Age, Sex, and Remote Monitoring Differences in Device Acceptance for Patients With Implanted Cardioverter Defibrillators in Canada

Abstract

Background Implantable cardioverter defibrillator (ICD) acceptance and shock anxiety are issues that clinicians should address to improve quality of life among device recipients. Previous findings have indicated that younger patients experience poorer device adjustment. The purpose of this study was to examine age and ICD-specific quality-of-life outcomes in a large sample of Canadian ICD patients. We tested the hypothesis that patient age is related to device acceptance and shock anxiety in an Alberta (Canada) ICD population. Methods The Florida Patient Acceptance Survey (FPAS) and Florida Shock Acceptance Survey (FSAS) were completed by ICD patients attending the Cardiac Implantable Electrical Device Clinics in Alberta. The population was dichotomized into those aged ≤ 65 years (younger) and those aged > 65 years (older). Sex, ICD shock history, and remote monitoring use were also examined. Results Surveys were completed by 126 younger (53 ± 11 years; 79% male) and 216 older (74 ± 6 years; 85% male) patients. Younger, compared with older, patients had greater device-related distress ( P < 0.001) and more body-image concerns ( P < 0.001), but no differences in return to function or positive appraisal. Younger patients reported lower total device acceptance ( P = 0.001) and greater total shock anxiety ( P < 0.001) compared with older patients. Conclusions ICD patients aged ≤ 65 years reported poorer device acceptance and greater shock anxiety than older patients. Younger patients may require targeted interventions addressing adjustment to the ICD, and impact of the ICD on body image. Moreover, education about the relatively low probability of shocks may alleviate shock anxiety in younger patients.

Device nurse intervention facilitates the patients’ adaptation to cardiac shock devices in the remote monitoring era

“…The health related QOL in patients with a shock device was previouslyreported. 5,8,23,39 However, we could not directly compare the QOL score of our results and the previous reports, because the purpose, patient background, and methods for evaluating the patients' QOL differed in each study. 23,39 Furthermore, the impact of the shock device on the QOL may differ between remotely and in-office follow-up patients.…”

“…The patient-reported QOL in remote monitoring is reported to be noninferior to that of an in-office follow-up. 5,7 However, some patients desire the feedback from remote monitoring 26,40 or wish to consult with medical professionals during the remote monitoring follow-up. 6,41 In this regard, the device nurse's support in our study might have been in accordance with the patients' needs, and the SF-36 mental component score improved through our support.…”

“…Although the majority of patients are satisfied with remote monitoring, some have felt barriers. 5 About 60% of patients preferred outpatient follow-up at a hospital or a combination of both hospital and remote monitoring. 26 In the REMOTE-CIED trial, 47 the patientreported health status and ICD acceptance did not differ between remote monitoring and in-clinic follow-up.…”

“…Cardiovascularimplantable electric devices (CIEDs) are widely indicated, and recently remote monitoring systems have become acornerstone of the management of CIEDs. [1][2][3][4][5] Remote monitoring provides physicians with tremendous data on the performance of CIEDs, and on the patient's activity and condition such as the arrhythmia burden, which can improve the patient's safety and care. 3 Further, the patients can save the time they would have spent visiting their clinics, and in general their satisfaction with remote monitoring seems to be high.…”

“…3 Further, the patients can save the time they would have spent visiting their clinics, and in general their satisfaction with remote monitoring seems to be high. [5][6][7] However, in exchange for the convenience obtained, the opportunity and amount of time for patient-medical staff communication have decreased, 8 which might attenuate the patient's acceptance and benefit of the remote monitoring.…”