Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator

Background: Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using a prospective study design. Methods and Results: Consecutively implanted ICD patients (n=383; 79% men) completed the Type D Scale at baseline and the Short-Form Health Survey 36 (SF-36) at baseline and 3, 6, and 12 months. Of all patients, 23.5% had a Type D personality and 13.8% received a shock during follow-up. Shocked patients reported significantly poorer health status, as did Type D patients. Health status patterns were poorest in patients with combined Type D personality and shock during follow-up. Shock during follow-up was a significant independent associate of poorer health status for 4 of 8 subscales of the SF-36 and the Mental Component Summary (all P<.05), with shocked patients scoring between 2.60 to 13.30 points lower than nonshocked patients. Type D personality was an independent associate of poor postimplantation health status for 6 of 8 of the SF-36 subscales and the Mental Component Summary, with Type D patients scoring between 2.12 to 8.02 points lower, adjusting for demographic and clinical characteristics. Conclusions: ICD shock and the patient's preimplantation personality disposition were equally important associates of health status 12 months after implantation. Identification of the patient's personality profile before ICD implantation may help identify subsets of patients who may need additional care, for example, with a psychosocial component

Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation

Background The impact of ICD therapy on patient well being has typically focused on mean differences between groups, thereby neglecting changes within individuals. Using an intra-individual approach, we examined (i) the prevalence of implantable cardioverter defibrillator (ICD) patients maintaining their pre implantation level of psychological functioning at 12 months, and (ii) factors associated with deterioration in functioning. Methods Consecutively implanted ICD patients (n = 332) completed a set of standardized and validated patient reported measures at baseline and at 12 months post implantation. Results The majority of patients (72.8% to 81.7%) preserved their pre implantation level of psychological functioning 12 months post implantation. In adjusted analysis, ICD shock (all ps < .001) and Type D personality (all ps < .05) were independent predictors of deterioration in psychological functioning at 12 months across all domains, while baseline psychological status was associated with an improvement (all ps < .05). Patients with a primary prevention indication experienced a decrease in ICD concerns (p = .03) and anxiety (p = .006), and older patients (p = .04) a decrease in anxiety symptoms during the follow-up period. By contrast, patients with left ventricular dysfunction (p = .007) and atrial fibrillation (p = .02) were more likely to experience an increase in anxiety. Conclusions The majority of ICD patients maintained their pre implantation level of psychological functioning at 12 months. A subset of patients was at risk of poor psychological adaptation, attributable to ICD shocks, Type D personality, atrial fibrillation, and left ventricular dysfunction, while primary prevention indication and older age had a protective effect against deterioration in functioning

Pre implantation psychological functioning preserved in majority of implantable cardioverter defibrillator patients 12 months post implantation

Background The impact of ICD therapy on patient well being has typically focused on mean differences between groups, thereby neglecting changes within individuals. Using an intra-individual approach, we examined (i) the prevalence of implantable cardioverter defibrillator (ICD) patients maintaining their pre implantation level of psychological functioning at 12 months, and (ii) factors associated with deterioration in functioning. Methods Consecutively implanted ICD patients (n = 332) completed a set of standardized and validated patient reported measures at baseline and at 12 months post implantation. Results The majority of patients (72.8% to 81.7%) preserved their pre implantation level of psychological functioning 12 months post implantation. In adjusted analysis, ICD shock (all ps < .001) and Type D personality (all ps < .05) were independent predictors of deterioration in psychological functioning at 12 months across all domains, while baseline psychological status was associated with an improvement (all ps < .05). Patients with a primary prevention indication experienced a decrease in ICD concerns (p = .03) and anxiety (p = .006), and older patients (p = .04) a decrease in anxiety symptoms during the follow-up period. By contrast, patients with left ventricular dysfunction (p = .007) and atrial fibrillation (p = .02) were more likely to experience an increase in anxiety. Conclusions The majority of ICD patients maintained their pre implantation level of psychological functioning at 12 months. A subset of patients was at risk of poor psychological adaptation, attributable to ICD shocks, Type D personality, atrial fibrillation, and left ventricular dysfunction, while primary prevention indication and older age had a protective effect against deterioration in functioning

Relation of statin therapy to psychological functioning in patients with an implantable cardioverter defibrillator

Statin therapy is an important secondary prevention measure in cardiovascular disease. However, the side effects associated with statin use could potentially affect patients' quality of life. Little is known about the influence of statin therapy on the well-being and health status of cardiac patients, in general, and patients with an implantable cardioverter defibrillator (ICD), in particular. We investigated the association between statin therapy and symptoms of anxiety and depression and patients' health status during the 12 months after implantation, reckoning with statin type and dosage. Consecutively implanted ICD patients (n = 409; 78.2% men) completed the Hospital Anxiety and Depression Scale and the Medical Outcomes Study Short Form 36-item Health Survey at baseline and 3, 6, and 12 months after implantation. The data were analyzed using general linear mixed modeling repeated measures multivariate analysis of variance. Of the 409 patients, 60% were prescribed statins. Statin use was independently associated with poorer role limitations–physical (p = 0.001), social functioning (p = 0.007), and role limitations–emotional (p = 0.006) during the 12 months after implantation, independent of statin type, dosage, and other potential confounders. The associations between statin therapy and depression (p = 0.06) and statin therapy and physical functioning (p = 0.05) were borderline significant, and no association was found with anxiety (p >0.05). In conclusion, statin therapy was associated with impaired health status on 3 of the 8 Medical Outcomes Study Short Form 36-item Health Survey health status subdomains. This is the first study of ICD patients to examine the association between statin therapy and patient well-being. Future research is warranted to replicate these findings

Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease

Objective The objective of the current study was to examine whether depression and anxiety are independently associated with 5-year cardiac-related hospitalizations and all-cause mortality in patients with ischemic heart disease (IHD). Methods Patients treated for MI, angina, or ischemic heart failure (N = 610) were recruited from Holbæk Hospital, Denmark. All patients completed the Hospital Anxiety and Depression Scale (HADS) in December 2005. Data regarding patient characteristics at baseline, and hospitalizations and deaths during follow-up were collected from Danish population-based registers. Cox and negative binomial regression analyses were performed to examine the relationship between depression, anxiety and the endpoints. Results At baseline, 71 (11.6%) patients reported depression and 120 (19.7%) reported anxiety. Models including both depression and anxiety showed that depression was independently associated with time to first cardiac-related hospitalization, cumulative number and length of cardiac-related hospitalizations, and all-cause mortality, while anxiety was only associated with the total length of hospitalizations (all p-values < .05). After adding sociodemographic and clinical factors, depression remained associated with the number (incidence rate ratio (IRR) = 2.00, 95% confidence interval (CI): 1.44–2.77) and length of cardiac-related hospitalizations (IRR = 3.69, 95% CI: 2.75–4.96), and all-cause mortality (hazard ratio (HR) = 2.12, 95% CI: 1.13–3.96). The associations between depression and time to first hospitalization and between anxiety and length of stay were eliminated. Conclusions The current study showed that depression, and not anxiety, is associated with the number and length of cardiac-related hospitalizations and all-cause mortality in IHD patients, independent of traditional risk factors. In order to improve health outcomes, better awareness and treatment of depression in IHD patients are crucial.Keywords: Ischemic heart disease, Depression, Anxiety, Hospitalization, Mortalit

Undertreatment of anxiety and depression in patients with an implantable cardioverter-defibrillator:impact on health status

Objective: Twenty-five to 33% of patients with an implantable cardioverter-defibrillator (ICD) experience anxiety and depression, but it is not known whether their symptoms are adequately treated. We investigated (a) whether patients with clinically relevant symptoms of distress received appropriate treatment, and (b) whether patients not treated for their emotional distress reported poorer health status using a prospective study design. Methods: A consecutive cohort of 448 first-time patients with an ICD (21% women; mean age, 58 +/- 12 years) completed the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey 36 (SF-36). Information on psychological treatment was obtained via purpose-designed questions. Results: At baseline, 35.5% of patients were emotionally distressed, of which 70.2% received no psychological treatment. At 12 months postimplantation, 24.3% of all patients had clinically significant levels of distress, of which 58.3% received no treatment. Patients experiencing distress but without treatment reported a significantly poorer health status than patients without distress and treatment (all ps < 0.001) and compared to patients without emotional distress who did receive treatment (ps varying between p = .027 and p < .001 for six subscales). Health status was better on four subscales than for patients with emotional distress and treatment (ps varying between p = .034 and p < .001). Conclusions: There was a serious gap between the need for psychological treatment and the actual delivery of treatment, with consequences to patients' health status. Detection and adequate treatment of distress in ICD patients remains an important target in this patient group in order to safeguard health status postimplantation

Comorbidity burden is associated with poor psychological well-being and physical health status in patients with an implantable cardioverter-defibrillator

Comorbidity burden has been linked to survival in patients with an implantable cardioverter-defibrillator (ICD), but no study has examined the influence on psychological well-being and health status. We examined the relationship between comorbidity burden and anxiety, depression, and health status in patients with an ICD during the first 12 months post-implantation using a prospective study design. Consecutively, implanted ICD patients (N 401; 78 men) completed the Hospital Anxiety and Depression Scale and the Short Form Health Survey 36 (SF-36) at baseline, 3, 6, and 12 months post-implantation. Data were analysed using general linear mixed modelling repeated measures multivariable analysis of variance. The mean Charlson comorbidity index score was 3.5 (2.4). In adjusted analyses, comorbidity burden was significantly associated with depression (P 0.003) and the physical health status domains of the SF-36 (Physical Functioning: P 0.001; Role LimitationsuPhysical: P 0.023; Bodily Pain: P 0.004; and General Health: P 0.025) but not with anxiety (P 0.62) and the mental health status domains of the SF-36 (all Ps 0.05). Chronic heart failure, chronic obstructive pulmonary disease, cerebrovascular disease, and renal failure were the comorbidities with the most impact on depression and physical health status. Comorbidity burden was a significant predictor of poorer psychological well-being and physical health status in ICD patients during the first 12 months post-implantation. In the care and management of ICD patients, it is important to recognize the impact of comorbidity burden on patients mood and health status, and that adjunctive intervention may be warranted to enhance well-being