Abstract
Background: Despite its established effectiveness, living with an implantable cardioverter defibrillator (ICD) is associated with ongoing physical and psychosocial distress. Little is known about which factors impact the patients' adjustment to living with the device and whether there are racial or gender differences related to these factors. The purpose of this study was to investigate factors (demographic, clinical, psychosocial, and religiosity) related to patients' ICD acceptance and to examine racial and gender differences in ICD acceptance.
Methods: A total of 101 ICD patients (mean age, 65 +/- 12.8 years, 34% female, 42% African American [AA]) seen in a cardiology clinic between January and August 2010 completed the Florida Patient Acceptance Survey (FPAS), Florida Shock Anxiety Scale, ENRICHD Social Support Instrument, Hospital Anxiety and Depression Scale, Hoge Religiosity Scale, and a demographic sheet during their clinic visit.
Results: All multiple-item scales demonstrated good internal consistency reliability, with Cronbach [alpha] values ranging from .77 to .89. Overall patient acceptance of the ICD was high, with an average FPAS acceptance score of 80.9 on the 0-to-100 point scale. The FPAS subscale scores indicated that the group was very positive about the benefits of having the device (mean, 90.3) and had few body image concerns (mean, 10.6), low device-related distress (mean, 15.6), and moderate return to function scores (mean, 63.0). White ICD participants were more accepting of their device than AA ICD patients were, scoring statistically significantly higher than AA patients on total patient acceptance and return to function and significantly lower than AA patients on device-related distress and shock anxiety. Controlling for ethnicity ([beta] = .10, P = .15), age ([beta] = .01, P = .90), and number of comorbidities ([beta] = .19, P = .003) in a hierarchical multiple regression, shock anxiety ([beta] = .31, P < .001), knowledge of the device ([beta] = .23, P = .001), social support ([beta] = .13, P = .08), Hospital Anxiety and Depression Scale anxiety ([beta] = .06, P = .51) and depression ([beta] = .25, P = .01), and importance of religion ([beta] = .17, P = .01) explained 46.8% of the variance in FPAS scores.
Conclusions: Although overall patient acceptance was high, AAs in the study had statistically significant lower mean total Florida Patient Acceptance Scale scores and Return to Function scores than whites did and higher Device-Related Distress scores. The strongest predictors of patient acceptance for the total group were shock anxiety, depressive symptoms, and device knowledge. African Americans had significantly lower device knowledge scores and higher shock anxiety scores than whites did. These findings suggest that ICD patients, especially AA ICD patients, may require education and psychosocial measures to enhance acceptance of their device. This study supports a holistic and culturally sensitive approach to focused clinical and psychological assessment and interventions for those living with this life-saving technology.