title: Poor health status and distress in cardiac patients: the role of device therapy vs. underlying heart disease.
abstract: OBJECTIVE
  Implantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influence of living with an ICD vs. congestive heart failure (CHF) on PROs and compared (i) ICD patients without CHF (ICD only), (ii) CHF patients without an ICD (CHF-only), and (iii) CHF patients with an ICD (ICD + CHF).
  
  
  RESULTS
  Separate cohorts of ICD and CHF patients (N = 435; 75% men) completed PROs at baseline, 6 and 12 months. Groups differed on physical health status only at baseline (F((2,415)) = 7.15, P = 0.001) and on anxiety at 12 months (F((2,415)) = 4.04, P = 0.01); ICD + CHF patients had the most impaired physical health status but the lowest anxiety level followed by the ICD only and CHF only patients. Congestive heart failure only patients had the most impaired mental health status and reported the highest level of anxiety as compared to the ICD only (P < 0.001) and ICD + CHF groups (P = 0.009), while the two latter groups did not differ. The effect sizes ranged from very small (0.03) to moderate-large (0.69). Groups did not differ in depression scores.
  
  
  CONCLUSIONS
  Congestive heart failure patients reported worse PROs as compared to ICD patients, although the magnitude of the differences was relatively small. This suggests that the well being of patients is not necessarily negatively influenced by the implantation of an ICD, and that underlying heart disease may have at least an equal if not greater influence on PROs.
authors.affiliation: CoRPS-Department of Medical and Clinical Psychology,  Tilburg University, PO Box 90153, 5000 LE Tilburg,  The Netherlands.
authors.forename: Mirela
authors.initials: M
authors.lastname: Habibović
authors.forename: Henneke
authors.initials: H
authors.lastname: Versteeg
authors.forename: Aline J M
authors.initials: AJ
authors.lastname: Pelle
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
authors.forename: Luc
authors.initials: L
authors.lastname: Jordaens
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology; D016009:Chi-Square Distribution; D017281:Cost of Illness; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000523:psychology*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome