Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients
Open accessAbstract
AIMS: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time. METHODS: Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria. RESULTS: Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges' g = 0.39 (95%CI 0.15-0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges' g = 0.13 (95%CI 0.03-0.23)] and anxiety symptoms after 6 months [Hedges' g = 0.07 (95%CI 0-0.14)]. CONCLUSION: Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.
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ICD patients are at risk for mental health issues after implantation, with a recent meta-analysis estimating prevalence rates of clinically relevant anxiety and depression at 23% and 15%, respectively.
“Implantable cardioverter defibrillator patients are also at risk for mental health issues after implantation with a recent meta-analysis estimating prevalence rates of clinically relevant anxiety and depression at 23% and 15%, respectively.5”
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- Authors
- Ghezzi, E. S., Sharman, R. L. S., Selvanayagam, J. B., Psaltis, P. J., Sanders, P., Astley, J. M., Knayfati, S., Batra, V., & Keage, H. A. D.
- Affiliations
- University of South Australia (AU)
- Flinders University (AU)
- Royal Adelaide Hospital (AU)
- Corresponding author
- Keage, Hannah A D
- ORCID
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-06
- Volume
- 25
- Issue
- 6
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- PMC
- PMC10264222
- OpenAlex
- W4380577615
- Cited by
- 73
- References
- 41
- Citations by year
- 2026: 28 · 2025: 31 · 2024: 6 · 2023: 8
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- EP Europace (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by-nc)
- UniSA Research Outputs Repository (University of South Australia) (submittedVersion, other-oa)
- Funders
- National Heart Foundation (FLF102056)
- National Health and Medical Research Council (CDF1161506)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- implantable cardioverter-defibrillator, mood disorders, anxiety, depression, post-traumatic stress disorder, sudden cardiac death, ICD shocks, prevalence, sex differences, psychological burden, primary and secondary prevention
- MeSH terms
- Anxiety, Female, Humans, Male, Odds Ratio, Databases, Factual, Death, Sudden, Cardiac, Defibrillators, Implantable
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