioverter defibrillators

“…Nearly 30% of patients develop clinically significant levels of depression and/or anxiety [5], and 21% reported posttraumatic stress disorder (PTSD) [6]. ICD shocks, and more importantly, simply the fear of imminent shocks have a further detrimental effect on the patient's QoL [7,8].…”

Role of catheter ablation of ventricular tachycardia associated with structural heart disease

“…Finally, although undoubtedly valuable to decrease arrhythmic and all-cause mortality, ICDs represent a suppressive therapy and do not prevent recurrences of ventricular arrhythmias. Repeated shocks for the termination of multiple episodes of ventricular arrhythmias may affect both quality of life [5] and survival [6] , while inappropriate shocks for supraventricular arrhythmias represent a clinical problem, especially in patients receiving an ICD for primary prevention [7] . In this scenario, a single therapy might not be the best option for every patient.…”