CoRPS-Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
Europace. 2013 Mar;15(3):355-61. doi: 10.1093/europace/eus295. Epub 2012 Sep 18.
Implantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influence of living with an ICD vs. congestive heart failure (CHF) on PROs and compared (i) ICD patients without CHF (ICD only), (ii) CHF patients without an ICD (CHF-only), and (iii) CHF patients with an ICD (ICD + CHF).
Separate cohorts of ICD and CHF patients (N = 435; 75% men) completed PROs at baseline, 6 and 12 months. Groups differed on physical health status only at baseline (F((2,415)) = 7.15, P = 0.001) and on anxiety at 12 months (F((2,415)) = 4.04, P = 0.01); ICD + CHF patients had the most impaired physical health status but the lowest anxiety level followed by the ICD only and CHF only patients. Congestive heart failure only patients had the most impaired mental health status and reported the highest level of anxiety as compared to the ICD only (P < 0.001) and ICD + CHF groups (P = 0.009), while the two latter groups did not differ. The effect sizes ranged from very small (0.03) to moderate-large (0.69). Groups did not differ in depression scores.
Congestive heart failure patients reported worse PROs as compared to ICD patients, although the magnitude of the differences was relatively small. This suggests that the well being of patients is not necessarily negatively influenced by the implantation of an ICD, and that underlying heart disease may have at least an equal if not greater influence on PROs.
植入式心脏复律除颤器（ICD）治疗，包括电击风险，被认为是降低患者报告结果（PROs；例如健康状况和痛苦）的主要原因，从而否定了基础疾病严重程度的作用。我们研究了患有 ICD 与充血性心力衰竭（CHF）对 PROs 的相对影响，并比较了（i）无 CHF 的 ICD 患者（ICD 仅），（ii）无 ICD 的 CHF 患者（CHF 仅）和（iii）有 ICD 的 CHF 患者（ICD + CHF）。
分别有 ICD 和 CHF 患者（N = 435；75%为男性）在基线、6 个月和 12 个月时完成了 PROs。仅在基线时，各组在身体健康状况上存在差异（F((2,415)) = 7.15，P = 0.001），在 12 个月时在焦虑方面存在差异（F((2,415)) = 4.04，P = 0.01）；ICD + CHF 患者的身体健康状况最差，但焦虑程度最低，其次是 ICD 仅和 CHF 仅患者。与 ICD 仅（P < 0.001）和 ICD + CHF 组（P = 0.009）相比，CHF 仅患者的心理健康状况最差，焦虑程度最高，而后两组之间没有差异。效应大小范围从很小（0.03）到中等大（0.69）。各组在抑郁评分上没有差异。
与 ICD 患者相比，充血性心力衰竭患者报告的 PROs 更差，尽管差异的幅度相对较小。这表明，患者的幸福感不一定会因植入 ICD 而受到负面影响，并且潜在的心脏病可能对 PROs 至少具有同等甚至更大的影响。
