Hallas Claire N, Burke Julie L, White David G, Connelly Derek T
Department of Rehabilitation and Therapies, Royal Brompton and Harefield NHS Trust, London, UK.
Pacing Clin Electrophysiol. 2010 Mar;33(3):256-65. doi: 10.1111/j.1540-8159.2009.02641.x. Epub 2009 Dec 31.
The implantable cardioverter defibrillator (ICD) is a device used in the treatment of ventricular arrhythmias and the prevention of sudden cardiac death. However, the ICD has been associated with negative psychological outcomes such as anxiety, depression, panic, and poor quality of life (QoL). Recent studies suggest that the preimplantation psychology of patients, combined with their postimplantation perceptions about their cardiac condition, are greater contributory factors than their medical status to a poor outcome.
Our study employed an interview-based qualitative grounded theory methodology to explore whether medical history hetereogeneity and illness beliefs impact on the QoL of 13 ICD patients.
Perceived control emerged as the core category related to QoL with three subsystem themes related to control: (1) illness beliefs, attributions, and appraisals; (2) coping resources and strategies; and (3) the social world. Patients at risk for the poorest adaptation were younger (<45), unemployed, and with an acute onset cardiac history. These patients interpreted their illness as severe, utilized emotion-focused coping (e.g., avoidance of situations), and believed themselves to be socially excluded. Adjusted patients used proactive problem-focused coping (e.g., normalizing) and minimized consequences of the device.
The data developed a theoretical model of QoL, which identified perceived control, illness beliefs, and coping impacting on adjustment. From our study, we have a wider understanding of the combination psychological issues relevant to ICD patients and are able to treat those at risk with interventions to promote adjustment in the context of a society that values health and well-being.
植入式心脏复律除颤器（ICD）是一种用于治疗室性心律失常和预防心源性猝死的设备。然而，ICD与焦虑、抑郁、恐慌和生活质量差等负面心理结果相关。最近的研究表明，患者植入前的心理状态，以及他们植入后对自身心脏状况的认知，比他们的医疗状况更能导致不良结果。
我们的研究采用基于访谈的定性扎根理论方法，探讨病史异质性和疾病信念是否会影响13名ICD患者的生活质量。
感知控制成为与生活质量相关的核心类别，有三个与控制相关的子系统主题：（1）疾病信念、归因和评估；（2）应对资源和策略；（3）社会世界。适应能力最差的风险患者年龄较小（<45岁）、失业且有急性心脏病史。这些患者将自己的疾病解释为严重，采用以情绪为中心的应对方式（如避免某些情况），并认为自己被社会排斥。病情好转的患者采用积极的以问题为中心的应对方式（如正常化），并尽量减少设备带来的影响。
这些数据建立了一个生活质量的理论模型，该模型确定了感知控制、疾病信念和应对方式对适应的影响。通过我们的研究，我们对与ICD患者相关的综合心理问题有了更广泛的理解，并且能够在一个重视健康和幸福的社会背景下，通过干预措施来治疗那些有风险的患者，以促进他们的适应。
