Abstract 17442: One-Year Defibrillator Adjustment is Influenced by Early Device Complications and Poor Mental Health in Primary Prevention Patients

Abstract

Background Sudden death prophylaxis using a standard implantable defibrillator (ICD) improves survival in patients who develop lethal ventricular arrhythmias. Patients identified to be at risk for sustained ventricular arrhythmias can be offered an ICD as prophylaxis. We previously reported that poor pre-implant mental health was associated with lower ICD acceptance in the first 3 months after implant. Over the longer-term, the role of these variables, as well as device complications, on patient device acceptance is less clear.

Methods/results We are reporting on our12-month follow-up of findings from a prospective study of 70 ICD recipients in Ontario receiving standard single or dual chamber ICDs. Exclusions were those receiving devices with cardiovascular resynchronization or for secondary prevention. At 12-months, 62 participants completed follow-up (89% male; mean age 64.9 ± 9.1). The primary outcome was device acceptance using the Florida Patient Acceptance Scale (FPAS). Higher FPAS scores are associated with positive adjustment to the ICD. Multivariate regression was used to determine the relationship between one-year device acceptance (FPAS) and baseline HRQL (mental and physical components), early device and health complications, and NYHA class. Poor mental-HRQL scores and ICD complications within the first 3 months after implant contributed most to lower FPAS scores. The variables accounted for 27% of the variance in FPAS scores (R² = .27; F6, 55; p < .005). By 12-months, 4 patients died; one patient received multiple appropriate shocks from the device. Additional secondary analysis revealed that 33% of patients reported elevated depressive symptoms based on Centre for Epidemiological Studies (CES-D) established cutoff scores ≥ 16; of these, only half were being adequately treated with anti-depressants.

Conclusions ICD complications within the first 3 months of implant, and poor mental health at the time of implant contributed to lower one-year patient-reported device adjustment. Pre-implant counseling regarding potential device complications is warranted. Ensuring adequate treatment for depressive symptoms should be considered to improve device adjustment.