Body image concerns in patients with an implantable cardioverter defibrillator: A scoping review

Background: Patients with an implantable cardioverter defibrillator (ICD) retain a scar and a bump at the site of implant. This may lead to body image concerns (BICs) that influence patients’ quality of life. Few studies have examined the prevalence and impact of BICs postimplant, prompting us to conduct a scoping review of the field. Methods: We searched the Medline, Embase, PsycINFO, and Cinahl databases in August 2016 and repeated in May 2017. Included were studies reporting on patients ≥ 18 years, an ICD implant (transvenous, subcutaneous, or ICD with cardiac resynchronization therapy [CRT-D]), reporting on BICs, and published in peer-reviewed English-language journals. We excluded nonsystematic reviews, opinion pieces/letters, case studies, conference abstracts, PhD dissertations, protocol papers, studies of ICD shock treatment of atrial fibrillation, and of abdominally or submammary implanted ICDs. Results: A total of 40 articles were included: 16 qualitative and 24 quantitative. None of the included studies had BICs as their primary endpoint. Results showed that BICs are present in various degrees in the ICD population and can be attributed to the visibility of the ICD (the scar and bump). Women and younger patients had greater problems with BICs, although men also had concerns. Two items of the “Florida Patient Acceptance Survey” were the most frequently used to assess BICs. Conclusion: BICs were present among ICD patients, but the degree of impact on their lives varied. There is a need for developing a BICs questionnaire to examine the prevalence of BICs and the potential impact on patients’ lives in longitudinal studies.