Impact of Sudden Cardiac Arrest and Implantable Cardiac Defibrillator Shocks on Mental Health: Review and Management Guidance

Estelle Torbey¹, Carlos Mena-Hurtado², Jamie L Jackson³, Zainab Samaan⁴, Samuel F Sears⁵, Susanne S Pedersen⁶, Anuradha Lala⁷, Rosy Thachil⁷, Jill Steiner⁸, Onyedika J Ilonze⁹, Davis Jones¹⁰, Karol Watson¹¹, Andrea Price¹², Christopher Knoepke¹³, Jim W Cheung¹⁴, Kim Smolderen²; ACC Cardiopsychology Work Group

Affiliations

¹ Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. Electronic address: estelle.torbey@brownhealth.org.
² Department of Internal Medicine, Yale University, New Haven, Connecticut, USA.
³ Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA.
⁴ Department of Psychiatry, Queen's University, Kingston, Ontario, USA.
⁵ Department of Psychology, East Carolina University, Greenville, North Carolina, USA.
⁶ Departments of Psychology and Cardiovascular Sciences, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
⁷ Department of Internal Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA.
⁸ Department of Internal Medicine, University of Washington Medical Center, Seattle Washington, USA.
⁹ Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA.
¹⁰ Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
¹¹ Department of Cardiology, UCLA School of Medicine, Los Angeles, California, USA.
¹² Indiana University Health System, Indianapolis, Indiana, USA.
¹³ Department of Psychology, University of Colorado, Denver, Colorado, USA.
¹⁴ Department of Internal Medicine, Weill Cornell, New York, New York, USA.

PMID: 40373523
PMCID: PMC12144438
DOI: 10.1016/j.jacadv.2025.101797

Impact of Sudden Cardiac Arrest and Implantable Cardiac Defibrillator Shocks on Mental Health: Review and Management Guidance

Estelle Torbey et al. JACC Adv. 2025 Jun.

. 2025 Jun;4(6 Pt 1):101797.

doi: 10.1016/j.jacadv.2025.101797. Epub 2025 May 14.

Authors

Affiliations

¹ Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA. Electronic address: estelle.torbey@brownhealth.org.
² Department of Internal Medicine, Yale University, New Haven, Connecticut, USA.
³ Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA.
⁴ Department of Psychiatry, Queen's University, Kingston, Ontario, USA.
⁵ Department of Psychology, East Carolina University, Greenville, North Carolina, USA.
⁶ Departments of Psychology and Cardiovascular Sciences, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark.
⁷ Department of Internal Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA.
⁸ Department of Internal Medicine, University of Washington Medical Center, Seattle Washington, USA.
⁹ Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, Indiana, USA.
¹⁰ Department of Internal Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
¹¹ Department of Cardiology, UCLA School of Medicine, Los Angeles, California, USA.
¹² Indiana University Health System, Indianapolis, Indiana, USA.
¹³ Department of Psychology, University of Colorado, Denver, Colorado, USA.
¹⁴ Department of Internal Medicine, Weill Cornell, New York, New York, USA.

PMID: 40373523
PMCID: PMC12144438
DOI: 10.1016/j.jacadv.2025.101797

Abstract

Survivors of sudden cardiac arrest (SCA) and those who experience shocks from an implantable cardiac defibrillator (ICD-S) are at risk of developing unrecognized and untreated mental health (MH) symptoms. MH sequelae can include anxiety, depression, or post-traumatic stress symptoms which hinder one's ability to return to usual life and activity, impeding follow-up, health care seeking, and adherence to care plans. Addressing MH as part of a whole person care in such scenarios could lead to improved wellness and recovery. This review examines the MH sequelae of SCA and ICD-S, explores potential therapies for managing these issues, proposes strategies to improve MH post-SCA or defibrillator shock, and identifies areas for future research.

Keywords: ICD shock; SCA; mental health.

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Conflict of interest statement

Funding support and author disclosures Dr Sears has served as a research consultant on quality of life to Medtronic, Abbott, Thryve, Solid Biosciences, Philips, and Milestone Pharmaceuticals; has received a research grant from CVRx that is paid to East Carolina University; and has received speaker honorarium from Medtronic and Zoll Medical in the last year. Dr Mena-Hurtado has served as a consultant for Terumo and has received research grants from Merck and Shockwave. Dr Smolderen has served as a consultant for Terumo, Happify, and Novo Nordisk; and has received research grants from Merck, J&J, Shockwave, and Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Central Illustration**
Recovery-Oriented Mental Health Care for Survivors of Sudden Cardiac Arrest and Post-ICD-S Figure illustrating steps toward recovery-oriented mental health care for SCA and ICD shock survivors, enhancing physical health and value-based care by addressing mental health gaps. Abbreviations as in Figure 2.

**Figure 1**
Anxiety Components Post-ICD-S Diagram depicting the main behavioral symptoms in the setting of anxiety post-ICD-S.

**Figure 2**
Inpatient and Outpatient Mental Health Care in Survivors of Sudden Cardiac Arrest and Post-ICD-S: A Practical Guidance Figure illustrating inpatient and outpatient mental health care for SCA and ICD shock survivors, featuring cardiopsychology-led assessment prior to discharge and on follow-up peer and spiritual support, behavioral therapy, and rehabilitation. ICD = implantable cardiac defibrillator; SCA = sudden cardiac arrest.

See this image and copyright information in PMC

References

1. Ghezzi E.S., Sharman R.L.S., Selvanayagam J.B., et al. Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients. Europace. 2023;25:791–806. - PMC - PubMed
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Impact of Sudden Cardiac Arrest and Implantable Cardiac Defibrillator Shocks on Mental Health: Review and Management Guidance

Affiliations

Impact of Sudden Cardiac Arrest and Implantable Cardiac Defibrillator Shocks on Mental Health: Review and Management Guidance

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources