title: Acceptance and psychological impact of implantable defibrillators amongst adults with congenital heart disease.
abstract: BACKGROUND
  The psychological impact of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (ACHD) has not been established.
  
  
  OBJECTIVE
  To compare device acceptance, quality of life, anxiety and depression between ACHD patients with ICDs (ICD-Congenital), with pacemakers (PPM-Congenital), with no devices (No Device-Congenital) and non-ACHD patients with ICDs (ICD-Non-Congenital).
  
  
  METHODS
  A total of 147 ACHD and 46 non-ACHD patients (age 45.0±14.7 years, 56.5% males) completed the Florida Patient Acceptance Survey (FPAS), the 36-item Short Form Health Survey (SF-36) and Hospital Anxiety & Depression Scale (HADS).
  
  
  RESULTS
  ICD-Congenital patients (n=59) showed lower device acceptance compared to PPM-Congenital patients (n=41), p=0.04, and reported worse quality of life (p=0.001) and higher prevalence of depression (p=0.009) when compared to No Device-Congenital (n=47) patients. ICD-Congenital and ICD-Non-Congenital patients (n=46) showed similar mental and physical health, device acceptance, anxiety and depression. Within ICD-Congenital, patients with poorest device acceptance (FPAS <67, "Non-Acceptors") showed significantly lower mental health scores (p=0.008), and higher levels of anxiety (p=0.02) and depression (p=0.01) compared to "Acceptors" (FPAS ≥67). "Non-Acceptors" were younger at survey (p=0.006), younger at ICD implantation (p=0.01) and were less likely to have received appropriate shocks (p=0.03).
  
  
  CONCLUSIONS
  Younger age and lack of appropriate ICD shocks are risk factors for poor ICD acceptance. Device acceptance is lower in adults with congenital heart disease who receive an ICD than those who receive pacemakers. Appropriate screening for anxiety and depression may be warranted for ACHD patients considered for ICD implantation or already living with ICDs.
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom.
authors.forename: Radwa
authors.initials: R
authors.lastname: Bedair
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, United Kingdom.
authors.forename: Sonya V
authors.initials: SV
authors.lastname: Babu-Narayan
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, United Kingdom.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom.
authors.forename: Sadia
authors.initials: S
authors.lastname: Quyam
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Doyle
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, United Kingdom.
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, United Kingdom.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.affiliation: Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, United Kingdom. Electronic address: tom.wong@imperial.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001519:Behavior; D017147:Defibrillators, Implantable / Q000523:psychology* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*
keywords: Adult congenital heart disease; Anxiety; Depression; Device acceptance; Implantable cardioverter defibrillator; Quality of life