ABC | Volume 114, Nº5, May 2020

Original Article Validity Evidence of the Brazilian Version of the Florida Shock Anxiety Scale for Patients with Implantable Cardioverter Defibrillators Katia Regina Silva, 1 Roberto Costa, 1 Giovanna Regina Garcia de Oliveira Melo, 1 Flávio Rebustini, 2 Marcos Sidney Benedetto, 1 M arcia Mitie Nagumo, 1 Samuel F. Sears 3 Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, 1 São Paulo, SP – Brazil Universidade de São Paulo - Escola de Artes, Ciências e Humanidades, 2 São Paulo, SP - Brazil East Carolina University - Department of Psychology and Cardiovascular Sciences Greenville, 3 North Carolina – USA Mailing Address: Katia Regina Silva • Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Unidade de Estimulação Elétrica e Marcapasso - Dr. Enéas de Carvalho Aguiar, 44. Postal Code 05403-900, São Paulo, SP – Brazil E-mail: katia.regina@incor.usp.br Manuscript received December 19, 2018, revised manuscript June 04, 2019, accepted June 23, 2019 DOI: https://doi.org/10.36660/abc.20190255 Abstract Background: In spite of proven effectiveness of implantable cardioverter defibrillators (ICDs), shock therapy delivered by the device may result in increased levels of anxiety and depression, leading to deleterious effects on quality of life. Objective: To carry out the translation, cross-cultural adaptation and validation of the Florida Shock Anxiety Scale (FSAS) scale into Brazilian Portuguese. Methods: In this psychometric study, construct validity was performed by exploratory (EFA) and confirmatory (CFA) factor analyses, and by item response theory (IRT). The adjustment indexes of the CFA were: Robust Mean-Scaled Chi Square/df NNFI, CFI (Comparative Fit Index), GFI (Goodness Fit Index), AGFI (Adjusted Goodness Fit Index), RMSEA (Root Mean Square Error of Approximation) and RMSR (Root Mean Square of Residuals). Reliability was evaluated through Cronbach’s Alpha, McDonald’s Omega and Greatest Lower Bound (GLB). The analyses were carried out with the programs SPSS 23 and Factor 10.8.01. A 5 percent significance level was used. Results: The final Portuguese version of the FSAS was administered to 151 ICD patients, with a mean age of 55.7 ± 14.1 years, and predominantly male. The parallel analysis indicated that the FSAS is unidimensional, with an explained variance of 64.4%. The correlations ranged from 0.31 to 0.77, factor loadings from 0.67 to 0.86, and communalities from 0.46 to 0.74. The adjustment indexes of the CFA were above the quality threshold. Satisfactory reliability evidence was provided by the FSAS. Conclusions: The FSAS-Br showed consistent validity and reliability evidence. Therefore, it can be used in ICD patients in Brazil. (Arq Bras Cardiol. 2020; 114(5):764-772) Keywords: Implantable defibrillator, Shock therapies, Arrhythmias, Anxiety, Psychometric. Introduction Nowadays, there are no doubts regarding the role of the implantable cardioverter defibrillator (ICD) for prevention of sudden cardiac death, especially among patients with ventricular dysfunction and arrhythmogenic genetic diseases. 1-3 Due to its proven efficacy in identifying and correcting potentially lethal ventricular tachyarrhythmias, the number of ICD implantations has increased significantly worldwide, and more than 250,000 procedures are performed every year. 4 The primary purpose of ICD is to correct potentially fatal ventricular arrhythmias by delivering low- or high-energy therapy. Low-energy therapy, known as antitachycardia pacing or antitachycardia pacing (ATP), is a painless method. High-energy therapy delivers shocks of up to 40 J which, in spite of causing major discomfort, usually occur after the patient has lost consciousness, since they are applied about 15 seconds after the initiation of ventricular fibrillation or fast ventricular tachyarrhythmia. In undesirable situations, such as arrhythmias resistant to overstimulation, or in electrical storm, high-energy discharges can occur in awake patients. 3,5,6 It is estimated that the chances of ICD patients will need appropriate electric shocks for primary prevention of sudden cardiac death varies between 2 and 15% per year. 5-8 On the other hand, when the ICD is used for secondary prevention, the incidence of shock therapies may vary between 35 and 53%, within the first year after implantation. 5-8 Despite the high level of technological sophistication of ICDs, unfortunately, there is the risk that the patient may receive inappropriate shock deliveries as a result of erroneous discrimination between supraventricular and ventricular tachyarrhythmias. On these occasions, the sensation reported is a painful and distressing experience. 9-14 764