SHOxABILITY : Ability and avoidance of daily activity behaviors in ICD patients

Abstract

Background: Implantable Cardioverter Defibrillator (ICD) shocks terminate potentially life-threatening arrhythmias. ICD shock may alter patient behavior via patients attempting to avoid daily activities or increasing heart rate. Patients are aware of which activities they have the ability to perform, but may choose to avoid these behaviors. The current study, entitled SHOxABILITY, examined ICD patients' ability and avoidance of progressively exertive behaviors. In addition, the factors of sex, age, shock, and shock anxiety were examined for differences on avoidance behaviors. Methods: Four hundred forty-three ICD patients across the United States were surveyed using an online measure. The survey included the Duke Activity Status Index (DASI) and the Florida Shock Anxiety Scale (FSAS), and was designed to provide a brief, descriptive assessment of individual ICD experiences. Results: As expected, many patients reported being unable to participate in more physically exertive activities such as strenuous athletic exertion (68.8%), sex (35.4%), and running a short distance (49.0%). Avoidance rates were also relatively high, as patients who reported being able to participate in these activities also reported avoiding them (i.e. strenuous athletics, 55.1%). Similarly, the majority of patients reported ability to engage in sexual activity (64.6%), but many chose to avoid sexual activity (51.0%). Women reported greater shock anxiety than men. Patients aged 65 and older reported significantly greater levels of activity avoidance than younger individuals. Patients who are older reported significantly lower shock anxiety. Having experienced prior ICD shock did not affect the reported level of activity avoidance. As shock history increases, greater levels of shock anxiety were reported. Multiple reasons were reported for avoiding, including fear of shock, fear of heart rate increase, doctor instruction, no desire, and an "other" option. The effects of sex, age, and shock indicated greater shock anxiety in patients with shock history as well as younger patients. Conclusion: Many ICD patients experience behavioral limitations due to both a perceived inability and preference to avoid exertive activities, particularly strenuous athletic exertion. Clinical and research attention to ICD patient activity levels and reasons for avoidance may improve daily functioning and return to pre-implant levels of activity.