ABC | Volume 114, Nº5, May 2020

Original Article Silva et al. Florida Shock Anxiety Scale Arq Bras Cardiol. 2020; 114(5):764-772 Table 4 presents the factor loads, which ranged from 0.67 to 0.86, representing excellent levels of adherence of the items to the latent variable, greater than the minimum criterion of 0.50, with no evidence of multicollinearity. The unidimensionality ruled out the possibility of cross-loading. Communalities varied between 0.46 and 0.74, with all the items above the threshold of 0.40. For item discrimination (a), the values ranged from 0.91 to 1.71, also indicating good adherence to the latent variable and corroborating the data obtained from factor loading. The CFA revealed good adjustment to the unidimensional model, with values similar to those recommended by the literature: Robust Mean and Variance-Adjusted Chi Square X 2 / df (35) = 40.40; p < 0.243; NNFI= 0.997; CFI= 0,997; GFI= 0.986; AGFI= 0.982. The residual indicators were at good levels (RMSEA= 0.032; RMSR= 0.077), showing little difference between the original matrix and the matrix generated from factor loadings. 31 Reliability of the FSAS-Br Satisfactory reliability evidence was provided by the FSAS-Br scale, with a Cronbach’s alpha coefficient of 0.92, a McDonald’s Omega coefficient of 0.92 and GLB of 0.98. Discussion In the present study, we described the translation and cross-cultural adaptation process of a brief scale designed to provide a quantitative measure of ICD shock-related anxiety, folllowing international methodological standards. 23-25 The final translation of the FSAS into Brazilian Portuguese (FSAS-Br) presented conceptual, semantic, cultural and measurement equivalences compared to the original items in English. 15,16 Efforts were made to include patients with different sociodemographic profiles and various types of underlying heart diseases to ensure heterogeneous representation, aiming at providing the best calibration of the items. Thus, patients with different ICD types (ventricular, atrioventricular or associated with cardiac resynchronization therapy) were included, as well as patients with indications for primary or secondary prophylaxis of sudden cardiac death. Notwithstanding, the most common kinds of heart disease among these patients’ profiles have also been contemplated, with expressive prevalence of Chagas Disease, ischemic and hypertrophic cardiomyopathy. In the international scenario, the FSAS scale has been widely used in different scenarios, since it presents good sensitivity to identify the level of ICD shock-related anxiety and requires reduced time for completion. 15-22 Thus, it is important to highlight that the FSAS was not designed to assess relevant aspects of adaptation to the device and its real impact on quality of life, which makes it necessary to use other instruments to complement the assessment of these patients. Table 1 – Original and Brazilian version of the Florida Shock Anxiety Scale (FSAS-Br) instrument Item Original Instrument Brazilian version: FSAS-Br 1 I am scared to exercise because it may increase my heart rate and cause my device to fire. Eu tenho medo de fazer exercícios físicos porque isso pode aumentar meus batimentos cardíacos e fazer o meu CDI me aplicar um choque. 2 I am afraid of being alone when the ICD fires and I need help. Eu tenho medo de estar sozinho e precisar de ajuda quando o CDI me aplicar um choque. 3 I do not get angry or upset because it may cause my ICD to fire. Eu não posso ficar nervoso ou chateado porque isso pode fazer o CDI me aplicar um choque. 4 It bothers me that I do not know when the ICD will fire. Me sinto preocupado por não saber quando o CDI vai me aplicar um choque. 5 I worry about the ICD not firing sometime when it should. Eu me preocupo com a possibilidade do CDI não funcionar quando eu precisar. 6 I am afraid to touch others for fear I’ll shock them if the ICD fires. Eu tenho medo de tocar nas pessoas e dar um choque nelas caso o CDI dispare. 7 I worry about the ICD firing and creating a scene. Eu me preocupo sobre a possibilidade de assustar as pessoas quando o CDI me aplicar um choque. 8 When I notice my heart beating rapidly, I worry that the ICD will fire. Quando eu percebo que meu coração bate mais rápido, eu fico preocupado que o CDI vai me aplicar um choque. 9 I have unwanted thoughts of my ICD firing. Eu penso o tempo todo que a qualquer momento o CDI pode me aplicar um choque. 10 I do not engage in sexual activities because it may cause my ICD to fire. Eu não tenho relações sexuais porque isso pode fazer o CDI me aplicar um choque. Response options 1 - Not at all 2 - Rarely 3 - Some of the time 4 - Most of the time Opções de resposta 1 - Nunca 2 - Quase nunca 3 - Algumas vezes 4 - Na maioria das vezes 768