Psycho-educational support interventions for patients with an implantable cardioverter defibrillator

Abstract

The implantable cardioverter defibrillator (ICD) has established superiority in reducing mortality for survivors of cardiac arrest or patients at high risk of sudden death. However, because of the nature of their spontaneous, chronic, and potentiality life-treating condition, patients with an ICD are at risk of developing mild to serious psychological distress. Critical events, such as ICD shocks or ICD recalls may occur, significantly altering the course of individuals' psychosocial adjustment; a number of studies from different countries demonstrate that patients with an ICD that experience higher emotional difficulties undergo a greater incidence of shock therapy. A proper biopsychosocial assessment and conceptualization of the needs of patients with an ICD, and the delivery of tailored interventions is, therefore, mandatory for ensuring optimal clinical care. Brief education sessions are effective in reducing concerns among patients with mild levels of psychosocial distress, and a continuum of treatment strategies is available as the recipients' severity of psychological distress and associated maladaptive behavior grows, spanning in ICD support groups, individual consultations using cognitive behavioral techniques and pharmacotherapy. Yet, while short-term positive outcomes are usually achieved, applicable and effective long-term management of psychological symptoms secondary to ICD implantation is still a challenge for healthcare providers, and the high degree of heterogeneity in content and methodology across studies has made it difficult to formulate broad conclusions on the feasibility and effectiveness of existing interventions. Further research producing valid and reliable data needs to be undertaken in order to maximize positive patient outcomes.