Anxiety affects a high percentage of patients with ICD

According to the conclusion of a study published in EP Europace, nearly one-third of patients who had a device implanted to prevent sudden death suffered from anxiety within the first year while depression affected one in five. 

Study author Hannah Keage (University of South Australia, Adelaide, Australia) said: "The implantable defibrillator (ICD) is very good at prolonging a patient's life, but we need to make sure it is a good quality of life”. "The prevalence of mood disorders is much higher in individuals with ICD than in the general population, suggesting that psychotherapy assessment and therapy should be integrated into the routine care of these patients." 

An ICD is recommended for people at high risk for life-threatening heart rhythms and those in cardiac arrest.  

Anxiety and depression are associated with a higher likelihood of premature death in patients with  ICD. This study synthesized the best available evidence to determine the extent of depression, anxiety, and post-traumatic stress disorder (PTSD) in patients with  ICD.  “I am a professor of psychology and have worked with cardiologists for many years,” says Keage. "They found that mood disturbances were common in their ICD patients, so we collaborated to understand the extent." 

The review included 109 studies involving 39,954 ICD patients. When rates of anxiety, depression, and PTSD were examined from the time of ICD placement over a year of follow-up, the rates were 23%, 15%, and 12%, respectively. The prevalence of these conditions in the general population is estimated to be 13%, 7%, and 1‒2%, respectively. 

 Additional details are available for anxiety and depression, showing higher rates in the early post-implantation period. During the first five months, 32% and 23% experienced anxiety and depression, respectively. Six to 12 months after placement, levels of anxiety and depression were reduced by 29% and 21%, respectively. Further deterioration was observed  12 months after transplantation, when rates were 22% and 15%, respectively. 

 When the ICD detects a dangerously fast heart rate, it delivers a shock to return it to normal, which can make you feel like you've been punched in the chest. The analysis found that patients who experienced shock were four times more likely to be anxious and almost twice as likely to be depressed than those who did not experience shock. In an analysis by sex, women were more likely to feel anxious than men after receiving DAI. 

“The incidence of all three mood disorders is exceptionally high compared to what we would expect in people without an ICD, especially for PTSD,” says Keage. About 30% of patients with an ICD  will experience shock within the first two years, and for some patients, it is a constant fear that influences decisions to drive, swim, etc. Mood disturbances that fade over time can be due to a number of factors, including the patient's receiving psychological help or adjusting to a new life. 

 “We cannot rule out the possibility that people in better health tend to stay in school longer while those in poor health are more likely to drop out. Gender differences were to be expected because anxiety rates are generally higher in women than in men. 

The analysis also looked at mood disorders in people who did not participate in the ICD in 109 studies. An estimated 23% of DAI patients' partners experience post-transplant anxiety and 14% have depression, a rate similar to the prevalence in the patients themselves. Patients with heart disease but without an ICD also had similar rates of mood disturbances as those with an ICD. 

 “Partners are clearly worried their loved one is about to undergo surgery and may then go into shock,” says Keage. The involvement of ICD patient partners in psychotherapies is more effective in improving a patient's physical and psychological well-being than participation alone. The findings in heart patients are significant because heart health and mood disorders go hand in hand. 

“Poor psychological health can also lead to heart problems due to chronic stress and unhealthy lifestyles. Psychologists are less involved in the care of cardiovascular patients, but that must change. I  encourage patients and partners to seek help if their mood is low or they are overly anxious, as there are evidence-based therapies for anxiety, depression, and PTSD.