Abstract 10801: Quality of Life and Psychological Distress Do Not Differ between Primary vs. Secondary Prevention at ICD Implant

Abstract

Background and purpose: Clinicians have suggested that those who get an implantable cardioverter defibrillator (ICD) for primary prevention vs. secondary prevention experience significantly different quality of life and psychological distress at the time of implant. The purpose of this study was to examine the effect of ICD indication (primary vs. secondary) on self-reported quality of life and psychological distress in those who received an ICD for the first time.

Methods: Patients who had an initial ICD implant [N=139, 78 (56%) primary indication, 61(44%) secondary indication, mean age 64.1+11 vs. 61.7+9.6 years, 74% vs. 80% male, 92% Caucasian, Charlson Score 2.4+1.3 vs. 1.8+1.7] entered a behavioral clinical trial testing a self-efficacy intervention post-ICD. Questionnaires were completed at ICD implant related to quality of life (Short Form-36 PCS and MCS), depression (Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9), and anxiety (State-Trait Anxiety Inventory). Analysis of variance was to determine if baseline study outcomes at implant were significantly different by ICD indication.

Results: Quality of life and psychological distress outcomes did not differ significantly by primary vs. secondary indication [mean + SD] in physical health (SF-36 PCS 42.6+7.6 vs. 40.9+6.1, p=0.94), mental health (SF-36 MCS 40.4+10.9 vs. 40.2+10.8, p=0.16), depression (HADS 9.3+6.9 vs. 8.6+5.9, p=0.52 or PHQ-9 4.5+4.7 vs. 5.5+4.9, p=0.24), or anxiety (STAI 31.5+10.8 vs. 31.3+11.1, p=0.92). For HADS-Anxiety, 14% in primary and 13% in secondary had possible anxiety. For HADS-Depression, 7% in primary and 8% in secondary had possible depression. There were significantly higher Charlson Co-morbidity scores in the primary prevention group, p=0.04.

Conclusions: Although there is a general clinical impression that those who receive an ICD for primary prevention vs. secondary prevention reasons have lower psychological distress and quality of life, the data do not substantiate this. Overall there were low levels of anxiety and depression at the time of ICD implant in both groups. Interventions aimed at assisting individuals with adjustment post-ICD could benefit either primary or secondary groups.