Keywords

cognitive-behavioral therapy, computerized, implantable cardioverter defibrillator, quality of life

Authors

1. Kuhl, Emily A. PhD
2. Sears, Samuel F. PhD
3. Vazquez, Lauren D. MS
4. Conti, Jamie B. MD

Abstract

Background and Research Objective: Patients with implantable cardioverter defibrillators (ICDs) are at risk for postimplant anxiety. Computerized treatments for anxiety are well supported and desirable because of accessibility, anonymity, and cost-effectiveness. However, there currently exists no computerized psychosocial treatment for ICD populations. Our objective was to evaluate whether a pilot program (patient-assisted computerized education for recipients of ICDs [PACER of ICDs]) of a computerized intervention for ICD patients would improve ICD-related knowledge and psychological outcomes versus usual care. Outcomes were also compared with those from a related study that used the same intervention but in an in-person format.

Subjects and Methods: Patients (N = 30) with an ICD were randomized to PACER or usual care. Mean time from implantation was 10.71 months (SD, 21.81 months). Outcomes included ICD-related knowledge, trait anxiety, defibrillation-related anxiety, patient acceptance of the ICD, and quality of life. Patients were assessed at baseline and at 1 month follow-up.

Results and Conclusions: Knowledge score over time did not differ by treatment group, although both groups improved their scores. Among treatment patients, increased knowledge accounted for a significant amount of variance in device acceptance (R² change = 0.30, P =.02), irrespective of age, education, ejection fraction, and time from implantation. There was no relationship between knowledge and device acceptance among control patients. Compared with previous recipients, new device recipients (< 3 months) were more likely to demonstrate an increase in knowledge (P =.01), greater defibrillation anxiety (P =.02), and worse patient acceptance (P =.04). Patient-assisted computerized education for recipients of ICDs resulted in comparable improvements in trait anxiety, quality of life, and device acceptance as the in-person treatment. The potential utility of PACER to enhance device acceptance lends support for further testing among larger samples.