Versteeg Henneke, Timmermans Ivy, Meine Mathias, Zitron Edgar, Mabo Philippe, Denollet Johan
Department of Cardiology, University Medical Center Utrecht, The Netherlands.
Department of Cardiology, University Medical Center Utrecht, The Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, The Netherlands.
Int J Cardiol. 2017 Aug 1;240:208-213. doi: 10.1016/j.ijcard.2017.03.124. Epub 2017 Mar 31.
Evidence on psychological distress in patients living with an implantable cardioverter defibrillator (ICD) is inconclusive. The current study is the first to examine the prevalence and risk markers of anxiety and/or depression in a large international cohort of European ICD patients with or without cardiac resynchronization therapy (CRT).
Heart failure patients (N=569) from France, Germany, Spain, Switzerland and the Netherlands participating in the REMOTE-CIED study completed a set of questionnaires 1-2weeks post ICD-implantation, including the 7-item Generalized Anxiety Disorder scale and the 9-item Patient Health Questionnaire to assess anxiety and depressive symptoms, respectively. Patients' clinical data were obtained from their medical records.
The prevalence of anxiety was 16% and that of depression 19%, with 25% of patients reporting one or both types of distress. Multivariable logistic regression analysis showed that age <60years (odds ratio (OR)=2.5[95% confidence interval=1.2-5.0]), having a threatening view of heart failure (OR=4.7[2.7-8.2]), a high level of ICD-related concerns (OR=2.9[1.7-5.1]), Type D personality (OR=2.4[1.3-4.4]), poor patient-reported health status (OR=2.2[1.3-3.9]) and receiving psychotropic medication (OR=3.0[1.5-5.9]) were positively associated with distress, while attending cardiac rehabilitation (OR=0.3[0.2-0.7]) was negatively associated with distress.
A significant subset of European ICD and CRT-defibrillator patients reports anxiety and/or depression in the first weeks post implantation. Patients' psychological characteristics, especially negative perceptions about their illness and treatment, were the strongest associates of distress. Timely identification of these patients is essential as they may benefit from psychological interventions and cardiac rehabilitation in terms of improved quality of life and prognosis.
关于植入式心脏复律除颤器（ICD）患者心理困扰的证据尚无定论。本研究首次在一个大型国际队列中，对接受或未接受心脏再同步治疗（CRT）的欧洲ICD患者焦虑和/或抑郁的患病率及风险标志物进行研究。
来自法国、德国、西班牙、瑞士和荷兰的569例参与REMOTE-CIED研究的心力衰竭患者在ICD植入后1-2周完成了一组问卷，分别包括7项广泛性焦虑障碍量表和9项患者健康问卷，以评估焦虑和抑郁症状。患者的临床数据从其病历中获取。
焦虑患病率为16%，抑郁患病率为19%，25%的患者报告有其中一种或两种困扰。多变量逻辑回归分析显示，年龄<60岁（比值比（OR）=2.5[95%置信区间=1.2-5.0]）、对心力衰竭持悲观态度（OR=4.7[2.7-8.2]）、对ICD相关问题高度关注（OR=2.9[1.7-5.1]）、D型人格（OR=2.4[1.3-4.4]）、患者报告的健康状况较差（OR=2.2[1.3-3.9]）以及正在接受精神药物治疗（OR=3.0[1.5-5.9]）与困扰呈正相关，而参加心脏康复（OR=0.3[0.2-0.7]）与困扰呈负相关。
相当一部分欧洲ICD和CRT除颤器患者在植入后的头几周报告有焦虑和/或抑郁。患者的心理特征，尤其是对自身疾病和治疗的负面认知，是困扰的最强相关因素。及时识别这些患者至关重要，因为他们可能会从心理干预和心脏康复中受益，从而改善生活质量和预后。
