Patient-Reported Outcomes in a Multidisciplinary Electrophysiology-Psychology Ventricular Arrhythmia Clinic

Abstract

BACKGROUND: Ventricular arrhythmias (VAs) and their treatment have been associated with psychological distress and diminishedquality of life (QOL). We administered a battery of patient-reportedoutcome measures (PROMs) to patients seeing anelectrophysiologist and psychologist in a multidisciplinary VA clinic for patients referred for consideration of catheter ablationfor sustained VAs or implantable cardioverter-defibrillatortherapies.METHODS AND RESULTS: In this retrospective study of the initial VA clinic visit, we analyzed PROMs of: anxiety and depressionsymptoms, visual analog scales for physical health status and quality of life, cardiac anxiety, implantable cardioverter-defibrillatoracceptance, and implantable cardioverter-defibrillatorshock anxiety. We quantitated baseline PROM score meansand performed correlation analysis with clinical makers of cardiac and VA disease severity. We also performed an item-levelanalysis of each PROM question to quantify most frequent patient concerns. A total of 66 patients (56±15 years; 77% men)were included; 70% had prior implantable cardioverter-defibrillatorshock, and 44% with prior VA ablation. Elevated symptomsof anxiety (53%) and depression (20%) were common. Younger patients had greater symptom burden of general health anxiety,cardiac anxiety, and shock anxiety, and lower device acceptance, but indices of VA burden such as number of ICD shocksand time since last ICD shock did not predict anxiety or depression. Item-levelreview of cardiac-specificPROMs revealed that>40% of patients expressed concern regarding resumption of physical activity, sex and employment.CONCLUSIONS: Clinicians can expect elevated symptoms of depression, and cardiac and device-relatedanxiety among patientswith VAs. Routine use of PROMs may elicit these symptoms, which were otherwise not predicted by arrhythmia burden.Review of individual PROM items can facilitate targeting specific patient concerns, which commonly involved physical activity.