• Posted June 19, 2023

Stress, Anxiety Plague Many Who Get Implanted Heart Devices

New research finds that many of those who have received an implanted cardiac device to extend their life also have mood disorders, including anxiety, depression and PTSD.

“Implantable cardioverter defibrillators [ICDs] are effective at extending patients' lives, but we need to make sure that's a good quality life,” said study author Hannah Keage, a professor of psychology at the University of South Australia in Adelaide. “Rates of mood disorders in people with an ICD are much higher than in the general population, suggesting that psychological assessment and therapy should be integrated into the routine care of these patients."

In the study published June 13 in EP Europace, a journal of the European Society of Cardiology, the researchers found that nearly one-third of patients had anxiety in the first year after their device was implanted. Depression affected 1 in 5. More than 1 in 10 had PTSD.

Anxiety and depression are associated with higher likelihood of premature death in these patients who had a device implanted because of risk of a life-threatening heart rhythm.

The researchers analyzed 109 studies involving nearly 40,000 ICD patients.

They examined prevalence of mental health issues from the time the ICD was implanted to one year of follow-up, finding that rates of anxiety were 23%, depression was at 15% and PTSD at 12%.

In the general population, the rates of these conditions are 13%, 7% and 1%-2%, respectively.

Rates of anxiety and depression were higher at the initial stages after implantation, reduced by six to 12 months and lower still after 12 months.

Patients who had a shock to return their heart rhythm to normal after their ICD detected a dangerously fast heart rhythm were four times more likely to have anxiety and nearly twice as likely to have depression as those who did not experience shocks, the study showed.

“Rates of all three mood disorders were notably high compared to what we would expect in people without an ICD, particularly for PTSD,” Keage said in a journal news release. "Around 30% of ICD patients will experience a shock in the first two years and for some patients this is a constant fear that affects decisions about driving, swimming and so on."

She noted that the decline in mood disorders over time could be due to patients getting psychological help or adapting to their new life.

“We can't discount the possibility that healthier people tend to stay in studies longer while those in ill health are more likely to drop out. The sex differences were expected, as rates of anxiety are generally higher in women compared to men,” Keage said.

Researchers also examined mood disorders in participants who did not have ICDs implanted. An estimated 23% of ICD patients' partners had anxiety following the implantation and 14% had depression. Patients with heart disease but who did not receive an ICD also had similar rates of mood disorders as those with an ICD.

“Partners are clearly worried about their loved one undergoing surgery and then potentially having a shock,” Keage said.

Getting the partners of ICD patients involved in therapy is more effective in improving patients' physical and psychological health than for them to attend therapy alone, Keage said.

“The findings in cardiac patients make a lot of sense, as heart health and mood disorders go hand in hand. Psychological ill health can also lead to heart problems through chronic stress and unhealthy lifestyles. Psychologists have had little involvement in the care of cardiac patients but this needs to change,” Keage said. “I would encourage patients and partners to seek help if their mood is low or they are overly worried, as there are evidence-based therapies for anxiety, depression and PTSD.”

More information

The American Heart Association has more on implantable cardiac devices.

SOURCE: European Society of Cardiology, news release, June 16, 2023