Anxiety disorders in patients with implantable cardioverter Defibrillators: frequency, course, predictors, and patients' requests for treatment

OBJECTIVES: To determine (1) the frequency and course of anxiety disorders in patients with implantable cardioverter defibrillators (ICDs), (2) the predictors of anxiety, (3) the treatment situation and patients' requests for therapy.

METHODS: Quantitative and qualitative methods in a prospective design. At baseline, 327 ICD outpatients completed validated self-report questionnaires (participation rate = 77%). Five months later, a predefined subsample of patients (n = 108, participation rate = 81%) consisting of all patients with (n = 58) and a randomly selected subsample of patients without (n = 50) elevated symptoms of anxiety at baseline, was reassessed using a structured diagnostic interview, the baseline questionnaires, and open-ended questions.

RESULTS: At baseline, 19.2% of patients suffered from at least some form of clinically relevant anxiety with an overall remission rate of 56.5% at follow-up. Predictive for anxiety at follow-up were higher levels of stress (odds ratio [OR], 1.52, P < 0.001), depression (OR, 1.26, P < 0.001), somatic symptom severity (OR, 1.25, P < 0.001), more perceived ICD-related constraints (OR, 2.4, P = 0.007), lower quality of life (physical health: OR, 0.91, P = 0.004; mental health: OR, 0.87, P = 0.001), and a higher New York Heart Association class (OR, 7.99, P = 0.002) at baseline. Only 35.3% of patients received an evidenced-based treatment for their anxiety disorder. A supervised ICD patient group was the most preferred treatment (51.1%).

CONCLUSIONS: Most patients seemed to adapt well to ICD therapy. Patients suffering from additional psychological strains and reporting more negative ICD-related attitudes were at risk for developing an anxiety disorder. Special tailored interventions, such as a supervised ICD patient group, could reduce the gap between treatment needs and the treatment situation.