Pedersen Susanne S, Sears Samuel F, Burg Matthew M, Van Den Broek Krista C
Center of Research on Psychology in Somatic diseases, Tilburg University, The Netherlands.
Pacing Clin Electrophysiol. 2009 Feb;32(2):153-6. doi: 10.1111/j.1540-8159.2008.02196.x.
The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening arrhythmias, with ICD indications having recently been extended to include primary prophylaxis. Despite the medical benefits of the ICD, there is an ongoing debate as to the impact of the ICD on patients' lives, particularly whether primary prophylaxis implantation may impact adversely on patient-centered outcomes such as quality of life (QoL) and distress. We examined the evidence for a role of ICD indication on these patient-centered outcomes. A literature search was conducted on PubMed and Web of Science from 2002 to present, focusing on indication for ICD therapy and patient-centered outcomes (i.e., anxiety, depression, disease-specific, or general QoL). We identified five studies (seven articles) concerning the impact of indication on patient-centered outcomes. Sample sizes varied from 91-426 patients across studies, five of seven articles used a prospective design, and follow-up ranged from 2-12 months. No study reported an effect for indication on patient-centered outcomes. There is no evidence to suggest that patients receiving an ICD for primary prophylaxis have subsequent poorer QoL and greater distress than patients receiving an ICD for secondary prophylaxis. This knowledge may help cardiologists in the clinical management of patients, in particular when discussing ICD implantation with patients.
植入式心脏复律除颤器（ICD）是治疗危及生命的心律失常的首选方法，ICD的适应症最近已扩展到包括一级预防。尽管ICD有医疗益处，但关于ICD对患者生活的影响仍存在争议，特别是一级预防植入是否可能对以患者为中心的结果产生不利影响，如生活质量（QoL）和痛苦。我们研究了ICD适应症在这些以患者为中心的结果中的作用的证据。对2002年至今的PubMed和Web of Science进行了文献检索，重点关注ICD治疗的适应症和以患者为中心的结果（即焦虑、抑郁、疾病特异性或一般生活质量）。我们确定了五项关于适应症对以患者为中心的结果的影响的研究（七篇文章）。各研究的样本量从91至426名患者不等，七篇文章中有五篇采用前瞻性设计，随访时间为2至12个月。没有研究报告适应症对以患者为中心的结果有影响。没有证据表明接受一级预防ICD的患者比接受二级预防ICD的患者随后的生活质量更差，痛苦更大。这些知识可能有助于心脏病专家对患者进行临床管理，特别是在与患者讨论ICD植入时。
