Psychometric Performance of Florida Patient Acceptance Survey in Danish Implantable Cardioverter Defibrillator Patients

Background: Patient device acceptance reflects the psychological adjustment to living with an implantable cardioverter defibrillator (ICD) and is an important outcome for ICD patients. The Florida Patient Acceptance Survey (FPAS) is the gold standard for assessing patient device acceptance; however, the most optimal factor structure of the FPAS is an open question. Objectives: This study aimed to evaluate the psychometric properties of FPAS by conducting head-to-head comparison tests between the proposed factor structures using prospective data from a national, Danish randomized controlled trial (ACQUIRE-ICD). Methods: The sample included 478 first-time ICD recipients (mean age 59.6 +/- 11.6 years), predominantly male (83.1%), assessed at ICD implantation and at 1-year follow-up (n = 364; 76.2%), completing the FPAS and measures of anxiety, depression, and Type D personality. Results: Confirmatory factor analyses showed that the abbreviated 12-item, three-factor version had the best fit to the data (CFI = 0.929), shortly followed by the original 15-item, four-factor version (CFI = 0.917, Delta chi(2) (33) = 125.05, p < 0.001). Both were superior to the two-factor versions (CFI = 0.707 and 0.843). The psychometric properties of the abbreviated 12-item version and original 15-item version were satisfactory with a moderate fit to the data at both ICD implantation and at 1-year follow-up, along with good internal reliability and divergent validity. Conclusions: In a large prospective cohort from a national Danish ICD study, the shortened, three-factor, 12-item version of the FPAS appears to be the most suitable version. The FPAS demonstrated satisfactory psychometric properties at both ICD implantation and 1-year follow-up.