Influence of primary and secondary prevention indications on anxiety about the implantable cardioverter‐defibrillator

Abstract

BackgroundImplantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias.MethodsA multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD).ResultsPatients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8.ConclusionsIn our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality.

Prospective survey of implantable defibrillator shock anxiety in Japanese patients: Results from the DEF‐Chiba study

“…21 In contrast, more recently, Rahmawati et al showed that primary prevention was associated with general anxiety and poor QOL compared with secondary prevention. 16 This inconsistency may be attributed to the small sample sizes of patients and different assessments of psychological functioning that were employed F I G U R E 3 Alteration of the FSAS score over the 12-month follow-up period (female and male patients). FSAS = Florida Shock Anxiety Scale across studies.…”

“…ICD‐related anxiety may lead to increased device concerns, avoidance of behaviors, and limitations in performing everyday activities owing to possible future shock therapies . Previous studies indicated that ICD‐related anxiety is associated with reduced health‐related QOL, psychological distress, and even the risk of mortality . However, the current patient‐reported outcome studies that are available on ICD patients are composed predominantly of patients in the Western world.…”

“…7 Previous studies indicated that ICD-related anxiety is associated with reduced health-related QOL, psychological distress, and even the risk of mortality. [7][8][9][10][11][12][13][14][15][16] However, the current patient-reported outcome studies that are available on ICD patients are composed predominantly of patients in the Western world. Obviously, cultural differences broadly impact ICD patients in the Far East differently, and very little patient-reported data have focused exclusively on the outcomes of Japanese patients.…”

Predictors of appropriate ICD therapy in Japanese patients with structural heart diseases: A major role of prior sustained ventricular tachycardia in secondary prevention

“…The rate of appropriate therapy by ICD insertion has been reported to be higher in patients in whom the device was implanted for secondary prevention than in patients in whom the device was implanted for primary prevention . Clinical trials on ICD therapy have been mainly conducted in European countries and the United States, where most cases of underlying heart disease are ischemic heart disease, and thus, the findings may not be necessarily applicable to countries with different prevalences of heart diseases such as Japan, where SHD in 51%‐69% of candidates for ICD therapy is cardiomyopathy . In the Japanese guidelines of ICD implantation for secondary prevention, both documented ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in SHD are class I indication.…”

Comparison of ICD shock rates in Japanese and non‐Japanese patients in the PainFree SST study

“…[1][2][3][4] Although appropriate ICD shocks improve survival, shocks may cause anxiety and psychological distress and increase mortality. [5][6][7][8] The PainFree SST clinical study was conducted to evaluate the efficacy of a novel suite of detection algorithms designated as "Smart Shock Technology." Use of this technology combined with modern programming led to a very low inappropriate shock rate in the range of 1.5% per year for dual-chamber ICDs.…”