title: Pre-implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation.
abstract: BACKGROUND
  The impact of ICD therapy on patient well being has typically focused on mean differences between groups, thereby neglecting changes within individuals. Using an intra-individual approach, we examined (i) the prevalence of implantable cardioverter defibrillator (ICD) patients maintaining their pre implantation level of psychological functioning at 12 months, and (ii) factors associated with deterioration in functioning.
  
  
  METHODS
  Consecutively implanted ICD patients (n=332) completed a set of standardized and validated patient reported measures at baseline and at 12 months post implantation.
  
  
  RESULTS
  The majority of patients (72.8% to 81.7%) preserved their pre implantation level of psychological functioning 12 months post implantation. In adjusted analysis, ICD shock (all ps<.001) and Type D personality (all ps<.05) were independent predictors of deterioration in psychological functioning at 12 months across all domains, while baseline psychological status was associated with an improvement (all ps<.05). Patients with a primary prevention indication experienced a decrease in ICD concerns (p=.03) and anxiety (p=.006), and older patients (p=.04) a decrease in anxiety symptoms during the follow-up period. By contrast, patients with left ventricular dysfunction (p=.007) and atrial fibrillation (p=.02) were more likely to experience an increase in anxiety.
  
  
  CONCLUSIONS
  The majority of ICD patients maintained their pre implantation level of psychological functioning at 12 months. A subset of patients was at risk of poor psychological adaptation, attributable to ICD shocks, Type D personality, atrial fibrillation, and left ventricular dysfunction, while primary prevention indication and older age had a protective effect against deterioration in functioning.
authors: CoRPS - Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands. s.s.pedersen@uvt.nl
authors: Susanne S
authors: SS
authors: Pedersen
authors: Madelein T
authors: MT
authors: Hoogwegt
authors: Luc
authors: L
authors: Jordaens
authors: Dominic A M J
authors: DA
authors: Theuns
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000368:Aged; D000369:Aged, 80 and over; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000523:psychology*; D011300:Preoperative Care / Q000523:psychology*; D011446:Prospective Studies; D013997:Time Factors