Bedair Radwa, Babu-Narayan Sonya V, Dimopoulos Konstantinos, Quyam Sadia, Doyle Anne-Marie, Swan Lorna, Gatzoulis Michael A, Wong Tom
Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom.
Adult Congenital Heart Disease Centre, Royal Brompton Hospital, United Kingdom; National Heart and Lung Institute, Imperial College, London, United Kingdom; NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, United Kingdom.
Int J Cardiol. 2015 Feb 15;181:218-24. doi: 10.1016/j.ijcard.2014.12.028. Epub 2014 Dec 3.
The psychological impact of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (ACHD) has not been established.
To compare device acceptance, quality of life, anxiety and depression between ACHD patients with ICDs (ICD-Congenital), with pacemakers (PPM-Congenital), with no devices (No Device-Congenital) and non-ACHD patients with ICDs (ICD-Non-Congenital).
A total of 147 ACHD and 46 non-ACHD patients (age 45.0±14.7 years, 56.5% males) completed the Florida Patient Acceptance Survey (FPAS), the 36-item Short Form Health Survey (SF-36) and Hospital Anxiety & Depression Scale (HADS).
ICD-Congenital patients (n=59) showed lower device acceptance compared to PPM-Congenital patients (n=41), p=0.04, and reported worse quality of life (p=0.001) and higher prevalence of depression (p=0.009) when compared to No Device-Congenital (n=47) patients. ICD-Congenital and ICD-Non-Congenital patients (n=46) showed similar mental and physical health, device acceptance, anxiety and depression. Within ICD-Congenital, patients with poorest device acceptance (FPAS <67, "Non-Acceptors") showed significantly lower mental health scores (p=0.008), and higher levels of anxiety (p=0.02) and depression (p=0.01) compared to "Acceptors" (FPAS ≥67). "Non-Acceptors" were younger at survey (p=0.006), younger at ICD implantation (p=0.01) and were less likely to have received appropriate shocks (p=0.03).
Younger age and lack of appropriate ICD shocks are risk factors for poor ICD acceptance. Device acceptance is lower in adults with congenital heart disease who receive an ICD than those who receive pacemakers. Appropriate screening for anxiety and depression may be warranted for ACHD patients considered for ICD implantation or already living with ICDs.
植入式心脏复律除颤器（ICD）对患有先天性心脏病（ACHD）的成年人的心理影响尚未明确。
比较患有ICD的ACHD患者（ICD - 先天性）、患有起搏器的ACHD患者（PPM - 先天性）、未植入设备的ACHD患者（无设备 - 先天性）以及非ACHD的ICD患者（ICD - 非先天性）之间的设备接受度、生活质量、焦虑和抑郁情况。
共有147例ACHD患者和46例非ACHD患者（年龄45.0±14.7岁，男性占56.5%）完成了佛罗里达患者接受度调查（FPAS）、36项简短健康调查（SF - 36）以及医院焦虑与抑郁量表（HADS）。
与PPM - 先天性患者（n = 41）相比，ICD - 先天性患者（n = 59）的设备接受度较低，p = 0.04；与无设备 - 先天性患者（n = 47）相比，ICD - 先天性患者报告的生活质量较差（p = 0.001），抑郁患病率较高（p = 0.009）。ICD - 先天性患者和ICD - 非先天性患者（n = 46）在心理和身体健康、设备接受度、焦虑和抑郁方面表现相似。在ICD - 先天性患者中，设备接受度最差的患者（FPAS < 67，“不接受者”）与“接受者”（FPAS≥67）相比，心理健康得分显著较低（p = 0.008），焦虑水平较高（p = 0.02），抑郁水平较高（p = 0.01）。“不接受者”在调查时年龄较小（p = 0.006），ICD植入时年龄较小（p = 0.01），且接受适当电击的可能性较小（p = 0.03）。
年龄较小和缺乏适当的ICD电击是ICD接受度差的危险因素。接受ICD的先天性心脏病成年人的设备接受度低于接受起搏器的成年人。对于考虑植入ICD或已植入ICD的ACHD患者，可能有必要进行焦虑和抑郁的适当筛查。
