How Do Illness Perceptions Impact Device Acceptance in Patients with an Implantable Cardioverter Defibrillator?

The implantable cardioverter defibrillator (ICD) is the first-line treatment for the prevention of sudden cardiac death in patients at high risk of a life-threatening arrhythmia. Illness perceptions encompass the cognitive and emotional representations each ICD patient has about their health condition, thus influencing coping strategies and health behaviors essential to adjusting to life with their device and underlying heart disease. We investigate how illness perceptions are prospectively linked to device acceptance in ICD patients. To examine how illness perceptions at ICD implantation are associated with patient device acceptance one-year post-implantation. Secondary analysis of the ACQUIRE-ICD, national, multi-center, randomised controlled trial. Illness perceptions were measured with the Brief Illness Perceptions Questionnaire (B-IPQ) with 350 first-time ICD or cardiac resynchronization therapy defibrillator (CRT-D) recipients filling out the questionnaire at ICD implantation. B-IPQ was only assessed at baseline. Patient device acceptance, a disease-specific quality of life measure for ICD patients, was measured at both ICD implantation and at 12 months follow-up with the Florida Patient Acceptance Survey (FPAS). Of the 350 patients, 261 patients (75%) completed FPAS at 12 months follow-up. The participants’ mean age was 59.7 ± 11.4 years with the majority being male (83%). Total illness perceptions scores were categorised into low experienced threat (n = 182, 52%), medium experienced threat (n = 82, 23%), and high experienced threat (n = 86, 25%). In the multivariate analysis, high experienced threat at ICD implantation was associated with significantly lower device acceptance at 12 months follow-up compared to low (B = -5.80, 95% CI [- 10.61, – -1.00], p = .018) and moderate experienced illness threat (B = -7.35, 95% CI [- 12.32, – -2.38], p = .004) while adjusting for device acceptance at baseline, age, sex, NYHA-class, indication, ischemic heart disease, education, intervention group and device type. In an exploratory analysis investigating associations of all 8 B-IPQ illness perception dimensions (single item-scores) simultaneously regressed on 12-months total FPAS-scores with baseline FPAS-scores as covariate, B-IPQ item 4 measuring treatment control showed the strongest association (B = 0.94, 95% CI [0.13, – 1.76], p = .023) with higher perceived treatment control linked with higher device acceptance. ICD patients with high experienced illness threat at ICD implantation had substantially lower device acceptance at one-year post-implantation compared to patients with low-to-moderate experienced illness threat. Perceptions of treatment control at ICD implantation appear to be a potential mediator of this relationship.