Understanding preoperative state anxiety in patients awaiting Cardiac Implantable Electronic Device procedures: Implications for patient-centered care

BACKGROUND: While preprocedural anxiety is common, evidence regarding state anxiety among patients awaiting Cardiac Implantable Electronic Device procedures (CIEDs) remains limited. OBJECTIVES: To explore levels of preprocedural state anxiety among this population, and to gain an in depth understanding of how these patients with state anxiety experience and make sense of this anxiety in the cardiac catheterization laboratory setting. METHODS: The Pacewise study, at Copenhagen University Hospital is an explanatory sequential mixed methods study of state anxiety in patients awaiting CIED procedures. State anxiety was assessed pre-and post-procedurally using the State-Trait Anxiety Inventory - State scale (STAI-S) with total scores ≤40 indicating no/low state anxiety, 41-45 mild state anxiety, and ≥46 probable state anxiety. A subgroup of five participants underwent individual interviews. RESULTS: Overall, 149 patients (mean age 68 years, 73.2% men) scheduled for CIED procedures participated. Mild state anxiety was reported by 12.1%, and 10.7% met the criteria for probable state anxiety. Somatic manifestations contributed most to the STAI-S* total score, while feelings of insecurity emerged as a salient cognitive-affective component. Younger age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.93-0.99; p = 0.01) and first-time implantation (OR 2.68; 95% CI 1.20-5.98; p = 0.02) were independently associated with higher odds of preprocedural anxiety. Qualitative findings linked anxiety to a self-reinforcing cycle of bodily tension, lost control, insecurity, and existential fear. CONCLUSION: One-quarter of participants reported preprocedural state anxiety, with prominent somatic manifestations. Younger age and first-time implantation were associated with higher anxiety levels. Systematic assessment of state anxiety may facilitate timely, patient-centered preprocedural care.