Objective: The purpose of this study was to examine the interrelationship among attitudes towards technology dependency, shock experience, and history of sudden cardiac arrest (SCA) on Health-Related Quality of Life (HRQL) in recipients of implantable defibrillators (ICD). Findings from several investigations have suggested that recipients' appraisal of device therapy may be important to consider when describing HRQL as a function of shock experience and history of SCA. However, no studies have evaluated the way these factors might combine to influence HRQL. Therefore, this study explored whether HRQL varies depending on recipients' attitudes towards dependency on ICD technology, their shock experience, and history of SCA. Design: Cross-sectional, mailed survey. Population, Sample, Setting, Years: Adult ICD recipients (N=115) receiving follow-up at clinics, physician offices, or support groups. Concept or Variables Studied Together or Intervention and Outcome Variable(s): Predictor variables were attitudes towards technology (ATTD) (more positive; less positive), shock experience (no shocks; shocks 1 or greater), and SCA history (no prior SCA; prior SCA). ATTD was measured by the Dependency on Technology Scales (DOTS) (scored 1-7) with higher scores indicating better attitudes. The mean DOTS score was used to create more positive (5.5 or greater) or less positive (less than 5.5) groups. Shock experience and history of SCA were derived from recipients' self-report of shocks and prior SCA. The criterion variable was HRQL measured by the physical (PCS) and mental (MCS) summary scores of the Short Form-36 (SF-36) with higher scores indicating better physical and mental health. Methods: Data were collected as part of a study that modeled the influence of ATTD on HRQL. Results were analyzed using 2 separate three way Factor ANOVA designs (alpha=.05). Simple effects analyses were performed to interpret significant interactions (alpha=.10). Findings. Recipients were predominantly male (81%), married (75%), and approximately 4 years post implant. The average age of recipients was 62 years (SD=14, range 25 - 82 years). Recipients had been shocked (44%) on average 4 times and 50% experienced prior SCA. Factor ANOVA indicated a significant three way interaction effect for ATTD, shock experience, and SCA history on MCS scores (F(1,107)=4.1, p < .05), Additional analysis indicated a significant simple interaction for shock experience and history of SCA on MCS scores for recipients with more positive ATTD (F(1,107)=2.9, p < .10). Among recipients with more positive ATTD who received no shocks, there was no difference in MCS scores related to whether they had a history of SCA (M=55, SD=8) or they did not (M=53, SD=10). However, among recipients with positive ATTD who received shocks, those who had no history of SCA had significantly higher MCS scores (M=57, SD=7) than those who had a history of SCA (M=51, SD=10). For recipients with less positive ATTD, MCS scores did not vary based on the combination of shock experience and history of SCA. Factor ANOVA indicated no significant main or interaction effect for ATTD, shock experience, and SCA history on PCS scores. Conclusions: The interaction of shock experience and history of SCA on mental health differs depending on recipients' appraisal of device therapy. In those recipients with more favorable attitudes towards dependency on ICD technology, improved mental health is associated with those who have experienced a shock and have no prior history of SCA. Implications: This study advances nursing knowledge by providing new information regarding individual responses to technology dependency that can be used in patient education, support group counseling, and education of health care providers.
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