Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator.
Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator.
复制标题
多症状特征预测首次放置植入式心脏复律除颤器后不良结果的风险增加。
DOI：
10.1016/j.jpainsymman.2019.10.024
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发表时间：
2020
影响因子：
4.7
通讯作者：
Dougherty,CynthiaM
中科院分区：
文献类型：
--
作者：
Streur,MeganM;Thompson,ElaineA;Dougherty,CynthiaM
植入心律转复除颤器（ICD）的患者存在多种生理和心理症状的风险。识别与不良结局相关的特定症状特征可能阐明增强症状管理的新策略。ObjectivesThe objectives是确定初始ICD植入后的常见症状，识别具有相似症状特征的个体类别，描述与不同症状特征相关的患者特征，并确定出院时的症状特征是否能预测植入后3个月和12个月的结果。比较了患者+伴侣与仅患者干预，旨在帮助患者管理症状，为ICD电击做好准备，并恢复日常活动。通过患者关注评估来测量症状。潜在类别回归分析用于确定基线、3个月和12个月随访时的症状类别。患者特征，类成员，和结果之间的关联进行了检查，卡方，方差分析，Poisson regression.ResultsThe研究包括301例患者（74%男性，平均年龄64 ± 11.9岁）。确定了三个类别：多症状（N= 119，40%）、疲劳-衰弱（N= 130，43%）和大多数无症状（N= 52，17%）。多症状组患者较年轻（59.9岁，P< 0.001），焦虑（P< 0.001）和抑郁（P< 0.01）较其他组多。成员在多症状类预测较低的生活质量，并导致近一倍的住院率12个月后（P= 0.02，IRR 1.9）。结论ICD植入后的症状评估提供了一个有前途的策略，以确定患者的健康状况不佳的风险。
ContextPatients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management.ObjectivesThe objectives were to determine common symptoms after initial ICD implantation, identify classes of individuals with similar symptom profiles, describe patient characteristics associated with different symptom profiles, and determine if symptom profiles at hospital discharge predicted outcomes three and 12 months after implantation.MethodsThis was a secondary data analysis of a randomized controlled trial that compared patient + partner versus patient-only interventions designed to help patients manage symptoms, prepare for ICD shocks, and resume daily activities. Symptoms were measured with the Patient Concerns Assessment. Latent class regression analysis was used to identify symptom classes at baseline, three-month, and 12-month follow-up. Associations between patient characteristics, class membership, and outcomes were examined using chi-square, analysis of variance, and Poisson regression.ResultsThe study included 301 patients (74% male, mean age 64 ± 11.9 years). Three classes were identified: Multi-Symptom (N= 119, 40%), Tired-Rundown (N= 130, 43%), and Mostly Asymptomatic (N= 52, 17%). Patients in the Multi-Symptom class were younger (59.9 years,P< 0.001) and reported more anxiety (P< 0.001) and depression (P< 0.01) than the other classes. Membership in the Multi-Symptom class predicted lower quality of life and resulted in nearly double the rate of hospitalizations after 12 months (P= 0.02, IRR 1.9).ConclusionEvaluation of symptom profiles after ICD implantation offers a promising strategy for identifying patients at risk for poor health outcomes.