ABC | Volume 114, Nº5, May 2020

Original Article Silva et al. Florida Shock Anxiety Scale Arq Bras Cardiol. 2020; 114(5):764-772 In this sense, the authors who had created the FSAS developed another instrument, the Florida Patient Acceptance Survey (FPAS), 32 which aims at assessing the psychosocial adjustment of ICD patients. The results of the cross-cultural adaptation and validation process of the FPAS into Portuguese will be published in due course. Evidence of validity of an instrument has been recommended by the scientific community as a way to check whether the instrument actually and accurately measures the latent variable of interest. In addition, it is important to analyze whether the instrument factor structure is adequately represented by its dimensionality, that is, the number of dimensions that make up the instrument of assessment. 27-31 In the original publication of the FSAS, the authors claim that the instrument was bidimensional, presenting two dimensions: Consequence (composed of 7 items) and Trigger (composed of 3 items). 15 This model was not reproducible to the Brazilian version, because all analyses performed in this study supported the FSAS-Br scale unidimensionality. Revisiting the study by Kuhl et at., 15 it is important to highlight that the sample was constituted by only 72 participants, which may have had an impact on the results of the psychometric analyses. Afterwards, the psychometric properties of the FSAS were evaluated, with a sample of 443 participants. 16 The CFA showed that the two previously identified dimensions were highly related to a second-order factor (“Shock anxiety”). In other words, the two dimensions identified previously could have been better explained by their association to a common factor, namely the “shock-related anxiety” dimension. Due to these results, the authors recommended that the total scale score may be more clinically useful, instead of subdividing it into the two dimensios described before. These results corroborate the factor structure identified in our study. Reliability assessment of the FSAS-Br scale revealed the accuracy of the Brazilian version, which was confirmed by Table 2 – Demographic and clinical profile of the study participants Characteristics Male sex 64.0% Age (years) 55.7 ± 14.1 White 85.4% Education Higher Education 14.8% High School 34.9% Middle School 49.0% Illiterate 1.3% Marital Status Married 64.9% Single 14.6% Divorced 7.9% Widow 6.6% Stable union 6.0% Structural Heart Disease Chagas Disease 30.5% Ischemic Cardiomyopathy 25.2% Hypertrophic Cardiomyopathy 14.6% Dilated Cardiomyopathy 13.2% Brugada syndrome 4.6% Congenital Long QT Syndrome 3.3% Right Ventricular Arrhythmogenic Dysplasia 2.6% Others 5.9% New York Heart Association Functional Class I 37.1% II 47.7% III 11.3% IV 4.0% Left Ventricular Ejection Fraction (Echocardiography) 41.2 ± 15.6 Comorbidities None 29.1% Hypertension 49.5% Coronary Artery Disease 15.9% Diabetes 20.6% Atrial Fibrillation 27.1% Chronic Kidney Disease 6.5% Dislipidemia 51.4% Charlson comorbidity index 1.3 ± 1.0 Use of medication ACEI/ARB 72.7% Beta blockers 85.4% Diuretics 50.7% Antiarrhythmic drugs 58.9% Platelet antiaggregants 31.8% Oral anticoagulants 27.8% ICD indication Primary prevention of sudden cardiac death 19.9% Secondary prevention of sudden cardiac death 80.1% ICD Type Ventricular ICD 41.1% Atrioventricular ICD 46.4% Cardiac resynchronization ICD 12.6% Time of ICD implantation (years) 6.7 ± 4.4 ICD therapies Received shock therapies 60.3% Never received shock therapies 39.7% ARB: angiotensin receptor blocker; ACEI: angiotensin-converting enzyme inhibitor. 769