Abstract 12477: Acceptance and Psychological Impact of Implanted Devices in Adults with Congenital Heart Disease
The psychosocial impact of the growing number of ICDs amongst adults with congenital heart disease (ACHD) has not been established.
Aim: To compare device acceptance, quality of life, anxiety & depression in ACHD patients with ICDs (Gp A), or permanent pacing (Gp B) and in acquired heart disease patients with ICDs (Gp C).
Methods: Patients were recruited at least three months after device implantation to complete the Florida Patient Acceptance Survey (FPAS), SF-36 and Hospital Anxiety & Depression Scale questionnaires.
Results: In total 127 patients were studied: Gp A, n=56, 43±14yrs, 59% male; Gp B, n=39, 44±16yrs, 41% male; Gp C n=32, age 53±15yrs, 75% male. The complexity of underlying anatomy was similar in Gp A and Gp B (36% vs 31%) as was NYHA I (50% vs 62%). Group A showed lower overall device acceptance (71±19 vs 79±16, p=0.04) and worse Return to Life on FPAS (64±26 vs 76±25, p=0.03) than Group B. Mental & Physical Health, Anxiety & Depression were similar, however. Gp A and Gp C showed similar percentage of ICD use for primary prevention (56% vs 52%) and CRT-D (30% vs 35%). Mental & Physical Health, Device acceptance, Anxiety & Depression were similar, despite a tendency towards more shocks in Gp A (33% vs 21%, p=0.2), higher multiple ( 26% vs 7%, p=0.04) and inappropriate shocks (26% vs 3%, p=0.02). Within Gp A, patients with the lowest tertile of FPAS (poorest device acceptance) showed higher anxiety (9.2±4 vs 3.9±3, p<0.001), depression (7.4±5 vs 2.2±4, p<0.001) and worse mental health (38±11 vs 54±10, p<0.001) compared to highest tertile, despite similar Physical Health (40±11 vs. 45±13, p=0.2), years since ICD implantation (3.8±3 vs 3.4±2, p=NS), total procedures (3.1 vs 3.3, p=NS), ICD shocks (17%vs 39%, p=NS) and device related procedures (2.2 vs 1.6, p=NS). Those in the lowest tertile were younger at device implantation (32±14 vs 42±13 yrs, p=0.05) and at last operation (21±13 vs. 32±16yrs, p=0.03).
Conclusion: ACHD patients with an ICD cope equally well as non ACHD patients despite higher rates of ICD shocks. Device acceptance is lower, however, compared to ACHD patients with permanent pacing. Younger patients demonstrated poorer device acceptance. Appropriate counseling and ongoing support seem necessary for ACHD patients considered for device implantation.
- Adult congenital heart disease
- Implantable cardioconvert defibrillator
- Quality of life
- Sudden cardiac death
- © 2012 by American Heart Association, Inc.