Deaton Christi, Dunbar Sandra B, Moloney Margaret, Sears Samuel F, Ujhelyi Michael R
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia 30322, USA.
Heart Lung. 2003 Sep-Oct;32(5):291-9. doi: 10.1016/s0147-9563(03)00074-8.
Patient perspectives about their illness experiences, symptoms, and treatment are essential aspects of quality of life and provide direction for patient and provider decision making regarding innovative therapies such as implantable devices for arrhythmia.
The purpose of this qualitative study was to describe: 1) the experience of patients living with symptomatic, drug-refractory atrial fibrillation (AF) and 2) patient experiences and acceptance of treatment with the implantable cardioverter defibrillator (ICD) with atrial therapies (ICD-AT) including ventricular and atrial defibrillation therapy.
Subjects were 3 women and 8 men, 35 to 80 years of age, who received the Medtronic Jewel AF 7250 ICD-AT as therapy for recurrent, drug-refractory AF, had a history of AF for 3 to 20 years and had experienced multiple treatment modalities including frequent external cardioversion in an effort to control their AF.
A semi-structured interview addressed experiences of symptoms and prior treatment for AF and experiences, concerns, and perceived benefits of the ICD-AT. Interviews were recorded and transcribed verbatim. Narratives were coded and categorized using Atlas Ti(R) software. Qualitative interpretive analysis methods were used to identify key themes.
Before ICD-AT, patient themes focused on AF that was: 1) misdiagnosed, minimized, and poorly treated; 2) distressful because of frequent and intense AF symptoms (fatigue, dizziness, shortness of breath, and anxiety) before ICD-AT; 3) limiting of activities of daily living; 4) associated with distress from enduring previous treatment; and 5) associated with the continuous pursuit of successful treatment and maintenance of normalcy. Decision making regarding ICD-AT therapy included weighing symptom or treatment distress versus anticipated risks or benefits, hope for better outcomes, and lack of options. After ICD-AT, themes included positive perceptions of the device because of AF symptom relief, ability to resume normalcy, and medication tolerance; incorporation of shock experiences into life routines; and patient suggestions regarding preparation and social support.
Symptoms of AF have a major negative impact on overall quality of life. Treatment with the ICD-AT confers a sense of security and reduced symptom distress. Greater provider attention to patient preparation and facilitating social support are important for future ICD-AT patient care.
患者对自身疾病经历、症状及治疗的看法是生活质量的重要方面，为患者及医疗服务提供者在心律失常植入式器械等创新疗法的决策上提供指导。
这项定性研究的目的是描述：1）有症状的、药物难治性心房颤动（AF）患者的经历；2）患者对植入式心脏复律除颤器（ICD）伴心房治疗（ICD - AT，包括心室和心房除颤治疗）的体验及接受情况。
受试者为3名女性和8名男性，年龄在35至80岁之间，他们接受美敦力Jewel AF 7250 ICD - AT作为复发性、药物难治性AF的治疗，有3至20年的AF病史，且经历过多种治疗方式，包括频繁的体外心脏复律以控制AF。
采用半结构化访谈，涉及AF的症状及既往治疗经历，以及ICD - AT的体验、担忧和感知到的益处。访谈进行录音并逐字转录。使用Atlas Ti(R)软件对叙述进行编码和分类。采用定性解释分析方法确定关键主题。
在接受ICD - AT之前，患者的主题集中在AF方面：1）被误诊、被轻视且治疗不佳；2）在接受ICD - AT之前，由于频繁且严重的AF症状（疲劳、头晕、呼吸急促和焦虑）而痛苦；3）限制日常生活活动；4）与忍受既往治疗带来的痛苦相关；5）与持续追求成功治疗和维持正常状态相关。关于ICD - AT治疗的决策包括权衡症状或治疗痛苦与预期风险或益处、对更好结果的希望以及缺乏其他选择。在接受ICD - AT之后，主题包括因AF症状缓解、恢复正常状态的能力以及药物耐受性而对该器械有积极看法；将电击经历融入生活日常；以及患者关于准备工作和社会支持的建议。
AF症状对总体生活质量有重大负面影响。ICD - AT治疗带来安全感并减轻症状痛苦。医疗服务提供者更多地关注患者准备工作并促进社会支持对未来ICD - AT患者护理很重要。
