A randomized controlled trial of secondary prevention of anxiety and distress in a German sample of patients with an implantable cardioverter defibrillator.
OBJECTIVE
To evaluate a minimal, easy, accessible intervention targeting anxiety and reduced quality of life in patients with an implantable cardioverter defibrillator (ICD). An estimated 24% to 87% of patients experience anxiety, and 10% to 15% have reduced quality of life.


METHODS
A total of 119 ICD patients were assigned randomly to usual medical aftercare (n = 63) or additional psychological treatment (n = 56) comprising of written information on medical and psychological consequences of an ICD plus 6 months of individual phone counseling. Treatment efficacy was evaluated by comparing T0 (immediately after implantation) and T1 (6 months later) assessments.


RESULTS
Although 75% of patients considered the program helpful, age moderated treatment efficacy. As indicated by triple interactions, only in the treatment group, anxiety (HADS-Anxiety, p < .01), psychological distress (SCL-K-9, p < .02), and somatic quality of life (SF-36-PCS, p < .01) improved in ICD patients aged <65 years but deteriorated in older patients (age, 65-75 years). Frequency of ICD discharges was associated with a symptom increase from T0 to T1 in all patients (HADS-Depression, CAQ-Avoidance, and ICD-Constraints; all p < .05).


CONCLUSIONS
Our findings confirm that psychological treatments cannot be expected to have uniformly positive effects in ICD patients. Our minimal intervention may have adequately addressed ICD-related concerns in younger patients but may have fostered problems in older patients with fewer concerns. Therefore, our findings warrant custom treatment with particular attention to the elderly as well as patients with frequent ICD discharges.
Crössmann
Alexander
A
Department of Psychology, University of Würzburg, Marcusstrasse, Würzburg, Germany.
Schulz
Stefan M
SM
Kühlkamp
Volker
V
Ritter
Oliver
O
Neuser
Hans
H
Schumacher
Burghard
B
Bauer
Wolfgang
W
Pauli
Paul
P
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000367:Age Factors; D000368:Aged; D001008:Anxiety Disorders / Q000517:prevention & control*; D003376:Counseling / Q000379:methods*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000523:psychology*; D003866:Depressive Disorder / Q000517:prevention & control; D005260:Female; D005858:Germany; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011788:Quality of Life; D055502:Secondary Prevention / Q000379:methods*; D013315:Stress, Psychological / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome