1. Correlates of Patient Acceptance of the Cardioverter-Defibrillator: Cross-validation of the Florida Patient Acceptance Survey in Danish Patients Correlates of Patient Acceptance of the Cardioverter-Defibrillator: Cross-validation of the Florida Patient Acceptance Survey in Danish Patients The use of cardiac device therapy has entered a new era, as reflected in the increasing number of patients who receive cardioverter-defibrillator therapy, cardiac resynchronization therapy (CRT), or combined therapy The medical benefits of these therapies are well established, but a subset of patients has difficulty with emotional adjustment following device implantation, manifesting itself in increased anxiety, depression, avoidance behaviors, and poor quality of life Device acceptance may comprise one of the keys to identifying patients at high risk for adverse psychological outcome and poor quality of life in clinical practice We examined (1) the validity and reliability of the Florida Patient Acceptance Survey (FPAS) and (2) the correlates of patient acceptance of the cardioverter-defibrillator in a large sample of Danish patients The use of cardiac device therapy has entered a new era, as reflected in the increasing number of patients who receive cardioverter-defibrillator therapy, cardiac resynchronization therapy (CRT), or combined therapy The medical benefits of these therapies are well established, but a subset of patients has difficulty with emotional adjustment following device implantation, manifesting itself in increased anxiety, depression, avoidance behaviors, and poor quality of life Device acceptance may comprise one of the keys to identifying patients at high risk for adverse psychological outcome and poor quality of life in clinical practice We examined (1) the validity and reliability of the Florida Patient Acceptance Survey (FPAS) and (2) the correlates of patient acceptance of the cardioverter-defibrillator in a large sample of Danish patients BACKGROUNDBACKGROUND Dr. Susanne S. Pedersen. E-mail: s.s.pedersen@uvt.nls.s.pedersen@uvt.nl CONTACT INFORMATION METHODSMETHODS Susanne S Pedersen (PhD) 1, Helle Spinder (PhD) 2, Jens B Johansen (MD, PhD) 3, Peter Mortensen (MD) 3, Samuel F Sears (PhD) 4 1 Co RPS, Department of Medical Psychology, Tilburg University, The Netherlands; 2 Department of Psychology, Aarhus University, Denmark; 3 Department of Cardiology, Aarhus University Hospital, Denmark; 4 Department of Psychology, East Carolina University, USA Susanne S Pedersen (PhD) 1, Helle Spinder (PhD) 2, Jens B Johansen (MD, PhD) 3, Peter Mortensen (MD) 3, Samuel F Sears (PhD) 4 1 Co RPS, Department of Medical Psychology, Tilburg University, The Netherlands; 2 Department of Psychology, Aarhus University, Denmark; 3 Department of Cardiology, Aarhus University Hospital, Denmark; 4 Department of Psychology, East Carolina University, USA The study population comprised consecutive patients (n=566; 82.2% males; mean age=61.9 ±14.3) implanted with an ICD at Aarhus University Hospital, Denmark, since 1989 and still alive on November 1st 2006 Patients completed the FPAS (assessing Device-related distress, Positive appraisal, Return to function, and Body image concerns), the ICD Concerns (ICDC) questionnaire, the Type D Scale (DS14) and the Hospital Anxiety and Depression Scale (HADS) Demographic and clinical variables were obtained from purpose-designed questions and from the Danish ICD Registry The study population comprised consecutive patients (n=566; 82.2% males; mean age=61.9 ±14.3) implanted with an ICD at Aarhus University Hospital, Denmark, since 1989 and still alive on November 1st 2006 Patients completed the FPAS (assessing Device-related distress, Positive appraisal, Return to function, and Body image concerns), the ICD Concerns (ICDC) questionnaire, the Type D Scale (DS14) and the Hospital Anxiety and Depression Scale (HADS) Demographic and clinical variables were obtained from purpose-designed questions and from the Danish ICD Registry METHODSMETHODS RESULTSRESULTS FPAS was shown to be a valid and reliable measure of device acceptance in a large sample of Danish ICD patients Psychological factors rather than clinical factors were the primary correlates of poor device acceptance, whereas having a partner was associated with better acceptance These preliminary findings suggest that screening for psychological factors may aid clinicians in identifying patients at risk of poor device acceptance FPAS was shown to be a valid and reliable measure of device acceptance in a large sample of Danish ICD patients Psychological factors rather than clinical factors were the primary correlates of poor device acceptance, whereas having a partner was associated with better acceptance These preliminary findings suggest that screening for psychological factors may aid clinicians in identifying patients at risk of poor device acceptance CONCLUSIONSCONCLUSIONS This research was supported by the Netherlands Organization for Scientific Research (NWO) with a VENI grant (451-05-001) to Dr. SS Pedersen ACKNOWLEDGEMENTSACKNOWLEDGEMENTS Patient acceptance stratified by Type D personalityCorrelates of poor device acceptance (adjusted analysis) __________________________________________________________________________ OR[95% CI] p __________________________________________________________________________ Demographics Female gender0.62[0.32-1.20].16 Age1.03[1.01-1.05].003 Partner/living together0.53[0.31-0.91].021 Clinical Non-ischemic etiology1.17[0.69-1.98].56 Symptomatic heart failure*3.59[2.12-6.08]<.001 Cardiac resynchronization therapy0.91[0.51-1.62].74 Co morbidity§1.13[0.65-1.97].67 Device-related complications1.46[0.61-3.49].40 Shocks0.87[0.51-1.47].59 Years since implantation0.93[0.86-1.02].12 Psychological Type D personality3.51[1.95-6.30]<.001 Anxiety2.33[1.24-4.38].009 Depressive symptoms2.24[1.00-5.00].049 ICD concerns4.16[2.55-6.80]<.001 __________________________________________________________________________ * Based on the 75th percentile on the Minnesota Living with Heart Failure Questionnaire § E.g. cancer The four-factor structure of FPAS was largely confirmed, accounting for 64.3% of the variance: I: Device-related distress = 33.0% II: Positive appraisal = 13.8% III: Return to function = 11.1% IV: Body image concerns = 6.4% Overlap between FPAS and other questionnaires: - with ICDC: 5-27% - with DS14-NA: 5-24% - with DS14-SI: 3-12% - with HADS-A: 7-28% - with HADS-D: 8-37% Internal consistency, measured by Cronbach’s alpha ranged from.73-.85 for the total scale and the subscales