Electrophysiology, Pacing, and Arrhythmia
Examining the psychosocial impact of implantable cardioverter defibrillators: A literature review
Version of Record online: 3 FEB 2009
Copyright © 1999 Wiley Periodicals, Inc.
Volume 22, Issue 7, pages 481–489, July 1999
How to Cite
Camm, A. J., Sears, S. F., Todaro, J. F., Lewis, T. S., Sotile, W. and Conti, J. B. (1999), Examining the psychosocial impact of implantable cardioverter defibrillators: A literature review. Clin Cardiol, 22: 481–489. doi: 10.1002/clc.4960220709
- Issue online: 3 FEB 2009
- Version of Record online: 3 FEB 2009
- Manuscript Accepted: 21 JAN 1999
- Manuscript Received: 30 SEP 1998
- implantable cardioverter defibrillator;
- quality of life;
- risk factors
Background: The implantable cardioverter defibrillator (ICD) has proven to be superior to medications in treating potentially life-threatening ventricular arrhythmias, resulting in reduced mortality rates. Despite the number of patients receiving this therapy, its psychosocial impact is not well understood.
Hypothesis: The purposes of this paper are (1) to review the available literature documenting the psychosocial impact of the ICD on patients, (2) to hypothesize possible mechanisms for this psychosocial impact, and (3) to suggest clinical risk profiles and indications for psychological consultation.
Methods: Electronic and library searches (e.g., MEDLINE, PsychLit) were used to gather studies examining the psychosocial impact of the ICD. Only studies investigating psychosocial outcomes (e.g., psychological distress, quality of life, social and role functioning), either prospectively or cross-sectionally, were admitted into the review. No literature reviews or secondary 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 anxiety. Depressive symptoms are reported at rates that are generally consistent with other cardiac populations. Although the incidence of psychological disorders appears to be similar to that found in general cardiac populations, specific ICD-related concerns such as fear of shock, fear of device malfunction, fear of death, and fear of embarrassment have been identified. Selected psychological theories such as classical conditioning, learned helplessness, and a cognitive appraisal model help to explain the occurrence of psychological symptoms post implantation. Psychosocial adjustment risk profiles indicate that young ICD recipients and those with high discharge rates may experience the most adjustment difficulties.