Psychopathology in postinfarction patients implanted with cardioverter-defibrillators for secondary prevention. A cross-sectional, case-controlled study☆

Abstract 

Objective

To determine (1) the incidence of anxiety and depression in patients implanted with defibrillators for secondary arrhythmia protection after myocardial infarction; (2) the effect of comorbidity and receipt of shock therapy on psychosocial maladjustment.

Methods

Cross-sectional, one-off, questionnaire-based (HADS; MOS SF-36), case-controlled study of defibrillator recipients (n=100) from a 3-year implant period and three groups of matched controls [pacemaker (n=50), coronary intervention (n=50), atrial fibrillation (n=50)], sharing specific preselected previous health experiences. Spouses of each subgroup (n=106) were also studied. Although a cardiac rehabilitation program was available routinely for postinfarction patients, no specific rehabilitation was provided after defibrillator or pacemaker implant.

Results

Mean scores for each assessment were similar for each group. Individual patient scores, however, revealed similarly high incidences of anxiety (24–34%) and depression (14–22%) in all groups. Experience of implantable cardioverter-defibrillator (ICD) ‘shock(s)’ and ‘shock storm(s)’ (≥3 shocks in 24 h) increased anxiety significantly. HADS criteria for anxiety ‘caseness’ or borderline ‘caseness’ were met in 63.6% of shock-storm recipients. Abnormal anxiety scores did not differ with interval from index event. Individual HADS scores also identified high incidences of anxiety in all spouse groups (25–48%).

Conclusions

Experience of shock storm precipitates pathological levels of anxiety in ICD recipients, and need for an ICD contributes to spouse anxiety. Individual CBT is indicated for patients who experience multiple shocks along with psycho-education for spouses. Anxiolytic and antidepressant medications may be indicated as part of their psychological rehabilitation.

Abbreviations: AF, atrial fibrillation, CBT, cognitive behavior therapy, DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, HADS, Hospital Anxiety and Depression Scale, ICD, implantable cardioverter-defibrillator, MOS-36, medical outcomes study short form 36, PCI, percutaneous coronary intervention, SPSS, Statistical Package for Social Sciences

Keywords: Arrhythmia, Implantable defibrillator, Stress disorder, Psychological therapy, Cardiac rehabilitation