A comparative study of uncertainty, optimism and anxiety in patients receiving their first implantable defibrillator for primary or secondary prevention of sudden cardiac death

Abstract 

Background

Increasingly, patients are receiving implantable cardioverter defibrillators (ICDs) for prevention of sudden cardiac death. ICDs are implanted for primary prevention (patients at risk for ventricular arrhythmia [PP]) and secondary prevention (patients who have had/survived a sustained ventricular arrhythmia or cardiac arrest [SP]). Few prospective studies have examined psychosocial factors associated with these patients.

Objectives

To determine if patients receiving their first ICD for PP versus SP differed in uncertainty, anxiety, and optimism, before, 1 week, and 1 month after implant.

Design

Prospective, descriptive, correlational pilot.

Participants and setting

Fifteen PP and 15 SP patients receiving their first ICD were enrolled. Mean ages (± SD) were 65.7±11.3 and 67.9±7.7 respectively.

Methods

Mishel's Uncertainty in Illness Scale (MUIS-C), State-Trait Anxiety Inventory (STAI) and the Life Orientation Test (LOT-R) were taken pre-implant, at the first post-implant visit, and at 1 month. Measures were compared using Student’ t-tests and ANOVA.

Results

Pre-implant, both groups had moderately high MUIS-C scores (mean±SD; PP=67.67±13.36; SP=70.27±6.80; t=0.67; t_df=28; p=0.507). LOT-R scores were 15.67±3.8 for PP and 16.47±3.6 for SP; t=0.59; t_df=28; p=0.557. Pre-implant state anxiety scores were (mean PP=37.40±10.0, SP=37.73±13.6; t=0.076; t_df=28; p=0.940). At 1-month PP patients had significantly lower uncertainty scores than the SP group (mean 62.33±4.17 versus 67.87±4.61; t=3.45; t_df=28; p=0.002).

A main effect for time, between pre-implant and 1-month, was found for uncertainty (F_2,56=3.26; p<0.05) and state anxiety (F_2,56=3.61, p<0.05), where both groups showed lower scores.

Conclusion

This study identified moderately high uncertainty in PP and SP patients prior to receiving their ICD. Though uncertainty was high, both groups reported an optimistic disposition and normal anxiety. At 1-month, SP patients had higher uncertainty scores than PP patients. This post-intervention uncertainty among patients who experienced an arrhythmic event warrants attention from nurses caring for ICD patients. Interventions to ameliorate uncertainty should be tailored to consider ICD indication.

Keywords: Defibrillators, Implantable, Uncertainty, Psychology, Anxiety, Nursing