Abstract 11461: A Prospective Study of Anxiety in ICD Patients With Randomized Controlled Pilot Trial of Cognitive Behavioral Therapy for Moderate to Severe Anxiety
Introduction: Implantable cardioverter defibrillator (ICD) shocks can cause anxiety but effective therapy to reduce this morbidity has not been identified. We assessed anxiety in ICD patients and whether cognitive behavior therapy (CBT) reduces moderate-high anxiety.
Hypothesis: Patients receiving a CBT intervention compared to patients receiving usual care would have higher reduction in anxiety levels at 3 months and 1 year follow-up.
Methods: In this prospective 2-part study, Part 1 was a cross-sectional and longitudinal observation of consecutive ICD patients, including collection of anxiety scores (Beck Anxiety Inventory [BAI], Generalized Anxiety Disorder scale [GAD7]). Part 2 was a randomized controlled trial of CBT (3 sessions in 3 months) vs. usual care (UC) in moderate to high anxiety patients (BAI≥ 19) from Part 1. Surveys were repeated at 3, 6 and 12 months.
Results: In Part 1 (N=704), mean BAI score was 7.2±7.8 and mean GAD7 was 3.2±4.2. By BAI 64.5% had minimal and 3.9% had severe anxiety. By GAD7 73.0% had a low probability of anxiety and 2.9% had high anxiety (Top Fig). Higher anxiety was associated with recent (p=0.017) and inappropriate (p=0.029) shocks, but not with appropriate shocks (p=0.13). In Part 2 (N=29), CBT and UC patients had similar anxiety at baseline. In the CBT group BAI scores decreased from 26.6 to 14.4 at one year, p=0.028, and GAD7 scores decreased from 10.45 to 6.14, p=0.041 (Bottom Fig); no change in anxiety was observed in the UC arm.
Conclusions: Severe anxiety was present in a small proportion of ICD patients, but higher anxiety was associated with recent and inappropriate shocks. CBT lowered moderate-high anxiety with lasting effects to 1 year.
Author Disclosures: M. Qintar: None. J. George: None. M. Panko: None. S. bea: None. K. Broer: None. J. St. John: None. S. Sears: None. S. Pederson: None. L. Pozuelo: None. M. Chung: None.
- © 2014 by American Heart Association, Inc.