[Psychocardiological practice guidelines for ICD implantation and long-term care]

Abstract

In the literature there are only very few reports on systematic education or information for patients after implantation. Research in this field has only just begun so that there are no sufficiently evaluated models which could serve as the foundations for recommendations. Approximately 80% of affected patients, relatives and partners show a good cognitive acceptance and are capable of coping with the situation. However, in the first 12 months following ICD implantation some 20% of patients are in a state of anxiety and depression. These patients must be recognized and if necessary treated and given support. For this reason it is important in the consultation and routine appointments to give patients the chance to express their views on this if necessary. Only then can cardiologists recognize whether a patient is under substantial mental stress. It is recommended that immediately after the implantation and before being discharged from hospital, a screening procedure for anxiety and depression should be carried out using, e.g. the Hospital Anxiety and Depression Scale (HADS) and to distribute a questionnaire on desired information and unanswered questions. This would not only give a lead in for a targeted consultation during the follow-up appointment in the first year but also allow the opportunity to offer such patients an education course in order to specifically approach the problem being experienced. Patients who have experienced more than 5 shocks in 12 months or more than 3 shocks in 1 episode should attend a psychocardiological consultation in order to check whether there are post-traumatic disorders. It is imperative that these be treated because they do not in general resolve spontaneously.