Abstract
Implantable cardioverter defibrillators (ICD) are used for primary and secondary prevention of sudden cardiac death (SCD). Shocks delivered by ICDs, while life-saving, can affect patients’ quality of life. Psychoeducational and Cognitive behavioral therapy (CBT) have been shown to offer a novel approach to reducing ICD shocks and improving quality of life (QOL) in ICD recipients. This systematic review and meta-analysis of randomized controlled trials (RCT) evaluated the pooled effect of CBT and psycho-education on QOL measures and ICD shocks. Systematic searches of literature were conducted for RCTs on the effectiveness of psycho-education and CBT in management of patients with ICD across Medline, PubMed, EMBASE, CINAHL and Web of Science from 1967 to April 2019. All RCTs on patients >18 years of age with ICDs who underwent CBT or psychoeducational treatment post-ICD implantation were included in the study. The meta-analysis was conducted using R statistical software. The mean difference of QOL (Short-form 12 questionnaire (SF-12)), and anxiety measures (STAI questionnaire) were pooled and analyzed using random-effects model. The I2 statistic was used to assess the heterogeneity between studies. I2 with values of 0, 25, 50, and 75 represented none, low, moderate, and high heterogeneity respectively. Results: Overall, 21 studies met the inclusion criteria for systematic review, however only 14 met inclusion criteria for meta-analysis. The meta-analysis of SF-12 components showed significance only in the physical component score (PCS). The mean difference for PCS across all studies was 2.14 [95% CI(1.2-3), p < 0.001, i2 =0.00%, P=0.95], while the mean difference for Mental Component score (MCS) was 0.49 [95%CI(-1.97-2.95), P=0.6, i2=80.7%, P < 0.001] favoring the intervention group. Analysis of studies using STAI anxiety score did not show a significant change in STAI after CBT and psychoeducational therapy. The number of ICD shocks during 12-months follow-up decreased compared to the baseline across all studies by -0.2 [95% CI (-0.4-0), p=0.04, i2 =0.00%, P=0.8] favoring the intervention group (Figure1). Meta-regression analysis showed that the effect of treatment on the mean change in the number of ICD shocks during follow-up compared to the baseline did not vary significantly with the duration of follow-up (p=0.5). The Meta-analysis revealed that CBT and psychoeducation are associated with significant improvement in the Physical component of QOL measures and significant decrease in the number of ICD shocks during follow-up. However, there was no significant improvement in patients’ Mental component of QOL or anxiety scores post intervention.
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