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 physiological 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. Methodological quality was assessed using the QualSyst checklist. Intervention effects and attrition were evaluated using 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%CI 0.08 to 0.18), lower in education-based interventions (8.6%) than psychotherapy-based ones (23.5%). Psychosocial interventions significantly reduced anxiety for patients with an implantable cardioverter-defibrillator compared to controls, with a small to medium effect following intervention (Hedges' g = -0.30, 95%CI -0.51 to -0.09); moderator analysis indicated that psychotherapy based on cognitive-behavioral principles and face-to-face interventions were 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 four 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 differences in outcomes.