Depression, anxiety and post-traumatic stress disorder are common among people with implanted heart defibrillators, but improved patient education and ongoing psychological support can help them cope.
That's the message in a new scientific statement from the American Heart Association.
An implantable cardioverter defibrillator (ICD) restores normal heart rhythm and prevents sudden cardiac death.
"A shock from an ICD can be lifesaving, but it can also affect a person's quality of life and psychological state," statement writing group chair Sandra Dunbar said in an AHA news release. "It's important to look at this issue now because 10,000 people have an ICD implanted each month. They range from older people with severe heart failure to healthy children who have a gene that increases the risk of sudden cardiac arrest."
Before they receive an implantable defibrillator, patients should be provided with clear information about the benefits and limitations of the device, their prognosis, and the impact it will have on their lifestyle, including activity and work, the statement recommends.
Patients with implantable defibrillators should undergo regular screening and receive appropriate treatment for anxiety, depression and PTSD.
The statement recommends that doctors and nurses should:
- Ensure that patients understand that the ICD protects against sudden death but does not improve their underlying heart condition unless the device does other things, such as certain types of pacing.
- Assess patients' concerns and psychological status at each follow-up visit.
- Develop a clear plan so that patients and family members know what to do if an ICD delivers a shock to correct heart rhythm.
- Provide gender-specific, age-appropriate information for children and their families.
"Experiencing a shock is distressing and patients have a wide variety of responses," Dunbar said. "Some find it very reassuring that it's working, while others find the actual physical sensations frightening and overwhelming. That's why we suggest that clinicians provide an ongoing assessment of ICD patients' psychological needs."
The statement was published in the Sept. 24 issue of the journal Circulation.
SOURCE: HealthDay
Abstract
Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families: A Scientific Statement From the American Heart Association.
Dunbar SB, Dougherty CM, Sears SF, Carroll DL, Goldstein NE, Mark DB, McDaniel G, Pressler SJ, Schron E, Wang P, Zeigler VL; on behalf of the American Heart Association Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Council on Cardiovascular Disease in the Young.
Significant mortality benefits have been documented in recipients of implantable cardioverter defibrillators (ICDs); however, the psychosocial distress created by the underlying arrhythmia and its potential treatments in patients and family members may be underappreciated by clinical care teams. The disentanglement of cardiac disease and device-related concerns is difficult. The majority of ICD patients and families successfully adjust to the ICD, but optimal care pathways may require additional psychosocial attention to all ICD patients and particularly those experiencing psychosocial distress. This state-of-the-science report was developed on the basis of an analysis and critique of existing science to (1) describe the psychological and quality-of-life outcomes after receipt of an ICD and describe related factors, such as patient characteristics; (2) describe the concerns and educational/informational needs of ICD patients and their family members; (3) outline the evidence that supports interventions for improving educational and psychological outcomes for ICD patients; (4) provide recommendations for clinical approaches for improving patient outcomes; and (5) identify priorities for future research in this area. The ultimate goal of this statement is to improve the precision of identification and care of psychosocial distress in ICD patients to maximize the derived benefit of the ICD.
SOURCE: PubMed