According to the American Heart Association (AHA), significant psychological distress, chronic anxiety and depression are common among people who have ICDsand as many as 70 percent of those patients aren't being treated. The good news is that living with an implant doesn't mean you have to live with distress.
An ICD prevents sudden cardiac death by restoring normal heart rhythm in patients with heart failure or heart-muscle damage. These patients have a very high risk of life-threatening abnormal heartbeats called ventricular arrhythmias. The device constantly monitors the heart's rhythm; when it detects a dangerous rhythm, it delivers an electrical shock that attempts to return the heartbeat to normal.
Most patients and their families adjust successfully to living with an ICD, but some may need extra help adjusting emotionally. Doctors traditionally expect some cardiovascular disease patients to be anxious and depressed, but the feelings appear to be more widespread for ICD patients.
If you have an ICD, you not only have to cope emotionally, you may be dealing with other challenges as well, such as:
- Your underlying heart disease
- The realization that the ICD won't reverse your disease
- The technological aspects and maintenance of your device
- Other coexisting illnesses
You may also be fearful of an electrical shock from the ICD, which can feel like a thump or strong kick to the chest. Shocks can trigger psychological distressas can the anticipation of a shock or the inability to predict one. The AHA's evidence review pointed to several studies that suggest patients can tolerate up to five shocks without a significant difference in quality of life, but after about five shocks, quality of life declines. More comprehensive studies are needed to look for a link between psychosocial distress and ventricular arrhythmia that leads to ICD shock.
Another study concluded that the experience of just one shock is associated with reduced physical function and mental wellbeing. Other studies showed an association between a risk of shock and depression and psychological distress. The review authors report, however, that while some patients may find shock sensations frightening and overwhelming, others find them reassuring because they know the ICD is working.
When you add these concerns to other common fears like battery failure, device recall, traveling and general uncertainty about one's health, it's no wonder many ICD patients report mild to severe distress. The number of people estimated to suffer from post-implantation distress was cause enough for the AHA to urge health care professionals to educate patients better about ICDs and provide them with ongoing psychological support.
A Doctor's Viewpoint
James L. Weiss, MD, Michael J. Cudahy Professor of Cardiology, Johns Hopkins University School of Medicine
Implantable cardioverter-defibrillators have been credited with saving countless lives, and the American Heart Association's statement shouldn’t discourage anyone from having one implanted.
It serves, however, as a good reminder that ensuring mental well-being in ICD patients is a vital component of care that should never be overlooked. Patients and their families need guidance in adjusting their lifestyles and their attitudes. Loved ones need to be involved in any counseling because the device affects them also.
Family members can suffer from feelings of helplessness, anxiety and overprotectiveness and from changes in family roles and living patterns. Health care providers should play a role in helping patients and their families make necessary lifestyle and attitude adjustments.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50