Correlates of Patient Acceptance of the Cardioverter Defibrillator: Cross‐Validation of the Florida Patient Acceptance Survey in Danish Patients

Abstract

Device acceptance may comprise one of the keys to identifying implantable cardioverter defibrillator (ICD) patients at risk for adverse health outcomes in clinical practice. We examined (1) the validity and reliability of the Florida Patient Acceptance Survey (FPAS) and (2) correlates of device acceptance in a large sample of Danish patients. A cohort of consecutive patients (N = 566; 82.2% males; mean age = 61.9 +/- 14.3) implanted with an ICD since 1989 and still alive on November 1, 2006, completed a set of psychological questionnaires. The four-factor structure and the validity of the FPAS were confirmed, with the four factors accounting for 64.3% of the variance. The reliability, measured by Cronbach's alpha, was acceptable for the total scale and all subscales, ranging from 0.73 to 0.85. Correlates of poor device acceptance included older age (OR: 1.03; 95% CI: 1.01-1.05), symptomatic heart failure (OR: 3.59; 95% CI: 2.12-6.08), Type D personality (OR: 3.51; 95% CI: 1.95-6.30), anxiety (OR: 2.33; 95% CI: 1.24-4.38), depressive symptoms (OR: 2.24; 95% CI: 1.00-5.00), and ICD concerns (OR: 4.16; 95% CI: 2.55-6.80); having a partner was associated with better acceptance (OR: 0.53; 95% CI: 0.31-0.91), adjusting for demographic and clinical factors including shocks. Shocks were not associated with outcome (P = 0.59). The 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.