Abstract 2420: A Pilot Program of Computerized Cognitive-Behavioral Treatment Improves Psychosocial Outcomes in Implantable Cardioverter Defibrillator Recipients
Introduction: Patients with an implantable cardioverter defibrillator (ICD) are at risk for post-implant anxiety and depression. Computerized treatments for depression and anxiety are well-supported throughout the literature, and are desirable due to accessibility, anonymity, and cost-effectiveness. However, there currently exists no computerized psychosocial treatment for ICD populations. We hypothesized that a pilot program (Patient Assisted Computerized Education for Recipients of ICDs [PACER]) of a computerized cognitive-behavioral treatment for ICD patients would improve ICD-related knowledge and psychological outcomes versus usual care. Outcomes were also compared to those from a related study that utilized the same intervention but in an in-person format.
Methods: Patients (N = 30) with an ICD were randomized to a computerized treatment (PACER) or usual care. Measures included ICD-related knowledge, trait anxiety, shock anxiety, device acceptance, and quality of life (QOL). Patients were assessed at baseline and at 1 month follow-up.
Results: The sample was 59% male and 90% Caucasian. New device recipients (< 3 months) were significantly more likely to demonstrate an increase in knowledge (p = 0.01) over time, and have worse scores of shock anxiety (p = 0.02) and device acceptance (p = 0.04) than previous recipients. Knowledge over time did not differ by group. Among treatment patients, increased knowledge accounted for a significantly greater amount of variance in device acceptance (R2-Change = 0.30, p = 0.02) then demographic (age, education) and medical (ejection fraction, time since implant) variables. There was no relationship between knowledge and device acceptance among control patients. Compared to the in-person treatment, PACER resulted in comparable improvements in mental QOL and device acceptance, but less improvement in physical QOL over time (p = 0.01). User survey results suggest overwhelming support of PACER and recommendation of the program to others.
Conclusions: In conclusion, the potential utility of PACER to enhance device acceptance lends support for further testing among larger samples. Newer patients in particular may be a suitable population for a psycho-educational intervention such as PACER.