Mood disorders common in first year after ICD implantation
Click Here to Manage Email Alerts
Key takeaways:
- Anxiety, depression and PTSD are common in patients with an implantable cardioverter defibrillator.
- Psychological assessment and therapy for these patients may be warranted.
Among patients who received an implantable cardioverter defibrillator, a diagnosis or clinically relevant symptoms consistent with anxiety, depression or PTSD were common, especially in the first year, researchers reported.
“Implantable cardioverter defibrillators are effective at extending patients’ lives but we need to make sure that’s a good quality life,” Hannah Keage, PhD, professor of psychology at the University of South Australia, Adelaide, said in a press release. “Rates of mood disorders in people with an ICD are much higher than in the general population, suggesting that psychological assessment and therapy should be integrated into the routine care of these patients.”
Data were derived from Ghezzi ES, et al. Europace. 2023;doi:10.1093/europace/euad130.
Keage and colleagues conducted random-effects meta-analyses of 109 studies with 39,954 patients to estimate the prevalence of mood disorders before and after ICD implantation.
The overall prevalence of an anxiety diagnosis or clinically relevant anxiety symptoms was 22.58% (95% CI, 18.26-26.91), whereas the prevalence estimate was 30.43% before discharge (95% CI, 18.42-42.43), 32.29% between discharge and 5 months (95% CI, 23.96-40.61), 28.98% between 6 and 12 months (95% CI, 14.32-43.63) and 22.39% after 12 months (95% CI, 17.04-27.74), according to the researchers.
The overall prevalence of a depression diagnosis or clinically relevant depression symptoms was 15.42% (95% CI, 11.9-18.94), whereas the prevalence estimate was 16.81% before discharge (95% CI, 10.61-23.02), 22.56% between discharge and 5 months (95% CI, 11.41-33.71), 20.52% between 6 and 12 months (95% CI, 6.85-34.2) and 13.6% after 12 months (95% CI, 9.64-17.57), Keage and colleagues wrote.
The overall prevalence of a PTSD diagnosis or clinically relevant PTSD symptoms was 12.43% (95% CI, 6.9-17.96), and the prevalence estimate after 12 months was 11.68% (95% CI, 5.54-16.83), Keage and colleagues found.
Clinically relevant anxiety and depression were more common in those who experienced ICD shocks than in those who did not (OR for anxiety = 3.92; 95% CI, 1.67-9.19; OR for depression = 1.87; 95% CI, 1.34-2.59), according to the researchers.
Women were more likely to have anxiety than men (Hedges’ g = 0.39; 95% CI, 0.15-0.62), the researchers found.
Depression symptoms decreased after the first 5 months (Hedges’ g = 0.13; 95% CI, 0.03-0.23) and anxiety symptoms decreased after the first 6 months (Hedges’ g = 0.07; 95% CI, 0-0.14), according to the researchers.
“Rates of all three mood disorders were notably high compared to what we would expect in people without an ICD, particularly for PTSD,” Keage said in the release. “Around 30% of ICD patients will experience a shock in the first 2 years, and for some patients this is a constant fear that affects decisions about driving, swimming, and so on. The decline in mood disorders over time could be due to a number of factors including patients getting psychological help or adapting to their new life. We can’t discount the possibility that healthier people tend to stay in studies longer while those in ill health are more likely to drop out. The sex differences were expected, as rates of anxiety are generally higher in women compared to men.”
Reference:
- Posttraumatic stress disorder affects more than one in 10 cardiac device patients. www.escardio.org/The-ESC/Press-Office/Press-releases/Post-traumatic-stress-disorder-affects-more-than-one-in-ten-cardiac-device-patients. Published June 16, 2023. Accessed June 19, 2023.
Collapse
Click Here to Manage Email Alerts