Concerns about the implantable cardioverter defibrillator: a determinant of anxiety and depressive symptoms independent of experienced shocks.
BACKGROUND
Patients with an implantable cardioverter defibrillator (ICD) are at increased risk of anxiety disorders. In turn, anxiety has been identified as a precipitant of ventricular arrhythmias. Anxiety may in part be attributed to concerns about the ICD firing, but the relationship between ICD concerns, psychological morbidity, and shocks has not been systematically investigated. We examined the relative importance of experienced shocks versus subjective concerns about the ICD as determinants of anxiety and depressive symptoms in ICD patients.


METHODS
Consecutive surviving patients ( n = 182, response rate = 82%) having had an ICD implanted between October 1998 and January 2003 at the Erasmus Medical Centre Rotterdam were asked to fill in the ICD Patient Concerns Questionnaire and the Hospital Anxiety and Depression Scale. Clinical variables were obtained from the patients' medical records.


RESULTS
A total of 55 (30%) patients had received a shock from the ICD. Although patients who had experienced a shock scored higher on ICD concerns, ICD concerns was the only independent determinant of anxiety (odds ratio 6.35, 95% CI 2.84-14.20) and depressive symptoms (odds ratio 2.29, 95% CI 1.06-4.96) adjusting for shocks and all other factors.


CONCLUSIONS
Patient concerns about the ICD may be an important indicator of psychosocial adjustment. Screening for ICD patient concerns using the ICD Patient Concerns Questionnaire may identify patients at risk for psychological morbidity after ICD implantation.
Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands. s.s.pedersen@uvt.nl
Susanne S
SS
Pedersen
Ron T
RT
van Domburg
Dominic A M J
DA
Theuns
Luc
L
Jordaens
Ruud A M
RA
Erdman
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology*; D001145:Arrhythmias, Cardiac / Q000188:drug therapy / Q000523:psychology / Q000628:therapy; D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000523:psychology*; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology*; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000523:psychology* / Q000706:statistics & numerical data; D004868:Equipment Failure; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
D000889:Anti-Arrhythmia Agents