Psychological consultation for patients with implantable cardioverter defibrillator: Confounding challenges of cardiac disease, technology, and the patient experience

Abstract

Sudden cardiac arrest is a common and often lethal event, claiming roughly 400,000 lives annually in the United States alone. Implantable cardioverter defibrillators (ICDs) represent a significant technological advance in the medical arena and are the best available intervention for sudden cardiac arrest and subsequent prevention of sudden cardiac death. Over the last two decades, research has increasingly focused on understanding how living with an ICD presents unique and serious psychological challenges for many patients benefiting from this lifesaving technology. Employing a biopsychosocial model in caring for these patients' psychological health helps address relevant factors that can contribute to their psychologically distressed presentation, including cardiac disease burden, ICD treatment delivery (i.e., shock), psychiatric (s) disorder or symptoms, health behaviors, and disruption of day-to-day life or social functioning. This chapter highlights known, common psychological risks for ICD patients, which include depression, anxiety, and compromised quality of life. It further explores some key considerations or groups that are associated with risk for psychological distress, such as pediatric ICD patients, devices under recall, and end-of-life issues. Several relevant assessment measures are provided to assist providers in identifying which psychological risks are realities for each particular patient. In total, this information is designed to lend knowledge and confidence to consulting mental health providers, leaving them well equipped to deliver state-of-the-art assessment of ICD patients - a medically complex, and often psychologically distressed, group of individuals.