Exploratory factor analysis for identifying cieds patients' concerns during the covid-19 pandemic in Europe

The current COVID-19 pandemic affects healthcare worldwide. Patients living with cardiac implantable electronic devices (CIEDs) are at high-risk to experience emotional distress and severe COVID-19 symptoms. Assessing their mental and physical health condition during the pandemic is crucial. An online questionnaire consisting of 45 multiple-choice questions regarding the patients' emotional and physical status was completed by 210 CIEDs participants. On the eligible 184 responses, a principal axis factoring (PAF) multivariate analysis was performed, which is part of the Exploratory Factor Analysis (EFA) class, frequently used in healthcare research. The considered variables in the PAF were CIEDs patients' concerns related to: device functioning, having received a shock (if ICD), the possibility to receive a shock (if ICD), access to medical care, reaching physicians, access to medication, getting infected by SARS-CoV-2, the health of caretakers, the health of their loved ones. However, one of the most difficult tasks in PAF is the selection of an appropriate number of factors. We proposed three rules to be considered, the verification of: the Kaiser criterion, the Cattell's Scree test, and the cumulative variance (to explain at least 60-65 %). After the number of factors had been established, we proposed a final verification, the Monte Carlo Parallel Analysis. Two factors were identified, subsequently defined as "Healthcare-related concerns" and "Fear of COVID-19 disease", which explained 75.56% of the cumulative variance. The factors highlight the need for accurate medical information provision, patient education, and support to improve healthcare during the pandemic.