Undertreatment of Anxiety and Depression in Patients With an Implantable Cardioverter-Defibrillator: Impact on Health Status

Objective: Twenty-five to 33% of patients with an implantable cardioverter-defibrillator (ICD) experience anxiety and depression, but it is not known whether their symptoms are adequately treated. We investigated (a) whether patients with clinically relevant symptoms of distress received appropriate treatment, and (b) whether patients not treated for their emotional distress reported poorer health status using a prospective study design. Methods: A consecutive cohort of 448 first-time patients with an ICD (21% women; mean age, 58 +/- 12 years) completed the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey 36 (SF-36). Information on psychological treatment was obtained via purpose-designed questions. Results: At baseline, 35.5% of patients were emotionally distressed, of which 70.2% received no psychological treatment. At 12 months postimplantation, 24.3% of all patients had clinically significant levels of distress, of which 58.3% received no treatment. Patients experiencing distress but without treatment reported a significantly poorer health status than patients without distress and treatment (all ps < 0.001) and compared to patients without emotional distress who did receive treatment (ps varying between p = .027 and p < .001 for six subscales). Health status was better on four subscales than for patients with emotional distress and treatment (ps varying between p = .034 and p < .001). Conclusions: There was a serious gap between the need for psychological treatment and the actual delivery of treatment, with consequences to patients' health status. Detection and adequate treatment of distress in ICD patients remains an important target in this patient group in order to safeguard health status postimplantation.