Characteristics associated with low treatment satisfaction in patients with implanted cardioverter defibrillators: results from the LICAD study.
The evaluation of low treatment satisfaction (LTS) with an implanted cardioverter defibrillator (ICD) remains a neglected area of clinical research. However, a trustful attitude toward an ICD is crucial. Within the scope of ICD health technology assessment, we searched for predictors of LTS. Of 195 ICD patients enrolled (mean 59.8 years, standard deviation 12.6), 163 (83.6%) were men and 26 (16.4%) were women. We measured anxiety, helplessness, and depression with standardized instruments and LTS with 11 dichotomous items concerning a mistrustful attitude, a negative body image, and low appraisal. A total of 47 (24.1%) patients were considered as LTS patients. Multivariate logistic regression was used for assessment of LTS. Adjusted for age and survey, LTS was significantly more prevalent in depressed, anxious, and phobic patients. Multivariate logistic regression including medical and psychological covariates revealed the experience of > or =5 shocks with an odds ratio (OR) of 10.17 (95% CI 3.57-29.00, P < or = 0.001), being employed with an OR of 8.07 (95% CI 2.39-27.19, P < or = 0.001), and feelings of helplessness (OR 4.61, 95% CI 1.79-11.90, P < or = 0.002) as the most important predictors for LTS. Women had a slightly not significant effect on LTS. Age, educational status, and depression were not significant. LTS patients required more support for living with the ICD (P < or = 0.001). Thus, LTS serves as surrogate measure for deteriorated psychic health. Clinicians should be advised to identify LTS patients and to consider psychotherapeutic counseling for them.
Ladwig
Karl-Heinz
KH
Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Med. Psychologie des Klinikums rechts der Isar der Technischen Universität München, Langerstrasse 3, 81675 Munich, Germany. kh.ladwig@lrz.tu-munchen.de
Deisenhofer
Isabelle
I
Simon
Heidi
H
Schmitt
Claus
C
Baumert
Jens J
JJ
D000368:Aged; D017147:Defibrillators, Implantable / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*