Self-reported adjustment to implanted cardiac devices

Background and Research Objective: Although implantations of devices to support cardiovascular function are increasing, little is known about the factors involved in adjusting psychologically to having an implanted device, This study provides factor analysis of the Implanted Device Adjustment Scale (IDAS) and self-reported data on quality of life, mood states, and global adjustment. Subjects and Methods: This cross-sectional correlational design study included 174 subjects (46 women and 128 men). A convenience sample was recruited from electrophysiology practices in 2 large Midwestern cities. Subjects completed the IDAS, the SF-36 quality-of-life measure, the Profile of Mood States, and a device adjustment visual analog scale. Results and Conclusions: The factor analysis produced 4 subscales for the IDAS: fear/anxiety, attitude, preparation, and body awareness. Perceived adjustment was "good" for 89% of persons and was unrelated to age, sex, type of device, and whether a shock was received. All 4 subscales of the IDAS correlated negatively with adjustment (higher IDAS score means poorer adjustment). The overall IDAS was internally consistent with a Cronbach alpha = .89. Adjustment, as measured by the overall IDAS, had a weak but significant relationship with measures of quality of life including the mental component summary scale of the SF-36 (r = 0.19), but not the physical component summary scale of the SF-36. All the Profile of Mood States subscales correlated positively with the IDAS subscale anxiety/fear with the exception of vigor/activity which had a negative correlation. No sex differences in total adjustment were seen in this group of patients, although there were differences in body awareness, physical functioning, and fatigue. Although patients with implanted cardioverter defibrillator were more fearful/anxious than patients with pacemaker only, no differences in total adjustment were seen between the 2 groups. A better understanding of the experience of adjusting to an implanted device is foundational to the development of appropriate interventions.