E-Health to Manage Distress in Patients With an Implantable Cardioverter-Defibrillator: Primary Results of the WEBCARE Trial

Objective The Web-based distress management program for patients with an implantable cardioverter-defibrillator (ICD; WEBCARE) was developed to mitigate distress and enhance health-related quality of life in ICD patients. This study investigated the treatment effectiveness at 3-month follow-up for generic and disease-specific outcome measures. Methods Consecutive patients implanted with a first-time ICD from six hospitals in the Netherlands were randomized to either the WEBCARE or the usual care group. Patients in the WEBCARE group received a 12-week fixed, six-lesson behavioral treatment based on the problem-solving principles of cognitive behavioral therapy. Results Two hundred eighty-nine patients (85% response rate) were randomized. The prevalence of anxiety and depression ranged between 11% and 30% and 13% and 21%, respectively. No significant intervention effects were observed for anxiety ( = 0.35; p = .32), depression ( = -0.01; p = .98) or health-related quality of life (Mental Component Scale: = 0.19; p = .86; Physical Component Scale: = 0.58; p = .60) at 3 months, with effect sizes (Cohen d) being small (range, 0.06-0.13). There were also no significant group differences as measured with the disease-specific measures device acceptance ( = -0.37; p = .82), shock anxiety ( = 0.21; p = .70), and ICD-related concerns ( = -0.08; p = .90). No differences between treatment completers and noncompleters were observed on any of the measures. Conclusions In this Web-based intervention trial, no significant intervention effects on anxiety, depression, health-related quality of life, device acceptance, shock anxiety, or ICD-related concerns were observed. A more patient tailored approach targeting the needs of different subsets of ICD patients may be warranted.Trial registration: clinicaltrials.gov. Identifier: NCT00895700.