Improving the care for female subcutaneous ICD patients: A qualitative study of gender-specific issues.
BACKGROUND
The subcutaneous implantable cardioverter-defibrillator (S-ICD) consists of a large generator and is implanted near the left breast. This might lead to discomfort and problems with self-perception and sexuality, especially in the female population. We aimed to assess the issues that female S-ICD patients experience and to provide practical guidance for cardiologists and implanters on minimizing these issues.


METHODS
For this retrospective single-center study, we conducted semi-structured interviews with four female S-ICD patients and processed their experiences into a questionnaire. This consisted of three open questions and 17 statements that participants could answer through a five-point Likert scale. The questionnaire was subsequently sent to all female adult patients who received an S-ICD between February 2009 and November 2018 in our tertiary centre in Amsterdam, the Netherlands.


RESULTS
The response rate of the questionnaire was 73%, with 52 female respondents (mean age 47.4 ± 12.5 years, mean time since implant 4.6 ± 3.1 years). Postoperative pain exceeded the expectation of 54% of the respondents. Furthermore, 14 out of 49 respondents (29%) expressed an unpleasant feeling during intimate contact with their sexual partner since the implant. Many women (44%) reported daily discomfort caused by their bra and preferred a more cranial and posterior position of the S-ICD generator. Finally, a smaller design of the generator is desired by a great majority (63%) of female S-ICD patients CONCLUSION: Female S-ICD patients experience a variety of issues with a substantial impact on their daily life. Most issues that we identified would benefit from adequate counseling and implanter awareness.
['van der Stuijt|Willeke|W|', 'Quast|Anne-Floor B E|ABE|', 'Baalman|Sarah W E|SWE|', 'Olde Nordkamp|Louise R A|LRA|', 'Wilde|Arthur A M|AAM|', 'Knops|Reinoud E|RE|']
D000328:Adult D017147:Defibrillators, Implantable D005260:Female D006801:Humans D008875:Middle Aged D009426:Netherlands D012189:Retrospective Studies D040521:Subcutaneous Tissue D016896:Treatment Outcome
Device therapy Gender Outcomes Quality of life Subcutaneous implantable cardioverter defibrillator