Improved patient education and ongoing psychological support will help people cope with the psychological distress of having an implanted defibrillator, according to a scientific statement from the American Heart Association.
The statement, published in the American Heart Association journal Circulation, is a comprehensive review of the psychosocial and quality of life for people who receive an implantable cardioverter defibrillator (ICD) to restore normal heart rhythm and prevent sudden cardiac death. It includes recommendations for improved patient care and identifies areas where more research is needed. The authors recommend routine screening and appropriate treatment for anxiety, depression and post-traumatic stress disorder, which patients with ICDs often experience.
"A shock from an ICD can be lifesaving, but it can also affect a person's quality of life and psychological state," said Sandra B. Dunbar, R.N., D.S.N., chair of the statement writing group. "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 implantation, clinicians should provide clear information about the benefits and limitations of the ICD, prognosis and impact on lifestyle including activity and occupation.
"Education and support need to include the patient and the family and be broader than just a focus on maintaining the device. Providers need to help patients address ICD-specific concerns about symptoms, heart disease treatment, physical activities and end-of-life issues," said Dunbar, who is also the Charles Howard Candler Professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta. Among the statement's recommendations to improve psychological outcomes, physicians and nurses should:
- Emphasize that the ICD protects against sudden death, but does not improve your underlying heart condition unless the device does other things, such as certain types of pacing.
- Assess the patient's concerns and psychological status at each follow-up visit.
- Develop a clear "shock plan" so patients and family members know what to do in the event of a shock.
- Help patients and their families deal with stressful situations that may develop with an ICD.
- 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 identified several areas for further research, including predicting which patients are likely to experience psychological distress and how to alleviate it; the level of sports participation and physical activity appropriate for children and teens with ICDs; and when and how to discuss potential ICD deactivation near the end of life.
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