Examination of Patient Activation among Implantable Cardioverter Defibrillator Patients

Abstract

Background: Implantable cardioverter defibrillator (ICD) patients face psychosocial challenges related to the management of their cardiac conditions and devices. Factors including quality of life and rates of psychological distress among ICD patients have been previously explored; however, patient activation has not been examined. The purposes of the current study were to examine levels of patient activation among ICD patients and explore the relationship between patient activation and psychosocial and behavioral variables. Methods: Eighty-two patients completed a psychosocial survey including the Patient Activation Measure (PAM), Duke Activity Status Index (DASI), Morisky Medication Adherence Scale (MMAS), Florida Patient Acceptance Survey (FPAS), Cardiac Anxiety Questionnaire (CAQ), Florida Shock Anxiety Scale (FSAS), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire 8-item version (PHQ-8). Healthcare utilization was measured by examining hospital admissions and ED visits prospectively over a 6-month period. These data were used to examine the levels of patient activation among ICD patients and their relationship with clinical and psychosocial variables. Results: Results indicated that ICD patients reported generally favorable levels of patient activation, similar to levels in a primary care sample. ICD patients reported higher patient activation than a chronic obstructive pulmonary disorder (COPD) sample and a congestive heart failure (CHF) sample. Levels of patient activation did not significantly vary based on monitoring status. Lower device-specific anxiety and higher activity status and cardiac-specific anxiety were associated with higher levels of patient activation. Patient activation did not significantly predict healthcare utilization over a 6-month follow-up period. Conclusion: The current findings indicate that ICD patients display higher levels of patient activation than other chronic disease patient populations. Results suggest that ICD patients with lower cardiac-specific anxiety and activity status and higher levels of device-specific anxiety are at risk for lower levels of patient activation. Further research is necessary to better understand the relationship between patient activation and psychosocial variables among ICD patients.