A randomised, clinical trial of a psycho-educational nursing intervention in patients receiving an implantable cardioverter defibrillator

Implantable cardioverter defibrillators prevent Sudden Cardiac Death (SCD) in at-risk populations. Coming to terms with having an ICD, risk of SCD and a long-term condition may be impeded by negative psycho-social effects. Nurse-led psychoeducative support interventions have been trialled with mixed outcomes. As neither usual care or skills and knowledge of nurses delivering interventions were detailed, applicability within UK healthcare was unclear. This clinical trial tested a psychoeducational support intervention with usual care using arrhythmia clinical nurse specialists. Method Sixty-three people awaiting first ICD implant were randomised to usual care (n=33) or intervention (n=30) in one English cardiac centre between April 2009 and July 2011 . 'Treat-and-return' cases could not reliably access arrhythmia nurses preimplant and were therefore excluded. Participants completed validated self-report questionnaires (State Trait Anxiety Inventory-STAI; Beck Depression Inventory-Fast Screen- BDI-FS; COPE inventory; World Health Organisation Quality of Life tool- WHOQoL) pre-implant (T1), 6-weeks (T2) and 6-months (T3) post implant. The intervention was delivered 7-10 days post hospital discharge and following 6-week device check . 110 , Results Forty-nine participants (81 .6% male) completed pre-implant questionnaires (usual care n=25, intervention n=24) and 32/49 repeated these at T2 and T3. No significant differences were found between intervention and usual care groups postintervention. Both groups demonstrated increasing trait anxiety and altered coping over time (intervention group revealed increasing planning [p=0.037] and decreasing mental disengagement [p=0.008] but usual care group demonstrated increased denial [p=0.019]). At T3, denial significantly correlated with heightened state (r=0.573, p=0.010) and trait (r=0.577, p=0.010) anxiety for usual care, likewise BDIFS past failure (r=0.502, p=0.029 STAI-State; r=0.634, p=0.004 STAI-Trait) and selfcriticism (r=0.484, p=0.036 STAI-S; r=0.567, p=0.011 STAI-T). Conclusions and implications for practice Whilst small sample size limits generalisability, correlations between coping, anxiety and depression outcomes warrant further investigation with larger samples. Usual care for people having ICOs revealed inequitable access to psycho-educational support. Nurses are well placed to address these inequalities if appropriately resourced.