Depression, anxiety and device acceptance after ICD implantation: A longitudinal cohort analysis of the ACQUIRE-ICD trial

BACKGROUND: Patients with an implantable cardioverter defibrillator (ICD) and comorbid depression or anxiety are at risk of adverse clinical outcomes. Studies examining the prevalence, trajectories and predictors of psychological outcomes in ICD patients have yielded mixed results and long-term follow-up data are needed. OBJECTIVES: To investigate the prevalence, trajectories and predictors of depression, anxiety and device acceptance from ICD implantation to 24 months follow-up. METHODS: Secondary analysis from the Danish, national, ACQUIRE-ICD trial enrolling 478 first-time ICD patients with data collection at ICD implantation and 6-, 12-, and 24-months follow-up. Measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Questionnaire-7), and device acceptance (Florida Patient Acceptance Survey) were completed at each time point. Linear mixed effect regression models were used to analyse trajectories and predictors over time. RESULTS: All 478 participants (mean age 59.6 ± 11.6 years; 83.1 % male) completed the baseline assessment and 348 (72.8 %) provided 24-months follow-up data. The observed prevalence of depression decreased from 13.2 % at implantation to 7.2 % after two years, and anxiety decreased from 9.0 % at baseline to 4.3 %. Device acceptance levels increased from ICD implantation (mean score: 74.2, 95 % CI [72.8-75.6]) to 6-months follow-up (mean score: 78.3, 95 % CI [76.7-79.8]) and stabilised thereafter. Age under 60 years and symptomatic heart failure were predictors of increased depression, anxiety and lower device acceptance. CONCLUSIONS: Although most patients adjust well following ICD implantation, younger patients and patients with symptomatic heart failure are at risk of poor psychological adjustment and could need additional support.