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 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 vs. secondary ICD indication. METHOD: A longitudinal secondary analysis of data from a RCT testing the P+P intervention examined patient health outcomes over 12 months, stratified by the indication for the ICD: primary prevention without CRT (1(o) No CRT-n = 100), primary prevention with CRT (1(o) CRT-n = 78), secondary prevention after cardiac arrest (2 degrees 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 PCS and MCS), 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 > 0.05). Patients in the 2 degrees Cardiac Arrest group showed greater improvement from baseline to 3 months in physical and mental health outcomes. The 2 degrees Cardiac Arrest group had better physical (F = 11.48, p = 0.004) and mental health (F = 4.34, p = 0.038) and less severe physical (z = 2.24, p = 0.013) and depressive symptoms (z = 2.71, p = 0.003) 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. This article is protected by copyright. All rights reserved.
