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Managing Psychosocial Distress in ICD Recipients

Managing Psychosocial Distress in ICD Recipients

Implantable cardioverter defibrillators (ICDs) have been shown to prevent life-threatening ventricular arrhythmias, but recipients can sometimes have dramatic experiences resulting from care. Each month, about 10,000 Americans have ICDs implanted to restore normal heart rhythm and prevent sudden cardiac death. “Many people who experience cardiac arrhythmias are surprised to learn of their potentially life-threatening condition,” explains Sandra B. Dunbar, RN, DSN, FAAN, FAHA. “Patients and their family are often forced into critical medical decision making and required to confront and cope with their condition. They need to be educated on their treatment options and adjust to the fact that they need an ICD.” Studies have shown that ICDs can significantly improve survival and quality of life (QOL), but the underlying arrhythmia and its treatment may be accompanied by adverse psychological responses. “These responses may be underappreciated in some cases and warrant greater attention by healthcare providers,” says Dunbar. “Focusing on ways to optimize psychological outcomes for those who are considering or receiving an ICD is paramount.” Psychological outcomes are an important component of QOL and reflect an aspect of the costs and benefits beyond simply living longer.” “Focusing on ways to optimize psychological outcomes for those who are considering or receiving an ICD is paramount.” In an issue of Circulation, Dunbar and colleagues at the American Heart Association (AHA) had a scientific statement published that provides an evidence-based comprehensive review of psychosocial considerations and QOL for people who receive ICDs. The statement also describes the concerns and educational needs of ICD patients and their families and outlines evidence supporting interventions for improving educational and psychological outcomes for these patients....

Conference Highlights: American Heart Association’s 2010 Scientific Sessions

The American Heart Association held its 2010 Scientific Sessions from November 13 to 17 in Chicago. The features below highlight some of the news emerging from the meeting. » Benefits Observed With Experimental Cholesterol Drug » A New Approach for Difficult Hypertension Cases » PTSD Linked to Death, Atherosclerosis » Smoking Rates Decline, But Cessation Efforts Still Warranted » Scanning Matters When Managing Diabetics With Heart Disease » Combination Therapy Effective in Heart Failure Benefits Observed With Experimental Cholesterol Drug The Particulars:  Elevated LDL and low HDL cholesterol levels are risk factors for cardiovascular disease (CVD). Statins have been shown to reduce LDL and lessen CVD risk. Despite statin therapy, many patients still have a high risk of CVD. Anacetrapib is an experimental cholesteryl ester transfer protein (CETP) inhibitor. It is intended to block the ability of the CETP enzyme to transfer cholesterol particles from HDL to LDL cholesterol. Data Breakdown: The DEFINE study (Determining the Efficacy and Tolerability of CETP Inhibition with Anacetrapib) was a randomized, double-blind trial of 1,623 patients who took either 100 mg anacetrapib or a placebo for 18 months. Patients were already being treated with a statin and/or other lipid-lowering medicine. Anacetrapib reduced LDL by 40%—from 81 mg/dL to 49 mg/dL. It also more than doubled the level of HDL cholesterol—from 40 mg/dL to 101 mg/dL—without raising blood pressure. Take Home Pearls: Anacetrapib appears to more than double the level of HDL cholesterol and reduce LDL cholesterol without the blood pressure increase that has been linked to other CETP inhibitors. The full efficacy and safety of anacetrapib must be evaluated in a larger, phase...

The American Psychiatric Association 2010 Annual Meeting

The American Psychiatric Association held its 2010 annual meeting from May 22 to 26 in New Orleans. The features below highlight some of the news emerging from the meeting. » A Strategy to Improve PTSD Outcomes » Assessing Body Image in Anorexia Nervosa » New Insights on Opioid Dependence » Spotting College Depression With E-Mail » Does Bipolar Disorder Increase Hypertension Risks? A Strategy to Improve PTSD Outcomes The Particulars: Randomized controlled trials have shown that sertraline, an SSRI, and prolonged exposure (PE) are effective treatments for PTSD, but these treatment strategies are very different from each other. With PE, patients are encouraged to directly approach their trauma memories and trauma-related fears. With SSRI use, a level of engagement with trauma-related stimuli is not required. Data Breakdown: In a doubly randomized preference trial, researchers compared SSRI use and PE use and assessed efficacy for chronic PTSD and how patient preference for one strategy over the other may influence the treatment effect. Overall, both PE and SSRI interventions demonstrated good efficacy. Patients who had no choice in their treatment had more diminished effects. Response rates were higher among patients who had a choice (80%) as compared with a 55% rate for patients who were not allowed to choose their treatment. Patients who did not receive their preferred treatment tended to have more severe PTSD, as well as depression and anxiety. Take Home Pearls: Outcomes for patients with PTSD appear to improve when patient preference is taken into account as treatments are prescribed. Treatment with SSRIs and treatment via PE were both effective, but outcomes were optimized among patients who received...
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