UF researchers: psychological factors contribute to heart monitor recipients’ quality of life

July 19, 2001

GAINESVILLE, Fla. — Picture this: A battery-operated device is about to be implanted in your chest to monitor your heartbeat. At any moment, it could sense something amiss and zap you with a powerful 750-volt shock to restore a healthy rhythm and save your life.

That’s a scenario greeted with high levels of anxiety by some but optimism by those who welcome the device as a major hedge against death. Now University of Florida researchers have found that attitudes before receiving an implantable cardioverter defibrillator, or ICD, greatly influence ongoing mental and physical health.

In a study of 88 recipients of the device — the same kind Vice President Dick Cheney recently received — the scientists discovered that on average, those classified as optimists reported themselves to be in better overall health than their pessimistic counterparts.

The research was done in conjunction with a continuing series of investigations on recipients’ psychological health led by Samuel Sears, an associate professor in the UF College of Health Professions’ department of clinical and health psychology. Tara Lynn Saia Lewis, a UF doctoral candidate who collaborates with Sears, was the principal investigator of the most recent study.

“Our findings establish the need for psychological care by showing it is as valuable to the recipient’s quality of life as physical care,” said Saia Lewis, who defended her dissertation research earlier this month. “The data in this study show that four psychological factors — optimism, social support, history of depression and anxiety — are important to an implant recipient’s ability to enjoy their life, but optimism and anxiety appear to be the most influential. They affect not just mental health but general health, physical limitations and disease perception as well.”

An estimated 50,000 people with abnormal heart rhythms undergo implantation of cardioverter defibrillators in the United States every year in an effort to prevent sudden cardiac death, according to Medtronic, manufacturer of the device.

“If a patient survives a cardiac arrest, one out of three will die from sudden cardiac death within two years if this device is not implanted,” said Dr. Jamie B. Conti, a cardiologist and an associate professor of medicine in UF’s College of Medicine. “Our mission is to keep people alive; this is one of the best tools we have.”

The new UF study is one of the first to focus on psychological characteristics as predictors of a person’s quality of life after implantation of the heart-assisting device. In this study of first-time implant recipients, the psychological characteristics of research participants were assessed before they received the life-monitoring device, then again eight and 14 months afterward.

The participants, who had a median age of 65 and who consisted primarily of white men, were recruited from Shands at UF medical center in Gainesville, Fla., and Vanderbilt University Medical Center in Nashville. All had been diagnosed with an irregular heartbeat.

Before receiving the implant, about 19 percent reported significant levels of anxiety while 23 percent reported a history of depression. For those with these factors in their background, the experience of the device “firing,” or sending the heart a rhythm-taming shock, can substantially affect the recipient’s quality of life.

Nearly half of the recipients had experienced a firing by the time of their eight-month follow-up visit.

“These add up to a significant percentage of implant recipients who are at risk for developing psychological problems based on their history or based on their experience of firings,” Sears said.

Recipients who reported high levels of optimism showed significantly better functioning in general health, mental health, physical limitations and perception of illness than recipients with low levels of optimism. The findings showed that high-level optimists scored at least 20 percent higher on all these measures than low-level optimists at both follow-up assessments.

Saia Lewis and Sears say that based on these findings, psychological care along with medical care may positively influence the ability of patients to function normally in day-to-day activities.

“General health is defined as the interaction among the biological, psychological and social health of a person, and yet most of our medical treatments are intended to only address biological factors,” Sears said. “We are defining health more broadly than we are treating it. Psychological intervention is a part of the comprehensive care that ultimately leads to better physical health.”

Sandra Dunbar, a professor of nursing and medicine at Emory University who also researches anxiety and depression in ICD recipients, said the UF study echoes some of her own findings.

“In our previous work, we found that optimism, anxiety, perceptions of illness as well as coping behaviors predicted psychological distress after implantation,” Dunbar said. “Saia Lewis’ research is significant in that it highlights potential ways we can help persons with these devices adapt to their new health issues.”

The UF researchers say they do not want fear and anxiety to prevent people from getting the life-saving device. Instead, they hope their research will help health-care professionals identify those patients who need psychological care to help adjust to life with an ICD.

“We can’t control or predict when an ICD will fire,” Saia Lewis said, “but how you deal with the firing is controllable.”