Body image concerns in patients with an implantable cardioverter defibrillator: associations with other patient-reported outcomes

Type of funding sources: None.

Implantation with an implantable cardioverter defibrillator (ICD) is for some patients associated with body image concerns (BICs). The associations of BICs with other patient-reported outcomes (PROs) have not yet been investigated.

The purpose of this study was to investigate the associations between BICs and other PROs in a cohort of ICD-recipients.

A cross-sectional survey design was used. Patients who had the ICD in minimum 3 months up to 2 years, age >18 years, implanted with a first-time ICD (both VVI-ICD, DDD-ICD and CRT-D) completed the 39-item ICD Body Image Concerns Questionnaire (ICD-BICQ) together with the Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), Type D Scale (DS14) and the Florida Patient Acceptance Survey (FPAS). Data were analyzed using linear regression to compare personality constructs between patients with and without BICs. Logistic repression and Reciever Operating Characteristic (ROC) curves were used to predict patients with BICs based on other PROs.

In total 331 patients completed the ICD-BICQ and other PRO questionnaires. Five patients were excluded due to re-operations, and one patient did not complete the ICD-BICQ, leaving 325 patients in the analyses. As anticipated 20% of patients reported body image concerns with a cut-off at the recommended 36 points. We found that patients with BICs reported higher anxiety and depression levels, lower device acceptance using the FPAS, and lower health status, while they were more likely to have a Type D personality as compared to patients without BICs. We observed that FPAS was moderately able to predict BICs, while other PROs only had limited ability to predict BICs in patients, hence indicating that the ICD-BICQ provides relevant clinical information.

In this study, we found that patients with BICs generally reported worse PRO scores. The included PRO instruments were not able to predict BICs the ICD recipients, hence in clinical practice, health care professionals can use the ICD-BICQ to identify and obtain a nuanced picture of patients with BICs. In case of implementing new operation techniques, the ICD-BICQ can be used as a tool for evaluation.