Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy

Alessandro Paoletti Perini, Valentina Kutyifa, Peter Veazie, James P. Daubert, Claudio Schuger, Wojciech Zareba, Scott McNitt, Spencer Rosero, Christine Tompkins, Luigi Padeletti, Arthur J. Moss

Research output: Contribution to journalArticle

Abstract

Effects of implantable cardioverter/defibrillator (ICD) shocks and antitachycardia pacing (ATP) on anxiety and quality of life (QoL) in ICD patients are poorly understood. Methods We evaluated changes in QoL from baseline to 9-month follow-up using the EQ-5D questionnaire in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial—Reduce Inappropriate Therapy (MADIT-RIT) (n = 1,268). We assessed anxiety levels using the Florida Shock Anxiety Scale (1-10 score) in patients with appropriate or inappropriate shocks or ATP compared to those with no ICD therapy during the first 9 months postimplant. The analysis was stratified by number of ATP or shocks (0-1 vs ≥2) and adjusted for covariates. Results In MADIT-RIT, 15 patients (1%) had ≥2 appropriate shocks, 38 (3%) had ≥2 appropriate ATPs. Two or more inappropriate shocks were delivered in 16 patients (1%); ≥2 inappropriate ATPs, in 70. In multivariable analysis, patients with ≥2 appropriate shocks had higher levels of shock-related anxiety than those with ≤1 appropriate shock (P < .01). Furthermore, ≥2 inappropriate shocks produced more anxiety than ≤1 inappropriate shock (P = .005). Consistently, ≥2 appropriate ATPs resulted in more anxiety than ≤1 (P = .028), whereas the number of inappropriate ATPs showed no association with anxiety levels (P = .997). However, there was no association between QoL and appropriate or inappropriate ATP/shock (all P values >.05). Conclusions In MADIT-RIT, ≥2 appropriate or inappropriate ICD shocks and ≥2 appropriate ATPs are associated with more anxiety at 9-month follow-up despite no significant changes in the assessment of global QoL by the EQ-5D questionnaire. Innovative ICD programming reducing inappropriate therapies may help deal with patient concerns about the device.

Original languageEnglish
Pages (from-to)75-84
Number of pages10
JournalAmerican Heart Journal
Volume189
DOIs
Publication statusPublished - Jul 1 2017

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Perini, A. P., Kutyifa, V., Veazie, P., Daubert, J. P., Schuger, C., Zareba, W., McNitt, S., Rosero, S., Tompkins, C., Padeletti, L., & Moss, A. J. (2017). Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy. American Heart Journal, 189, 75-84. https://doi.org/10.1016/j.ahj.2017.03.009