Examining the psychosocial impact of implantable cardioverter defibrillators: A literature review

Background: The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life-threatening ventric ular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well und erstood. Hypothesis: The purposes of this paper are (1) to review the available lite rature documenting the psychosocial impact of the ICD on patients, (2) to h ypothesize possible mechanisms for this psychosocial impact, and (3) to sug gest clinical risk profiles and indications for psychological consultation. Methods: Electronic and library searches (e.g., MEDLINE, PsychLit) were use d to gather studies examining the psychosocial impact of the ICD. Only stud ies investigating psychosocial outcomes (e.g., psychological distress, qual ity of life, social and role functioning), either prospectively or cross-se ctionally, were admitted into the review. No literature reviews or secondar y sources were included. Results and Conclusions: Current research suggests that ICD-specific fears and symptoms of anxiety (e.g., excessive worry, physiological arousal) are the most common psychological symptoms experienced by ICD recipients, with approximately 13-38% of recipients experiencing diagnosable levels of anxie ty. Depressive symptoms are reported at rates that are generally consistent with other cardiac populations. Although the incidence of psychological di sorders appears to be similar to that found in general cardiac populations, specific ICD-related concerns such as fear of shock, fear of device malfun ction, fear of death, and fear of embarrassment have been identified. Selec ted psychological theories such as classical conditioning, learned helpless ness, and a cognitive appraisal model help to explain the occurrence of psy chological symptoms post implantation. Psychosocial adjustment risk profile s indicate that young ICD recipients and those with high discharge rates ma y experience the most adjustment difficulties.