Social cognitive intervention following an initial implantable cardioverter defibrillator: Better treatment response for secondary versus primary prevention

Abstract

Background: The patient + partner (P+P) is a patient/partner-focused social cognitive intervention with demonstrated efficacy to improve outcomes following an initial implantable cardioverter defibrillator (ICD). Little is known about how the patient response may differ by ICD implant indication. The aim of this study was to examine the response to intervention for patients with an initial ICD by reasons for primary versus secondary ICD indication.

Method: A longitudinal secondary analysis of data from a randomized clinical trial testing the P+P intervention examined patient health outcomes over 12 months, stratified by the indication for the ICD: primary prevention without cardiac resynchronization therapy (CRT) (1^o No CRT, n = 100), primary prevention with CRT (1^o CRT, n = 78), secondary prevention after cardiac arrest (2° Cardiac Arrest, n = 66), and secondary prevention for other arrhythmias (2^o Other, n = 57). Outcomes included physical and mental health status (Short-Form-36 Physical Component Summary and Mental Component Summary), physical symptoms (Patient Concerns Assessment), depression (Patient-Health-Questionniare-9), and anxiety (State-Trait Anxiety Inventory).

Results: Participants (n = 301) were on average 64 years old, primarily male (73.7%) and Caucasian (91%) with reduced ejection fraction (34%). There were no baseline differences between ICD groups for all outcomes (P > .05). Patients in the 2° Cardiac Arrest group showed greater improvement from baseline to 3 months in physical and mental health outcomes. The 2° Cardiac Arrest group had better physical (F = 11.48, P = .004) and mental health (F = 4.34, P = .038) and less severe physical (z = 2.24, P = 0.013) and depressive symptoms (z = 2.71, P = .003) at 12 months compared to the 1^o No CRT group.

Conclusion: The P+P intervention was more effective for promoting physical and psychological health outcomes for individuals receiving an ICD for 2^o prevention after cardiac arrest.

Keywords: anxiety; clinical trial; depression; health status; symptoms.

FIGURE 1

Trajectories of each outcome are plotted over 12 months by the reason for ICD implant; primary prevention without CRT (1° No CRT), primary prevention with CRT (1° CRT), secondary prevention after cardiac arrest (2° Cardiac Arrest), and secondary prevention for other arrhythmias (2° Other). In each panel, the estimated slope for the 2^◦ Cardiac Arrest group (largest amount of change) was compared to the other ICD groups. Fit statistics for latent growth curve models: all growth models displayed excellent fit statistics: χ² test of model fit > 0.10, RMSEA < 0.05, CFI > 0.99, TLI > 0.98, and SRMR ≤ 0.06