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

Background: Research points to reciprocal influences that patients and partners may have on one another’s recovery in cardiac illness, yet interventions to enhance recovery after an implantable cardioverter defibrillator (ICD) are usually directed only toward the patient. Purpose: To compare 2 social cognitive (SC) intervention conditions (patient only or P-only, and patient + partner or P+P) from the Patient + Partner RCT. Patient physical symptoms and depression were compared with partner caregiver burden over 12 months post initial ICD. Methods: The study included 301 patient-partner dyads (151=P-only; 150=P+P) who participated in 1 of 2 nurse-led SC interventions delivered by telephone in the first 3 months after the patient received an ICD. Patient symptoms were measured with the PCA, depression with the PHQ-9, and partner caregiver burden with the OCBS, at baseline, 3, 6, and 12 months. Parallel process growth modeling and mixed effects models were used to compare intervention outcomes. Results: Patients were on average 64±12 years old, male (74%), white (91%), and most received an ICD for primary prevention (60%). Partners were on average 62±12 years, female (74%), and white (88%). In the first 3 months, decline in patient depression was significantly associated with decline in partner caregiver burden in P+P (β=0.93; p<0.001), but not in P-only (β= -0.14; p=0.54). Decline in physical symptoms was more strongly associated with decline in partner caregiver burden in P+P (β=0.93, p<0.001) than P-only (β=0.58, p=0.02). At 3 months, there were no significant differences in patient physical (p=0.59) and depressive symptoms (p=0.27) for P+P vs P-only. Partner caregiver burden was significantly lower in P+P vs P-only (p=0.01). At 12 months, patient physical and depressive symptoms and partner caregiver burden were significantly lower in P+P vs P-only (p=0.043, p=0.008, p=0.001, respectively). Conclusion: A SC intervention that included intimate partners (P+P) showed greater reductions in patient physical and depressive symptoms and partner caregiver burden and reflected greater reciprocal influence than the P-only intervention. Dyadic SC interventions can provide added support for patients after an ICD and may improve partner caregiver burden.

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Worldwide differences in primary prevention implantable cardioverter defibrillator utilization and outcomes in hypertrophic cardiomyopathy

European Heart Journal ◽

10.1093/eurheartj/ehab598 ◽

2021 ◽

Author(s):

Victor Nauffal ◽

Peter Marstrand ◽

Larry Han ◽

Victoria N Parikh ◽

Adam S Helms ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Primary Prevention ◽

Implantable Cardioverter Defibrillator ◽

Cox Proportional Hazards ◽

Icd Implantation ◽

Icd Therapy ◽

Cardioverter Defibrillator ◽

Significant Difference ◽

Implantation Rates ◽

The Impact

Abstract Aims Risk stratification algorithms for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) and regional differences in clinical practice have evolved over time. We sought to compare primary prevention implantable cardioverter defibrillator (ICD) implantation rates and associated clinical outcomes in US vs. non-US tertiary HCM centres within the international Sarcomeric Human Cardiomyopathy Registry. Methods and results We included patients with HCM enrolled from eight US sites (n = 2650) and five non-US (n = 2660) sites and used multivariable Cox-proportional hazards models to compare outcomes between sites. Primary prevention ICD implantation rates in US sites were two-fold higher than non-US sites (hazard ratio (HR) 2.27 [1.89–2.74]), including in individuals deemed at high 5-year SCD risk (≥6%) based on the HCM risk-SCD score (HR 3.27 [1.76–6.05]). US ICD recipients also had fewer traditional SCD risk factors. Among ICD recipients, rates of appropriate ICD therapy were significantly lower in US vs. non-US sites (HR 0.52 [0.28–0.97]). No significant difference was identified in the incidence of SCD/resuscitated cardiac arrest among non-recipients of ICDs in US vs. non-US sites (HR 1.21 [0.74–1.97]). Conclusion Primary prevention ICDs are implanted more frequently in patients with HCM in US vs. non-US sites across the spectrum of SCD risk. There was a lower rate of appropriate ICD therapy in US sites, consistent with a lower-risk population, and no significant difference in SCD in US vs. non-US patients who did not receive an ICD. Further studies are needed to understand what drives malignant arrhythmias, optimize ICD allocation, and examine the impact of different ICD utilization strategies on long-term outcomes in HCM.

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