Abstract 167: Predictors of Anxiety Disorder Episodes and Device Related Distress in the First Five Years following Implantable Cardioverter Defibrillator Placement
Authors: Magyar-Russell Gina , Morrell Christopher H , Tomaselli Gordon F 
Published: July 2021

Trait anxiety is a dispositional factor that predisposes individuals to respond to perceived threats with more frequent and intense elevations in emotional states associated with arousal of the autonomic nervous system, which is thought to lead to the development of anxiety disorders. Trait anxiety has demonstrated promise in the empirical literature as a potential predictor of long term outcomes in ICD recipients. The present study adds novel information to this body of literature by studying the relation of trait anxiety to clinical diagnoses of anxiety disorders based on the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID).
Two hundred and seven recipients of ICDs within the past five years were evaluated using the SCID to establish past and current anxiety disorder diagnoses. Self-report questionnaires were administered to assess device-related appraisals and functional impairment. Participants were 70% (n=144/207) male, 63% (n=130/207) married and 29% currently working (60/207) with a mean age of 63.0 (±12.3) years. Ninety-seven (47%) shocked and 110 (53%) non-shocked ICD recipients were interviewed.

ICD recipients high in trait anxiety (n = 59/207, 29%) had significantly higher rates of current episodes of obsessive compulsive disorder (χ
2
= 9.05; p<.01), and anxiety disorder due to a general medical condition (GMC; χ
2
= 6.38; p<.05) during the first five years post ICD implant in comparison to those low in trait anxiety (n=147/207, 71%). Additionally, ICD recipients high in trait anxiety had significantly higher rates of a history of episodes of anxiety disorder due to GMC (χ
2
= 9.05; p<.001).

ICD recipients high in trait anxiety (n = 59, 29%) reported greater device-related distress (
t
= 5.65;p<.001), greater body image concerns (
t
=2.39;p<.01), and greater fear of shock (
t
= -3.98;p<.001), as well as fewer positive perceptions of their ICD (
t
= 2.39; p<.05). Moreover, ICD recipients high in trait anxiety reported greater functional limitations (
t
= 5.69; p<.001), and greater perceptions of disability in work, social, and family life (
t
= -4.09; p<.001).

Women (n=63/207; 30%) reported greater mean levels of trait anxiety (
t
= -2.10; p<.05) and fear of shock (
t
= -2.41; p<.05) in comparison to men. Individuals who met criteria for current panic disorder (
t
= 2.86; p<.01), agoraphobia (
t
= 4.78; p<.001), social phobia (
t
= 3.04; p<.05), posttraumatic stress disorder (
t
= 3.82; p<.01), and anxiety due to GMC (
t
= 3.94; p<.001) were significantly younger than those without these diagnoses.

The results from the current study suggest that assessment of trait anxiety may help clinicians identify individuals at risk for poor adjustment following ICD placement, even before implantation. Early identification of risk for maladjustment via pre-implant predictors might allow ICD recipients to enjoy the full benefits associated with these devices - longer and better quality of life.