Understanding Trauma Reactions in Implantable Cardioverter Defibrillator Patients and Piloting a Brief Web-based Trauma Intervention Protocol Study (ICD-TIPS)

Abstract

Background: Approximately 20% of patients with an implantable cardioverter defibrillator (ICD), a medical device that prevents sudden cardiac arrest (SCA) and mortality, score above a clinical cutoff on a screening measure for posttraumatic stress disorder (PTSD) symptoms. Primary Aims: The purpose of this study was to (1) contribute to the literature on PTSD in ICD patients including prevalence estimates and associated posttraumatic events experienced by patients with ICDs, (2) pilot a brief web-based intervention for ICD patients with significant PTSD symptoms, and (3) evaluate the preliminary efficacy of this web-based program. Methods: Participants were 92 patients with ICDs recruited in EP clinics and internet ICD support forums. Measures assessed participants' trauma experiences, mental health, and quality of life. Participants with PTSD and partial PTSD were provided the ICD-TIPS web-based brief intervention, which combined elements of evidence-based treatment protocols for PTSD and cognitive-behavioral therapy (CBT) for ICD patients. Participants without PTSD symptoms were provided the web-based version of an existing, generic, CBT intervention for ICD patients. Results: Of participants recruited in clinic, 39% met diagnostic criteria for PTSD. Predictors of having PTSD were greater perceived pain of shock, primary prevention device indication, and lack of historic non-cardiac trauma. For those enrolled in ICD-TIPS, post-intervention scores on the PCL (M = 35.5, SD = 10.09) were significantly lower than pre-intervention scores (M = 46.31, SD = 9.88), t (16) = 3.51, p = .003, with a large effect size, d = 1.08. Discussion: A large number of ICD patients experience PTSD symptoms associated with their device or cardiac disease. For those with internet access, brief, web-based intervention may be an effective clinical treatment.