Five studies (151 patients) of pre-post test design and 18 studies (726 patients) reporting on post-implantation assessment were included.
The statistical significance of results was not reported making interpretation of the results difficult. Prospective studies (pre-post test design): there appears to be no testing of pre-post test differences. The timing of the post- implant assessment (where stated) varied from 3 to 12 months in 3 studies with an average of 30 months in another study. Sources of anxiety reported by patients included fear of ICD discharges, physical discomfort related to device, sleep difficulties, social isolation, limited physical activity, and fear of death. Postimplantation assessment: the timing of assessment post implantation (where stated) ranged from 1 to 12 months, with other studies reporting averages ranging from 7.5 months to 4.5 years. Many different measures were used to assess outcome, including self designed questionnaires. Patients reported the following experiences: fear of discharges; decrease in exercise related to fear of discharges, concerns of sexual activity triggering ICD discharges; increased preoccupation with cardiac condition since implantation; trouble sleeping; concerns about death, mental changes, lifestyle changes, fears about driving a car; nervousness; increases in anxiety, depression, and anger with some patients reporting decreased levels of anxiety and depression following implantation; desire for psychosocial support and interest expressed in contacting other patients with ICD; overprotective family members; fear of device malfunction; sense of loss of control. Particular areas of concern in younger patients included device appearance, physical activity limitations, sexual relations, social interactions, and driving restrictions. Positive attitudes towards the ICD were reported.