The psychosocial impact of the implantable cardioverter defibrillator: A meta-analytic review

Objective. The implantable cardioverter defibrillator (ICD) has become the treatment of choice for ventricular arrhythmia (VA; abnormal heart rhythms) and the prevention of sudden cardiac death (SCD). Recent clinical trials have shown the ICD to be superior to anti-arrhythmic medication in reducing mortality; however, research has suggested that ICD recipients experience poor psychosocial adjustment following implantation of the device. This aim of this study was to identify the key psychological characteristics associated with ICD implantation and to establish whether poor psychosocial outcome can be attributed directly to the device and its therapy. Method. Studies which reported valid and reliable measures of psychological functioning in ICD patients and appropriate comparison groups were considered for inclusion in a meta-analytic review. A systematic search of electronic databases and reference lists identified 20 studies which fulfilled the inclusion criteria. Results. There were no significant differences in psychosocial outcome between ICD patients and drug-maintained VA patients or between pre- and post-implant ICD patients. However, ICD patients reported significantly worse psychological functioning and physical functioning than other cardiac controls. Conclusion. These findings suggest that poor psychosocial outcome in ICD patients may occur as a result of variables associated with the underlying VA condition, rather than as a direct response to implantation of the device and its therapy. This holds important implications for the development and implementation of psychological interventions for patients experiencing VA, in preference to ICD-specific programmes.