Examining the effectiveness of psychosocial interventions for patients with a cardiac implantable electronic device: A systematic review and meta-analysis

Abstract

Background

Despite the well-established physiologic and survival benefits of cardiac implantable electronic devices, evidence highlights the psychosocial distress experienced by patients.

Objective

This systematic review examined the effectiveness of psychosocial interventions for improving psychosocial outcomes of patients with a cardiac implantable electronic device.

Methods

Eight databases (CINAHL, Cochrane Library, Embase, Emcare, PsycINFO, PubMed, Scopus, and Web of Science) were searched. Two reviewers screened all records. Methodologic quality was assessed with the QualSyst checklist. Intervention effects and attrition were evaluated by random effects meta-analyses, supported by a narrative synthesis of studies not included in the meta-analysis.

Results

Of the 9631 records screened, 34 articles representing 26 independent studies (3370 participants; 2952 with an implantable cardioverter-defibrillator, 418 with a pacemaker) were included. The attrition rate was 12.1% (95% confidence interval, 0.08–0.18), lower in education-based interventions (8.6%) than in psychotherapy-based ones (23.5%). Psychosocial interventions significantly reduced anxiety for patients with an implantable cardioverter-defibrillator compared with controls, with a small to medium effect after intervention (Hedges g = −0.30; 95% confidence interval, −0.51 to −0.09); moderator analysis indicated psychotherapy based on cognitive-behavioral principles and face-to-face interventions to be more effective. No effects were found for cardiac-specific anxiety, depression, or quality of life in the 12 studies available in the meta-analysis. The narrative synthesis supported these findings. Only 4 studies considered patients with a pacemaker.

Conclusion

Psychosocial interventions appear promising for improving the psychosocial outcomes of these patients. Further robust trials are needed to determine the effectiveness of these interventions, the patients who benefit most, and the differences in outcomes.