Author(s): Jane Mathew, Ankita Sharma, Nitish Naik, L. Gopichandran

Email(s): Email ID Not Available

DOI: 10.5958/2349-2996.2020.00099.3   

Address: Jane Mathew1, Ankita Sharma2, Nitish Naik3, L. Gopichandran4
1M.Sc. Student, College of Nursing, AIIMS, New Delhi.
2Nursing Officer, Department of Cardiology, AIIMS, New Delhi.
3Professor, Department of Cardiology, AIIMS, New Delhi.
4Associate Professor, College of Nursing, AIIMS, New Delhi.
*Corresponding Author

Published In:   Volume - 10,      Issue - 4,     Year - 2020

Introduction-With the rise in dependent population living with implanted cardioverter defibrillator, it’s crucial to explore their physical and psychosocial concerns. Once the device is implanted, patient has to learn to live with it. This concerns often decreases the device acceptability. Objectives of the study- To examine the specific implanted device related physical and psychosocial concerns in patients living with ICD. As well as to find correlation of these factors with demographic and clinical profile. Material and methods- Quantitative, descriptive, cross sectional study was conducted. Ethical permission was obtained. Consecutively, 60 medically stable ICD patients were taken for the study. Demographic profile, clinical profile, Florida patient acceptance survey, Florida shock anxiety scale, physical concern questionnaire were administered via interview technique. Time taken from each participant varies between 25-30 minutes. Results- Physical concerns assessment showed a mean burden score of 2.72+/-2.16, 31.7% had inadequate knowledge. Therapy shock related symptoms were predominantly felt as chest pain (46.70%) of moderate intensity and as jumping of the chest (63.3%), mean pain scale score was 5.50+/-2.21 and the pain lasted for less than 5 minutes (79%). Majority of the subjects were able to resume activity within an hour of therapy shocks. Lesser device acceptance scores (71.22+/-17.06) and greater anxiety scores (17.12+/-7.40) were seen among the subjects. Great symptom burden scores are associated with lower NYHA class (p=0.001), remote accessability to healthcare (p=0.001), greater duration of implantation (p=0.02), great number of therapy shocks (p=0.001) and lower BMI (p=0.037). Lesser acceptance scores were associated with young age (p=0.009), NYHA class (p=0.04) and number of therapy shocks (p=0.005). Greater pre pre-shock anxiety were found in subjects who have experienced greaternumber of therapy shocks (p=0.000), with lesser BMI (p=0.03) and lower educational qualification (p=0.03). Conclusion- The concern among ICD recipients in itself is complex field of study that can be affected by several factors other than symptom burden, pre-shock anxiety and device acceptance. The results showed that the patients were living with various physical and psychological problems and insufficient knowledge regarding the ICD.

Cite this article:
Jane Mathew, Ankita Sharma, Nitish Naik, L. Gopichandran. Physical and Psychosocial concerns among patient living with Implantable Cardioverter Defibrillator attending tertiary Health care Facility. Asian J. Nursing Education and Research. 2020; 10(4):463-470. doi: 10.5958/2349-2996.2020.00099.3

Jane Mathew, Ankita Sharma, Nitish Naik, L. Gopichandran. Physical and Psychosocial concerns among patient living with Implantable Cardioverter Defibrillator attending tertiary Health care Facility. Asian J. Nursing Education and Research. 2020; 10(4):463-470. doi: 10.5958/2349-2996.2020.00099.3   Available on:

1.    About Sudden Cardiac Arrest | Sudden Cardiac Arrest Foundation [Internet]. [cited 2014 Dec 31]. Available from:
2.    Rao BH, Sastry BKS, Chugh SS, Kalavakolanu S, Christopher J, Shangula D, et al. Contribution of sudden cardiac death to total mortality in India-A population based study. Int J Cardiol. 2012 Jan 26;154(2):163–7.
3.    Madhavan SR, Reddy S, Panuganti PK, Joshi R, Mallidi J, Raju K, et al. Epidemiology of sudden cardiac death in rural South India - insights from the andhrapradesh rural health initiative. Indian Pacing Electrophysiol J. 2011 Jul;11(4): 93–102.
4.    Naik N, Juneja R. ICD for primary prophylaxis of sudden cardiac death: an Indian perspective. J Assoc Physicians India. 2007 Apr; 55 Suppl: 47–53.
5.    Piotrowicz K, Noyes K, Lyness JM, McNitt S, Andrews ML, Dick A, et al. Physical functioning and mental well-being in association with health outcome in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II. Eur Heart J [Internet]. 2007 Feb 12 [cited 2015 Jan 2]; Available from:
6.    Kofflard MJ., Ten Cate FJ, van der Lee C, van Domburg RT. Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration. J Am CollCardiol. 2003 Mar 19;41(6):987–93.
7.    Olshansky B, Sullivan RM. Sudden Death Risk in Syncope: The Role of The Implantable Cardioverter Defibrillator. Prog Cardiovasc Dis. 2013 Jan; 55(4):443–53.
8.    Wathen MS, Sweeney MO, De Groot PJ, Stark AJ, Koehler JL, Chisner MB, et al. Shock Reduction Using Antitachycardia Pacing for Spontaneous Rapid Ventricular Tachycardia in Patients with Coronary Artery Disease. Circulation. 2001 Aug 14;104(7):796–801.
9.    Freeman JV, Wang Y, Curtis JP, Heidenreich PA, Hlatky MA. Physician Procedure Volume and Complications of Cardioverter-Defibrillator Implantation.Circulation. 2012 Jan 3;125(1):57–64.
10.    Van den Broek KC, Tekle FB, Habibović M, Alings M, van der Voort PH, Denollet J. Emotional distress, positive affect, and mortality in patients with an implantable cardioverter defibrillator. Int J Cardiol. 2013 May 10;165(2):327–32.
11.    Braunschweig F, Boriani G, Bauer A, Hatala R, Herrmann-Lingen C, Kautzner J, et al. Management of patients receiving implantable cardiac defibrillator shocks. EP Eur. 2010 Dec 1;12(12):1673–90.
12.    Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002 Mar 21;346(12):877–83.
13.    Dixit NK. Attentional bias in patients with implantable cardioverter defibrillators: Examining mechanisms of hypervigilence and anxiety [Internet]. University of Florida; 2008 [cited 2015 Jan 2]. Available from:
14.    Sethares KA, Sosa M-E, Fisher P, Riegel B. Factors associated with delay in seeking care for acute decompensated heart failure. J CardiovascNurs. 2014 Oct;29(5):429–38.
15.    Saito N, Taru C, Miyawaki I. Illness experience: living with arrhythmia and implantable cardioverter defibrillator. Kobe J Med Sci. 2011 Dec; 58(3): E72–81.
16.    Udlis KA. The impact of technology dependency on device acceptance and quality of life in persons with implantable cardioverter defibrillators. J CardiovascNurs. 2013 Dec; 28(6): E65–73.
17.    Jurgens CY, Hoke L, Byrnes J, Riegel B. Why do elders delay responding to heart failure symptoms? Nurs Res. 2009 Aug; 58(4): 274–82.
18.    Lam C, Smeltzer SC. Patterns of Symptom Recognition, Interpretation, and Response in Heart Failure Patients: An Integrative Review. J CardiovascNurs. 2013; 28(4): 348–59.
19.    Lemon J, Edelman S, Kirkness A. Avoidance behaviors in patients with implantable cardioverter defibrillators. Heart Lung J Crit Care. 2004 Jun; 33(3): 176–82.
20.    Strachan PH, de Laat S, Carroll SL, Schwartz L, Vaandering K, Toor GK, et al. Readability and Content of Patient Education Material Related to Implantable Cardioverter Defibrillators. J CardiovascNurs. 2012 Nov; 27(6): 495–504.
21.    Cinar FI, Tosun N, Kose S. Evaluation of an education and follow-up programme for implantable cardioverter defibrillator-implanted patients. J ClinNurs. 2013; 22(17-18): 2474–86.
22.    Burns JL, Serber ER, Keim S, Sears SF. Measuring patient acceptance of implantable cardiac device therapy: initial psychometric investigation of the Florida Patient Acceptance Survey.J CardiovascElectrophysiol. 2005 Apr; 16(4): 384-90.
23.    Keren A, Sears SF, Nervy P, Shaw J, Green MS, Lemery R, et al. Psychological adjustment in ICD paients living with advisory fidelis leads. J. CardiovascElectrophysiol. 2011; 22(1): 57-63
24.    Kuhl EA, Dixit NK, Walker RL, Conti JB, Sears SF. Measurement of patient fears about implantable cardioverter defibrillator shock: an initial evaluation of the Florida Shock Anxiety Scale. Pacing Clin Electrophysiol PACE. 2006 Jun; 29(6): 614-8.
25.    Ford J, Finch JF, Woodrow LK, Cutitta KE, Shea J, Fischer A, et al.The Florida Shock Anxiety Scale (FSAS) for Patients With Implantable Cardioverter Defibrillators: Testing Factor Structure, Reliability, and Validity of a Previously Established Measure. Pacing ClinElectrophysiol. 2012 Sep; 35(9): 1146-53.
26.    Bhavnani SP, Pavuluri V, Coleman CI, Guertin D, Yarlagadda RK, Clyne CA, et al. The Gender-Paradox among Patients with Implantable Cardioverter-Defibrillators: A Propensity-Matched Study. Pacing ClinElectrophysiol. 2013; 36(7): 878–84.
27.    Celikyurt U, Agacdiken A, Bozyel S, Argan O, Sade I, Vural A, et al. Assessment of Shoulder Pain and Shoulder Disability in Patients With Implantable Cardioverter-Defibrillator. J Interv Card ElectrophysiolInt J Arrhythm Pacing. 2013 Jan; 36(1): 91-4.
28.    Mastenbroek MH, Denollet J, Versteeg H, et al. Trajectories of patient-reported health status in patients with an implantable cardioverter defibrillator. Am J Cardiol. 2015; 115(6): 771‐777. doi: 10.1016/j.amjcard.2014.12.035
29.    Burns JL, Sears SF, Sotile R, et al. Do patients accept implantable atrial defibrillation therapy? Results from the Patient Atrial Shock Survey of Acceptance and Tolerance (PASSAT) Study. J CardiovascElectrophysiol. 2004; 15(3): 286‐291. doi:10.1111/j.1540-8167.2004. 03406.x
30.    Ingvild M Morken TMN. Perceptions of healthcare professionals' support, shock anxiety and device acceptance among implantable cardioverter defibrillator recipients. J Adv Nurs. 2014;
31.    Strömberg A, Fluur C, Miller J, Chung ML, Moser DK, Thylén I. ICD recipients’ understanding of ethical issues, ICD function, and practical consequences of withdrawing the ICD in the end-of-life. Pacing ClinElectrophysiol PACE. 2014 Jul; 37(7): 834–42.
32.    Vazquez LD, Conti JB, Sears SF. Female-specific education, management, and lifestyle enhancement for implantable cardioverter defibrillator patients: the FEMALE-ICD study. Pacing ClinElectrophysiol PACE. 2010 Sep; 33(9): 1131–40.
33.    Passman R, Subacius H, Ruo B, Schaechter A, Howard A, Sears SF, et al. Implantable cardioverter defibrillators and quality of life: results from the defibrillators in nonischemic cardiomyopathy treatment evaluation study. Arch Intern Med. 2007 Nov 12; 167(20): 2226–32.
34.    Schron EB, Exner DV, Yao Q, Jenkins LS, Steinberg JS, Cook JR, et al. Quality of Life in the Antiarrhythmics Versus Implantable Defibrillators Trial Impact of Therapy and Influence of Adverse Symptoms and Defibrillator Shocks. Circulation. 2002 Feb 5; 105(5): 589–94
35.    Lang S, Becker R, Wilke S, Hartmann M, Herzog W, Löwe B. Anxiety Disorders in Patients with Implantable Cardioverter Defibrillators: Frequency, Course, Predictors, and Patients’ Requests for Treatment. Pacing ClinElectrophysiol. 2014; 37(1): 35–47.
36.    Jacq F, Foulldrin G, Savouré A, Anselme F, Baguelin-Pinaud A, Cribier A, et al. A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry. 2009 May; 31(3): 266–73.
37.    Aktas MK, Zareba W, Huang DT, McNitt S, Polonsky S, Chen L, et al. The Effect of Weight Loss on Clinical Outcomes in Patients Implanted With a Cardiac Resynchronization Therapy Device-A MADIT-CRT Substudy. J Card Fail. 2014 Mar; 20(3): 183–9.

Recomonded Articles:

Asian Journal of Nursing Education and Research (AJNER) is an international, peer-reviewed journal devoted to nursing sciences....... Read more >>>

RNI: Not Available                     
DOI: 10.5958/2349-2996 

Popular Articles

Recent Articles