Quality of life and psychological functioning of ICD patients
Quality of life and psychological functioning of ICD patients
复制标题
DOI：
10.1136/heart.87.5.488
复制
发表时间：
2002-05-01
期刊：
影响因子：
5.7
通讯作者：
Conti, JB
中科院分区：
文献类型：
--
作者：
Sears, SF;Conti, JB
使用植入式心律转复除颤器（ICD）治疗危及生命的室性心律失常是标准的治疗方法，这在很大程度上是因为临床试验数据一贯表明，ICD在预防心源性猝死方面优于药物治疗。这一成功促使对ICD患者的生活质量（QOL）结果进行更密切的检查和改进。尽管生活质量没有统一的定义，但大多数研究人员都认为，“生活质量”是一个通用术语，指的是生物、心理和社会功能相互依存的多维健康结果。2迄今为止，证明ICD有效性的临床试验主要集中在ICD与药物治疗之间的死亡率差异上。虽然这些试验的大多数生活质量数据尚未发表，但许多小型研究可供审查，并支持ICD植入对大多数ICD受者产生理想生活质量的概念。然而，在一些患者中，当需要电击来完成心律转复或除颤时，这些益处可能会因焦虑和抑郁症状而减弱。本文综述了ICD患者生活质量与心理功能的相关文献，并概述了这些发现的临床和研究意义。c生活质量与ICD：患者报告在缺乏大型、随机、对照试验的情况下，很难得出关于ICD和抗心律失常药物治疗患者生活质量差异的明确结论。现有证据表明，ICD受者的生活质量从基线短暂下降，但在随访一年后改善到植入前的水平。以最终形式发表的最大临床试验数据来自冠状动脉旁路移植术（CABG）贴片试验，该试验将接受CABG手术的患者随机分为ICD组（n= 262）和非ICD组（n= 228）。与May及其同事的观点相反，该试验的数据表明，与没有ICD的患者相比，ICD患者的生活质量（精神和身体）明显更差。亚分析显示，非触电ICD患者与非触电ICD患者的生活质量没有差异。这些结果表明，接受过电击的ICD组在两组之间的精神和身体生活质量结果得分明显较差。总的来说，这些数据表明，休克的经历可能会导致心理困扰和生活质量下降。图1详细描述了患者继发于休克后可能经历的心理连续体。
The use of the implantable cardioverter-defibrillator (ICD) for life threatening ventricular arrhythmias is standard therapy, in large part because clinical trials data have consistently demonstrated its superiority over medical treatment in preventing sudden cardiac death. 1 This success prompts closer examination and refinement of quality of life (QOL) outcomes in ICD patients. Although no universal definition of QOL exists, most researchers agree that “quality of life” is a generic term for a multi-dimensional health outcome in which biological, psychological, and social functioning are interdependent. 2 To date, the clinical trials demonstrating the efficacy of the ICD have focused primarily on mortality differences between the ICD and medical treatment. While the majority of the QOL data from these trials is yet to be published, many small studies are available for review and support the concept that ICD implantation results in desirable QOL for most ICD recipients. 3 In some patients, however, these benefits may be attenuated by symptoms of anxiety and depression when a shock is necessary to accomplish cardioversion or defibrillation. This paper reviews the published literature on QOL and psychological functioning of ICD patients and outlines the clinical and research implications of these findings. c QUALITY OF LIFE AND THE ICD: PATIENT REPORTSDefinitive conclusions about QOL differences between patients managed with an ICD and those treated with antiarrhythmic drugs are difficult to make in the absence of large, randomised, controlled trials. Available evidence indicates that ICD recipients experience a brief decline in QOL from baseline but improve to pre-implant levels after one year of follow up. 4 The largest clinical trial data published in final form is from the coronary artery bypass graft (CABG) Patch trial which randomised patients to ICD (n= 262) versus no ICD (n= 228) while undergoing CABG surgery. 5 In contrast to May and colleagues, 4 data from this trial indicate that the QOL outcomes (mental and physical) for the ICD patients were significantly worse compared to patients with no ICD. Subanalyses revealed that there was no difference in QOL for non-shocked ICD patients versus no ICD patients. These results indicated that the ICD group who had received shocks was responsible for the significantly worse mental and physical QOL outcome scores between the groups. Collectively, these data suggest that the experience of shock may contribute to psychological distress and diminished QOL. Figure 1 details the psychological continuum a patient may experience secondary to shock.