Measuring ICD shock anxiety: Status update on the Florida Shock Anxiety Scale after over a decade of use

Approximately 44% of patients with implantable cardioverter defibrillators (ICDs) experience some form of shock anxiety, associated with cardiac fear, physical inactivity, and increased morbidity and mortality. The Florida Shock Anxiety Scale (FSAS) was created to measure ICD-specific fears for a more precise target of patient psychologic distress and potential need for intervention. The current paper describes results from a focused literature review of studies using FSAS over the past 15 years, with the aim of summarizing its current reliability and validity, associated outcomes, and potential future directions for its clinical and research implementation.

In this review, 26 peer-reviewed articles were analyzed and selected from an in-depth literature search of two electronic databases.

The reliability and validity of FSAS has been upheld since its initial validation and remain positive. The majority of studies used FSAS as an assessment tool to evaluate a clinical need for psychologic support or psychoeducation. The most frequently reported predictors of FSAS shock anxiety include experience of shock, appropriate and inappropriate, and number of shocks experienced. Common correlates of higher FSAS scores include lower device-related knowledge, lower perceived support from healthcare providers, greater posttraumatic stress disorder symptoms, and negative attitudes about device dependency. Younger age and female gender are also associated with increased shock anxiety.

Since 2006, FSAS has been widely represented as a valid and reliable assessment tool for quantifying device-related anxiety in ICD recipients in diverse populations. Future directions for FSAS should explore its potential role in support of measurement-based care.