Psychological Support Recommended for Patients with ICDs

Routine screening and treatment of anxiety, depression, and post-traumatic stress disorder for patients who receive implantable cardioverter-defibrillators (ICD) has been recommended in a scientific statement from the American Heart Association, and endorsed by the Heart Rhythm Society and American Association of Critical-Care Nurses.

"Providers (electrophysiologists, nurses, cardiologists, and primary care physicians) who see ICD patients during follow-up visits should assess for any questions or concerns as well as evidence of clinically significant emotional distress," the authors wrote. 

Although anxiety and depression are not uncommon among cardiac patients, its manifestation in ICD patients, researchers wrote “should be emphasized for its magnitude.”

Anxiety and depressive disorders are common in 13% to 38% of ICD patients and 11% to 28%, respectively.  Of these patients with emotional distress, approximately 58% to 70% go untreated.

The statement’s authors recommend use of the Patient Health Questionnaire to screen for depressive symptoms, asking whether the patient has had little interest or pleasure in doing things or feelings of depression or hopelessness in the last 2 weeks.  Affirmative answers to either questions should be followed by administration of the 9-item depression scale included with the questionnaire. 

“As clinicians become more cognizant of the need for… providing greater psychosocial support in the preimplantation, postimplantation, and recovery periods, during times of ICD events and at the end of life, we are hopeful that ICD patient and family psychological outcomes will benefit,” the authors concluded.

-Michael Potts