DIFFERENCES IN DEVICE ACCEPTANCE IN INDIVIDUALS WITH PACEMAKERS AND ICDS

Background: Heart disease is the leading cause of death in the United States (Benjamin et al., 2019) and triggers a host of concerns about virtually all aspects of a patient’s life including physical and psychological health. Treatment for heart conditions often utilizes implantable technology, such as ICDs and pacemakers, that reduce mortality (Al-Khatib et al., 2017; Simon & Janz 1982). Research on this technology and its effect on QoL is mixed, with some findings indicting positive effects of ICDs on QoL, while others have shown an increase of psychological disorders and decreased QoL (Magyar-Russell et al., 2011). Device specific QoL-related concerns include acceptance of the technology into the patient’s life (Burns, Serber, Keim, & Sears, 2005) and fear, worry, or avoidance related to ICD shocks (Ford et al., 2012). Health care providers typically obtain information from the device during in-clinic visits to better understand the course of the disease and guide treatment decisions. More recently, continued technological advances allow caregivers to monitor a patient’s device remotely (Braunschweig, Anker, Proff, & Varma, 2019). This new method of patient care reduces health care costs, reduces the number of required clinic visits and has comparable survival rates as compared to in clinic visits (Parthiban et al., 2015). Remote monitoring may be particularly valuable in single-payor health systems such as Canada. Remote monitoring has been shown to be comparable to usual care for ICD patients, but patient reported outcomes such as QOL, are understudied (Versteeg at al., 2014). Purpose: The current study seeks to examine cardiac patients with an implantable device, ICDs or pacemakers, who have received remote monitoring and compare differences between these groups and change over time on patient reported outcomes such as patient acceptance, health security, and shock anxiety. There were three hypotheses for the study 1) Individuals with ICDs will have lower device acceptance and health security than individuals with pacemakers. 2) Both groups (ICDs and Pacemakers) will have lower levels of device acceptance and health security at baseline as compared to 12-month follow-up. 3) ICD patients will have higher shock anxiety at baseline as compared to 12-month follow-up. Methods: Data was collected on 176 participants who were part of the Remote Patient Management for Cardiac Implantable Electronic Devices (RPM-CIED- Pilot). Three analyses were conducted including a principal components analysis on the novel construct of Health security, a 2x2 mixed model ANOVA and a dependent samples t-test. Results: Health Security was found to be comprised of 2 factors: Positive and Negative Outlook. Health Security total score significantly decreased over time for both pacemaker and ICD patients. Device acceptance did not differ over time or by device type. There was no change in shock anxiety over time. Conclusion: Device specific QoL remained stable during the one-year study period and did not differ significantly based on device type. Patient reported health security declined and may warrant attention in future clinical and research considerations to examine its potential utility and its relationship to QOL.

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