Feasibility and Acceptability of a Self-Care Intervention for Implantable Cardioverter Defibrillator Patients: A “Systems Check” For ICD Patients

Abstract

Implantable cardioverter defibrillators (ICDs) are a foundational component of management of patients who are high risk for sudden cardiac death (SCD), and efficacy of ICD therapies for both primary and secondary prevention have been well evidenced (Kusumoto et al., 2014). Despite the life-saving benefits of the device, however, poor adjustment to the ICD is common, and rates of psychological distress are high (Sears et al., 2014). Maladjustment to the device can result in adverse clinical outcomes including diminished quality of life and disease progression.

Similar patient concerns have been addressed in heart failure patient populations utilizing a model for self-care although no model for ICD-specific self-care has been tested. As such, the present study employed a self-care intervention for ICD patients in rural-serving cardiology clinics. This three-part, in-person, group-based intervention utilized the American Heart Association’s conceptualization of self-care behaviors and was tailored for ICD management to include disease, device, and shock management, promotion of psychological well-being, and behavioral and lifestyle modification. The current study aimed to examine the feasibility and acceptability of this program and examined changes in primary outcomes of self-care activity engagement and overall shock anxiety ratings. Changes in subjective ratings of self-efficacy, ICD-specific knowledge, device acceptance, fear of exercise, and cardiac anxiety were also measured, and objective activity data was collected via wearable actigraphy watches. At the conclusion of the study, participants were asked to complete a brief evaluation of the intervention, designed to capture patient satisfaction with the program, perceived improvements in knowledge and confidence in device management, and interest in future ICD self-care programs.

At the East Carolina Heart Institute, 468 ICD patients screened eligible across cardiology clinics, and 123 were approached for participation in the study. Of those approached, 62.61% either expressed interest in the study or agreed to participate and 17.07% (21 patients) were consented. The most common reasons for declining to participate were transportation (28.46%) and time conflict (17.07%). A total of 16 ICD patients (M age = 64.13, SD = 12.23) consented and attended all three sessions. Attrition rate was 23.80% when accounting for all patients who consented but did not complete the intervention. Among the sample, 56% identified as women, and 75% identified as Black. Only a small portion of the sample (18.8%) had a prior history of shock. Ten patients (62.5%) showed improvements in self-care activities, and overall mean changes in engagement in self-care activities approached significance, p = .051, with moderate effect (Cohen’s d of .44). Six patients (37.5%) showed improvements in overall shock anxiety, although overall mean differences in shock anxiety pre and post were not significant. Changes in sedentary time and active time pre and post were not significant; however, 6 reduced sedentary time by >15 hours/week and 3 improved continuous exercise time by >2 hours/week. At completion, 87.5% of the sample endorsed improved ICD knowledge, confidence, and high satisfaction with the program. 75.1% indicated interest in self-care programs in the future. While feasibility metrics were poor, patient satisfaction reports point to high acceptability of the program, and individual improvements in self-care activities indicate benefit from self-care interventions for ICD patients. Findings suggest that programs focused on ICD self-care have the potential to improve psychological and behavioral factors integral to device and disease management and were acceptable in this patient population. Mode of delivery, recruitment constraints, and patient barriers should be considered in future studies.