Establishing a Standard for Peri-operative ICD Education : A Demonstration Project

Abstract

Introduction: An implantable cardioverter defibrillator (ICD) administers a shock to terminate potentially life-threatening cardiac arrhythmias. The device saves lives, but presents psychological challenges for patients. At present, there is a paucity of brief interventions for ICD patients designed for administration in a clinic setting that considers issues of cost, time, and available resources. The present study examined the impact of a brief cognitive behavioral (CBT) educational intervention on primary endpoints of patient acceptance and quality of life and secondary endpoints of depression and anxiety. Methods: Sixty-two participants from clinics in NC and CO were recruited for the study 7-15 days post ICD implant. Thirty-three participants were randomized to the standard of care group (educational video + Q & A session) and 29 participants were randomized to the intervention group (educational video + Q & A session + take-home educational CBT booklet). Participants completed psychosocial measures prior to treatment and again at six weeks follow-up. Results: Significant increases in pre-post patient acceptance across groups were evidenced t(44) = -2.13, p < .04 with a moderate effect ([mu]² = .09). There were no significant differences in quality of life. No significant differences were found on the secondary aim of depression. Contrary to our expectations, a significant difference was evidenced in anxiety between the control group (n = 19) and intervention group (n = 12) difference scores, U = 60.5, z = -2.20, p = .03, r = .40. Pre-post anxiety decreased significantly in the standard of care group, z = -2.69, p =.007, r = .34, but did not change significantly in the intervention group. Of note, nearly half the cases were excluded due to missing data. Conclusions: A standardized peri-operative ICD education intervention increased patient acceptance. However, minimal treatment created minimal effects on anxiety, depression, and quality of life scores. A more intensive intervention may be needed to significantly impact psychological distress. Our data suggests that patients may be affectively primed by health information that could hinder a natural improvement in psychological adjustment. Dosage and desire for the provision of health information should be considered in future interventions with ICD patients.