This work was in part supported by the Dutch Heart Foundation, a VIDI grant (91710393) from the Netherlands Organisation for Health Research and Development (ZonMW), The Hague, The Netherlands to Dr. Susanne S. Pedersen, and by a grant to Dr. M.M. Burg from the National Heart, Lung, and Blood Institute (R01HL084438).
Behavioral Interventions in Patients with an Implantable Cardioverter Defibrillator: Lessons Learned and Where to Go from Here?
Article first published online: 25 FEB 2013
©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 5, pages 578–590, May 2013
How to Cite
HABIBOVIĆ, M., BURG, M. M. and PEDERSEN, S. S. (2013), Behavioral Interventions in Patients with an Implantable Cardioverter Defibrillator: Lessons Learned and Where to Go from Here?. Pacing and Clinical Electrophysiology, 36: 578–590. doi: 10.1111/pace.12108
Conflict of interest: None declared.
- Issue published online: 24 APR 2013
- Article first published online: 25 FEB 2013
- Manuscript Accepted: 3 JAN 2013
- Manuscript Revised: 27 NOV 2012
- Manuscript Received: 25 SEP 2012
- Dutch Heart Foundation, a VIDI grant. Grant Number: 91710393
- National Heart, Lung, and Blood Institute. Grant Number: R01HL084438
- implantable cardioverter defibrillator;
- randomized controlled trials;
- psychological interventions
The implantable cardioverter defibrillator (ICD) is the first-line treatment for primary and secondary prevention of sudden cardiac death. A subgroup of patients experience psychological distress postimplant, and no clear evidence base exists regarding how best to address patients’ needs. The aim of this critical review is to provide an overview of behavioral interventions in ICD patients to date, and to delineate directions for future research using lessons learned from the ongoing RISTA and WEBCARE trials.
We searched the PubMed and PsycInfo databases to identify reports of behavioral trials targeting distress and related factors in ICD patients published between 1980 and April 2012.
We identified 17 trials for the review. Generally, compared to usual care, behavioral interventions were associated with reduced anxiety and depression and improved physical functioning, with effect sizes ranging from small to moderate-large (0.10–1.79 for anxiety; 0.23–1.20 for depression). Important limitations were small sample sizes and potential selection bias, hampering generalizability of the results. In addition to a need for larger trials, experiences from the RISTA and WEBCARE trials suggest that intervention trials tailored to the individual patient may be the way forward.
Behavioral interventions show promise with respect to reducing distress in ICD patients. Large-scale intervention trials targeted to the individual needs and preferences of patients are warranted, as a “one size fits all” approach is unlikely to work for all ICD patients.