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Helping defibrillator patients cope

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Experiencing the shock that restores normal heart rhythm can be distressing for patients who have an implanted defibrillator (ICD) and as a result, they often experience anxiety, depression and posttraumatic stress disorder. A comprehensive review statement published online in the journal Circulation, says that improved patient education and ongoing psychological support can help these people cope.

"A shock from an ICD can be lifesaving, but it can also affect a person's quality of life and psychological state," says Sandra B. Dunbar, RN, DSN, Charles Howard Candler Professor in the Nell Hodgson Woodruff School of Nursing at Emory University, and chair of the group co-writing the statement.

"Some people feel reassured that it's working, while others find the actual physical sensations frightening and overwhelming."

In the statement, the group advises that education and support are essential and should include both the patient and the family. "Providers need to convey gender-specific, age-appropriate information that helps families deal with stressful situations that may develop with an ICD. They also need to provide an ongoing assessment of ICD patients' psychological needs," Dunbar explains.

Other recommendations by the group include helping patients and their families develop a clear plan so they will know what to do in the event of a shock. They also advise that clinicians emphasize to patients and loved ones that the ICD protects against sudden cardiac death, but does not improve the underlying heart condition unless certain types of pacing are included.

Dunbar says it's important to look at this issue now because 10,000 people have an ICD implanted each month. "They range from older people with severe heart failure to healthy children who have a gene that increases the risk of sudden cardiac arrest."

Although pediatric ICD recipients make up less than 1 percent of the ICD population, she adds, complications are more frequent, and these patients will live with the defibrillators for a much longer period of time.

Several areas for further research were identified by the statement group, including the ability to predict which patients are likely to experience psychological distress and how to alleviate it; identifying the level of sports participation and physical activity that is appropriate for children and teens with ICDs; and choosing when and how to discuss potential ICD deactivation near the end of life.

The statement was developed on behalf of the American Heart Association Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Council on Cardiovascular Disease in the Young, and was endorsed by the Heart Rhythm Society and the American Association of Critical Care Nurses

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