CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, Tilburg, The Netherlands.
Int J Cardiol. 2013 Sep 10;167(6):2705-9. doi: 10.1016/j.ijcard.2012.06.114. Epub 2012 Jul 17.
Clinical trials have shown the benefit of implantable cardioverter defibrillator (ICD) treatment. In this study, we examined the importance of chronic psychological distress and device shocks among ICD patients seen in clinical practice.
This prospective follow-up study included 589 patients with an ICD (mean age=62.6 ± 10.1 years; 81% men). At baseline, vulnerability for chronic psychological distress was measured by the 14-item Type D (distressed) personality scale. Cox regression models of all-cause and cardiac death were used to examine the importance of risk markers.
After a median follow-up of 3.2 years, 94 patients (16%) had died (67 cardiac death), 61 patients (10%) had experienced an appropriate shock and 28 (5%) an inappropriate shock. Inappropriate shocks were not associated with all-cause (p=0.52) or cardiac (p=0.99) death. However, appropriate shocks (HR=2.60, 95% CI 1.47-5.58, p=0.001) and Type D personality (HR=1.85, 95% CI 1.12-3.05, p=0.015) were independent predictors of all-cause mortality, adjusting for age, sex, left ventricular ejection fraction, cardiac resynchronization therapy (CRT), secondary indication, history of coronary artery disease, medication and diabetes. Type D personality and appropriate shocks also independently predicted an increased risk of cardiac death. Other independent predictors of poor prognosis were older age, treatment with CRT and diabetes.
Vulnerability to chronic psychological distress, as defined by the Type D construct, had incremental prognostic value above and beyond clinical characteristics and ICD shocks. Physicians should be aware of chronic psychological distress and device shocks as markers of an increased mortality risk in ICD patients seen in daily clinical practice.
临床试验已经证明植入式心脏复律除颤器（ICD）治疗的益处。在这项研究中，我们研究了在临床实践中观察到的 ICD 患者慢性心理困扰和设备电击的重要性。
这项前瞻性随访研究包括 589 名 ICD 患者（平均年龄=62.6±10.1 岁；81%为男性）。在基线时，通过 14 项 D 型（苦恼）人格量表来衡量慢性心理困扰的脆弱性。使用 Cox 回归模型分析全因和心脏死亡的所有风险标志物的重要性。
在中位数为 3.2 年的随访后，94 名患者（16%）死亡（67 例为心脏死亡），61 名患者（10%）经历了适当的电击，28 名患者（5%）经历了不适当的电击。不适当的电击与全因（p=0.52）或心脏（p=0.99）死亡无关。然而，适当的电击（HR=2.60，95%CI 1.47-5.58，p=0.001）和 D 型人格（HR=1.85，95%CI 1.12-3.05，p=0.015）是全因死亡率的独立预测因子，调整了年龄、性别、左心室射血分数、心脏再同步治疗（CRT）、次要指征、冠心病史、药物和糖尿病。D 型人格和适当的电击也独立预测了心脏死亡风险的增加。预后不良的其他独立预测因素包括年龄较大、接受 CRT 治疗和糖尿病。
D 型人格结构定义的慢性心理困扰易感性具有超过临床特征和 ICD 电击的增量预后价值。医生应该意识到慢性心理困扰和设备电击是日常临床实践中 ICD 患者死亡风险增加的标志物。
