Rahmawati Anita, Chishaki Akiko, Ohkusa Tomoko, Sawatari Hiroyuki, Tsuchihashi-Makaya Miyuki, Ohtsuka Yuko, Nakai Mori, Miyazono Mami, Hashiguchi Nobuko, Sakurada Harumizu, Takemoto Masao, Mukai Yasushi, Inoue Shujirou, Sunagawa Kenji, Chishaki Hiroaki
Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
Department of Health Sciences, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.
J Arrhythm. 2016 Apr;32(2):102-7. doi: 10.1016/j.joa.2015.10.002. Epub 2015 Nov 19.
Implantable cardioverter-defibrillators (ICDs) have been established for primary and secondary prevention of fatal arrhythmias. However, little is known about the influence of ICD indications on quality of life (QOL) and psychological disturbances. This study aimed to examine whether there were differences in QOL and psychological distress in patients that have an ICD for primary or secondary prevention of fatal arrhythmias.
A multicenter survey of 179 consecutive outpatients (29.1% primary prevention) with ICD implantations completed the Short Form-8 (SF-8), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI), and Worries about ICD (WAICD).
Patients with an ICD for primary prevention had a higher trait anxiety score and worries about ICD score than patients with an ICD for secondary prevention (41.7±12.4 vs. 34.7±12.3, p=0.001 and 39.6±18.0 vs. 30.0±18.9, p=0.002, respectively), even after adjusting for demographic and clinical characteristics. In multivariable analysis of variance, primary prevention ICD recipients reported a poorer QOL on the vitality subscale of the SF-8.
In our study population, which mostly consisted of New York Heart Association (NYHA) class I and II subjects, primary prevention ICD recipients were more prone to experience worries about their ICD, anxiety, and a poorer QOL compared to secondary prevention ICD recipients. In clinical practice, primary prevention ICD patients should be closely monitored. If warranted, they should be offered psychological intervention, as anxiety and low QOL were predictors of mortality.
植入式心脏复律除颤器（ICD）已被用于致命性心律失常的一级和二级预防。然而，关于ICD适应症对生活质量（QOL）和心理障碍的影响知之甚少。本研究旨在探讨因致命性心律失常接受一级或二级预防ICD治疗的患者在生活质量和心理困扰方面是否存在差异。
对179例连续接受ICD植入的门诊患者（29.1%为一级预防）进行多中心调查，这些患者完成了简短健康调查问卷（SF-8）、贝克抑郁量表（BDI）、事件影响量表修订版（IES-R）、状态-特质焦虑量表（STAI）以及对ICD的担忧量表（WAICD）。
即使在调整了人口统计学和临床特征后，一级预防ICD患者的特质焦虑得分和对ICD的担忧得分仍高于二级预防ICD患者（分别为41.7±12.4对34.7±12.3，p = 0.001；39.6±18.0对30.0±18.9，p = 0.002）。在多变量方差分析中，一级预防ICD接受者在SF-8的活力子量表上报告的生活质量较差。
在我们主要由纽约心脏协会（NYHA）I级和II级受试者组成的研究人群中，与二级预防ICD接受者相比，一级预防ICD接受者更容易对其ICD感到担忧、焦虑，且生活质量较差。在临床实践中，应密切监测一级预防ICD患者。如有必要，应给予他们心理干预，因为焦虑和低生活质量是死亡率的预测因素。
