Assessing the psychosocial impact of the ICD: A national survey of implantable cardioverter defibrillator health care providers

The implantable cardioverter defibrillator (ICD) provides a survival advant age over antiarrhythmic medications for patients with life-threatening vent ricular arrhythmias. However, the effect of ICD therapy on quality-of-life and psychosocial functioning are not as well understood. Health care provid ers (e.g., physicians, nurses) can serve as a valuable source of informatio n related to these ICD outcomes. The purpose of this study was to investiga te health care provider perceptions regarding: (1) the quality-of-life and psychosocial functioning of their ICD recipients, (2) the concerns or probl ems reported by ICD recipients, and (3) the degree of provider comfort in m anaging these concerns. The final sample of health care providers (n = 261) rated ICD recipients' global quality-of-life and psychosocial functioning, and specific concerns about health care, lifestyle, special population adj ustment, marital and family adjustment, and emotional well-being. With rega rd to quality-of-life, health care providers reported that the majority of ICD recipients were functioning bet ter (38%) or about the same (47%) than before implantation. However, health care providers reported that 15% of re cipients experienced worse quality-of-life postimplantation. Similarly heal th care providers indicated that 10%-20% of ICD recipients experienced wors e emotional functioning and strained family relationships. Moreover, issues related to driving, dealing with ICD shocks, and depression were the most common ICD recipient concerns. Significant differences were noted between p hysicians and nurses/other health care professionals on a wide range of psy chosocial issues. Health care providers generally reported the most comfort dealing with traditional medical issues (i.e., patient adherence), and the least comfort in managing emotional well-being issues (e.g., depression an d anxiety). These results suggest that routine attention to ICD quality-of- life and psychosocial outcomes is indicated for health care providers who c are for ICD recipients.