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AOS.309.01-Tracings, Pacers and Defibrillators
14165 - Shock, Sexual Function and Implantable Cardioverter Defibrillators: An Evaluation of the Adult Congenital Community
Tuesday, Nov 15, 2011, 4:00 PM - 4:15 PM
Tuesday, Nov 15, 2011, 4:00 PM - 4:15 PM
+311. Adult Congenital Heart Disease
Adult congenital heart disease; Implantable cardioconvert defibrillator; Anxiety; Sexual dysfunction
Stephen C Cook
, Children's Hosp of Pittsburgh, Pittsburgh, PA; Paul Khairy, Montreal Heart Inst Adult Congenital Ctr, Montreal, QC, Canada; Doug Landsittel, Mary Amanda Dew, Univ of Pittsburgh, Pittsburgh, PA; Curt J Daniels, Jenne Hickey, Nationwide Children's Hosp, Columbus, OH; Jennifer Burger, The Ctr for Cognitive and Behavioral Therapy, Columbus, OH; Amy Harmon, Mathieu Clair, Frank Cecchin, Children's Hosp Boston, Boston, MA; Gregory R Webster, Children's Memorial Hosp, Chicago, IL; Anne Marie Valente, Children's Hosp Boston, Boston, MA; Alliance for Adult Research in Congenital Cardiology (AARCC)
Background: An increasing number of adults with congenital heart disease (CHD) require implantable cardiac defibrillators (ICDs), yet little is known regarding the impact of ICDs on quality of life and sexual function (SF). We sought to identify issues surrounding ICD-related shock anxiety and SF in adults with CHD.
Methods: A prospective multicenter cross-sectional study was conducted on adult CHD patients with (ICD+) and without (ICD-) ICDs. To assess SF and depression the Sexual Health Inventory for Men (SHIM), Female Sexual Function Index (FSFI) and Beck Depression Inventory-II were administered. To assess ICD-related shock anxiety, ICD+ patients completed a Florida Shock Anxiety Scale (FSAS). Demographic data included age, gender and CHD severity. Differences between ICD+ and ICD- groups were assessed with two-sample t-test (ANOVAs by CHD complexity) and chi-square test as appropriate. Pearson correlations were calculated between SHIM, FSFI, and FSAS scores. Total, Consequence, and Triggers scores were tested against established normative scores with a 1-sample t-test.
Results: Of the 151 patients recruited (ICD+ n=41; ICD- n=110), women comprised 41% of ICD+ group vs 49% of ICD- group (p=0.4). Mean age was 37.4±11 yrs in the ICD+ group vs 32.1±8.3 yrs in the ICD- group (p=0.002). SHIM scores were lower in ICD+ vs ICD- group 19.3±6.9 vs 21.7±5.1 (p=0.09). No differences were noted in FSFI (64.5±32.8 vs 67.1±20.7; p>0.7) or BDI-II (8.9±10.2 vs 9.0±9.5; p>0.7) scores between groups. Total FSAS, Consequence and Trigger scores were greater than normative scores: 18.2±7.7 vs 15.44±7.5 (p=0.03), 6.3±3.2 vs 1.54±1.04 (p<0.001) and 4.6±2 vs 1.55±1 (p<0.001) respectively, indicating a higher level of shock-related anxiety in ICD recipients. Higher total FSAS scores were inversely related to SF measured by SHIM (-0.35; p=0.09) and FSFI (-0.67;p=0.003) scores. Although CHD complexity was greater for ICD+ group (43.9% vs 26.4%; p=0.02), total FSAS scores were similar by CHD severity.
Conclusion: Adults with CHD and ICDs demonstrate a high level of shock-related anxiety, which is associated with lower SF scores. These results demonstrate the need for increased clinical attention related to ICD-related shock anxiety and impaired SF in this unique population.
Other Research Support; Significant; Research Support, Medtronic, Inc. Consultant/Advisory Board; Modest; Advisory Board, Boston Scientific. Other; Significant; Canada Research Chair, Electrophysiology and Adult Congenital Heart Disease.
Employment; Modest; Modest employment relationship as a result of psychological services provided to patients with ICDs and anxiety. None of the patients treated were participants in this study.
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