Guidance issued on educational, psychological interventions for ICD patients

The American Heart Association released a scientific statement last week on educational and psychological interventions for patients with implantable cardioverter defibrillators (ICDs).

An expert panel analyzed existing scientific evidence to examine psychological and quality-of-life outcomes after ICD receipt. The group also looked at data supporting interventions to improve ICD patients' educational and psychological needs, provided clinical recommendations for improving outcomes, and identified areas for future research.

The statement, which was published online Sept. 24 by Circulation, was endorsed by the Heart Rhythm Society and the American Association of Critical-Care Nurses.

The clinical practice recommendations covered four categories: preimplantation; postimplantation, early recovery and adjustment; ICD events; and end of life. They included the following:

• Emphasize the protective value of the ICD against sudden cardiac arrest but no effect on the underlying cardiac condition separate from biventricular pacing or other functions of the device, if present.
• Review the expected impact of the ICD on usual activities, including driving, travel, sexual and physical activity, and length of time for restrictions, if any.
• Provide instructions on wound care, medications, and pain and symptom management, and address concerns before hospital discharge.
• Provide a clear and succinct shock plan for what the patient and family are expected to do in the event of a shock.
• Promote problem solving, access to information, and ways to seek social support as problem-focused coping strategies. Consider structured support groups that focus on providing information and positive coping skills.
• Discuss the meaning of shocks with patients when they occur.
• Hold face-to-face discussions when possible with the patient and his or her family regarding the specifics of any advisory or recall.
• At end of life, review patient and family understanding of their disease, goals of care, and desired outcomes, as well as the relationship of the ICD to those stated goals. Discuss the potential to deactivate the shocking component of the ICD.

The panel experts recommended “that psychological and [quality-of-life] assessments be integrated into the designs of all mortality and morbidity focused clinical trials of new devices and ICD populations and that family members be included to the degree possible.”

The full text of the statement is available free of charge online.