E-health to manage distress in patients with an implantable cardioverter-defibrillator: Primary results of the WEBCARE trial

Mirela Habibovic, J. Denollet, Pim Cuijpers, Viola R. M. Spek, K.C. van den Broek, Lisanne Warmerdam, Pepijn H. van der Voort, Jean-Paul Herrman, Leon Bouwels, Suzanne S. D. Valk, Marco Alings, Dominic A. M. J. Theuns, Susanne S. Pedersen

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27 Citations (Scopus)


The Web-based distress management program for patients with an implantable cardioverter-defibrillator (ICD; WEBCARE) was developed to mitigate distress and enhance health-related quality of life in ICD patients. This study investigated the treatment effectiveness at 3-month follow-up for generic and disease-specific outcome measures.
Consecutive patients implanted with a first-time ICD from six hospitals in the Netherlands were randomized to either the “WEBCARE” or the “usual care” group. Patients in the WEBCARE group received a 12-week fixed, six-lesson behavioral treatment based on the problem-solving principles of cognitive behavioral therapy.
Two hundred eighty-nine patients (85% response rate) were randomized. The prevalence of anxiety and depression ranged between 11% and 30% and 13% and 21%, respectively. No significant intervention effects were observed for anxiety (β = 0.35; p = .32), depression (β = −0.01; p = .98) or health-related quality of life (Mental Component Scale: β = 0.19; p = .86; Physical Component Scale: β = 0.58; p = .60) at 3 months, with effect sizes (Cohen d) being small (range, 0.06-0.13). There were also no significant group differences as measured with the disease-specific measures device acceptance (β = −0.37; p = .82), shock anxiety (β = 0.21; p = .70), and ICD-related concerns (β = −0.08; p = .90). No differences between treatment completers and noncompleters were observed on any of the measures.
In this Web-based intervention trial, no significant intervention effects on anxiety, depression, health-related quality of life, device acceptance, shock anxiety, or ICD-related concerns were observed. A more patient tailored approach targeting the needs of different subsets of ICD patients may be warranted.
Original languageEnglish
Pages (from-to)593-602
JournalPsychosomatic Medicine
Issue number8
Publication statusPublished - Oct 2014


  • implantable cardioverter-defibrillator
  • anxiety
  • depression
  • quality of life
  • Web-based behavioral treatment


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