Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/138743
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Type: Journal article
Title: Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients.
Author: Ghezzi, E.S.
Sharman, R.L.S.
Selvanayagam, J.B.
Psaltis, P.J.
Sanders, P.
Astley, J.M.
Knayfati, S.
Batra, V.
Keage, H.A.D.
Citation: Europace, 2023; 25(6)
Publisher: Oxford University Press (OUP)
Issue Date: 2023
ISSN: 1099-5129
1532-2092
Statement of
Responsibility: 
Erica S. Ghezzi, Rhianna L.S. Sharman, Joseph B. Selvanayagam, Peter J. Psaltis, Prashanthan Sanders, Jack M. Astley, Sara Knayfati, Vrinda Batra, and Hannah A.D. Keage
Abstract: Aims: Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time. Methods: Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria. Results: Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26–26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90–18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90–17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67–9.19); depression OR = 1.87 (95%CI 1.34–2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges’ g = 0.39 (95%CI 0.15–0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges’ g = 0.13 (95%CI 0.03–0.23)] and anxiety symptoms after 6 months [Hedges’ g = 0.07 (95%CI 0–0.14)]. Conclusion: Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.
Keywords: ICD; Anxiety; Depression; PTSD; Shocks; Cardiac
Rights: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
DOI: 10.1093/europace/euad130
Grant ID: http://purl.org/au-research/grants/nhmrc/1161506
Published version: http://dx.doi.org/10.1093/europace/euad130
Appears in Collections:Medicine publications

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