Patient and Partner Sexual Concerns During the First Year After an Implantable Cardioverter Defibrillator: A Secondary Analysis of the P+P Randomized Clinical Trial

Abstract

Background Sexual concerns and changes in sexual activity are common among patients and their intimate partners after an implantable cardioverter defibrillator (ICD). Aims Our aims were to (i) describe patient and partner sexual activity and related concerns from the time of an initial ICD implant through 12-month follow-up and (ii) identify factors predictive of return to sexual activity and fears associated with sexual activity. Methods This secondary descriptive analysis was conducted with data from a randomized controlled trial (2009–2015) designed to compare 2 interventions for patients (Patient-Only) and for patients and their partners (Patient+Partner) after implant of an initial ICD. The sample included 105 patients and their intimate partners who reported sexual activity during the 24 months before ICD implant. Outcomes The Sexual Concerns Inventory was used to assess sexual activity and related concerns. Results Study participants comprised 72% male and were of mean age 65.6 ± 10.6 years; partners comprised 64% female and were of mean age 63 ± 11.6 years. Sexual activity increased after ICD: 73% of patients reported no sexual intercourse during 2 months before study enrollment, whereas only 46% reported no sexual intercourse during the 2 months before 12-month follow-up. Reductions in sexual concerns were evident 1 month after implant, with continued reductions through 12 months (patient 6.48 ± 4.03 to 5.22 ± 3.38, P = .004; partner 6.93 ± 4.01 to 5.2 ± 3.56, P < .001). Patient physical health predicted sexual activity 3 months after implant placement (P = .04); general ICD concerns (P < .001) predicted patient ICD-related sexual fears at 3 months. At 12 months, baseline general ICD concerns (P < .02) predicted sexual fears. Clinical Implications ICD patients and partners report low levels of sexual activity at the time of initial ICD implant, with reported increases in sexual activity over the 12-month recovery period: Sexual concerns were highest immediately after ICD implant. Strengths & Limitations Notably, the major strengths of this study were the repeated measures and longitudinal study design; the main limitation of the study was the lack of a “usual care” control group. Conclusion Sexual activity at the time of an initial ICD implant is low, and sexual concerns are most prominent for both patients and partners immediately after implant placement. Baseline physical health predicts subsequent sexual activity at 3 months, while general ICD-related worry predicts sexual fears at 3 and 12 months.

Patient‐Reported Outcomes in a Multidisciplinary Electrophysiology‐Psychology Ventricular Arrhythmia Clinic

“…Review of item‐level concerns also noted that 41% of patients reported being able to return to sexual activity, which is consistent with other studies noting 47% of patients with an ICD being sexually active 12 months after ICD implantation. 34 The VA clinic can be vital at counseling patients, appropriately allowing them to return to sexual activity once their concerns are addressed. 35 , 36 By using item‐level analysis of PROMs, the clinician is able to address specific patient concerns to improve their overall well‐being, which may not be readily observed when reviewing overall PROM scores.…”