How different from pacemaker patients are recipients of implantable cardioverter-defibrillators with respect to psychosocial adaptation, affective disorders, and quality of life?

Objective-To assess differences in psychosocial adaptation, quality of life , and incidence of affective disorders between patients with pacemakers and those with implantable cardioverter-defibrillators (ICDs). Design-Patients aged 40-70 years who underwent a first pectoral implantatio n of a pacemaker or an ICD system were studied. All subjects were asked to complete the hospital anxiety and depression scale (HAD), the short form ge neral health survey (SF-36), and a specially designed device related questi onnaire. Data analysis was performed for three patient groups: pacemaker (n = 76), ICD patients who received therapeutic shocks (n = 45), and ICD pati ents who did not receive shocks (n = 31). Results-There were no differences between the three patient groups in HAD s cores or in any of the SF-36 subscales or summary ratings. Probable depress ive disorder (depression score > 10) was observed in 5.2%, 6.5%, and 6.6%, and probable anxiety disorder (anxiety score > 10) In 13.1%, 9.7%, 13.3% of the pacemaker, non-shocked ICD, and shocked ICD patients, respectively. Th ere were no sex differences. However, patients in the shocked ICD group wer e more likely than those in the other groups to report limitations in their leisure activities, to perceive their device as a "life extender," and to admit anxiety about battery depletion and technical problems. Forty per cen t of shocked ICD patients would be interested in joining a support group. Conclusions-Despite having distinctly different medical histories and treat ments, patients with pacemakers and ICDs responded similarly to validated t ools of health status assessment; ICD patients who had received shocks perc eived their device as prolonging their life and had greater anxiety about t echnical problems. Their endorsement of the potential benefits of a support group warrants further investigation.