Implantable cardioverter defibrillator insertion was associated with clinically relevant anxiety in 22.58% (95% CI 18.26-26.91%) and depression in 15.42% of patients across all timepoints.
Meta-Analysis (n=39,954)
Mood disorders including anxiety, depression, and PTSD are highly prevalent in patients with ICDs, particularly those who experience shocks, highlighting the need for routine psychological assessment and care.
AIMS: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time. METHODS: Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria. RESULTS: Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59). Higher symptoms of anxiety were seen in females than males post-insertion Hedges' g = 0.39 (95%CI 0.15-0.62). Depression symptoms decreased in the first 5 months post-insertion Hedges' g = 0.13 (95%CI 0.03-0.23) and anxiety symptoms after 6 months Hedges' g = 0.07 (95%CI 0-0.14). CONCLUSION: Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.
Ghezzi et al. (Thu,) conducted a meta-analysis in Implantable cardioverter defibrillator (ICD) patients (n=39,954). Implantable cardioverter defibrillators (ICDs) vs. Control groups or within ICD patients by indication, sex, and shock status was evaluated on Prevalence of clinically relevant anxiety following ICD insertion (95% CI 18.26-26.91). Implantable cardioverter defibrillator insertion was associated with clinically relevant anxiety in 22.58% (95% CI 18.26-26.91%) and depression in 15.42% of patients across all timepoints.