Richardson Ebony, Spinks Catherine, Davis Andrew, Turner Christian, Atherton John, McGaughran Julie, Semsarian Christopher, Ingles Jodie
Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Locked Bag 6, Newtown, NSW, 2042, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
J Genet Couns. 2018 Jun;27(3):549-557. doi: 10.1007/s10897-017-0152-1. Epub 2017 Sep 23.
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic disease with a high risk of sudden cardiac death. The impact on health-related quality of life (HR-QoL) and psychosocial outcomes is not known. We sought to provide the first description of HR-QoL and psychosocial wellbeing of adults with CPVT, parents of affected children and at-risk relatives. Participants were recruited through the Australian Genetic Heart Disease Registry and invited to complete a cross-sectional survey comprising a number of validated scales and open-ended questions. Thirty-five participants completed surveys (response rate 65%), including 19 with CPVT, 10 unaffected parents of a child with CPVT, and 7 at-risk relatives (one participant considered patient and parent). Young patients <40 years were significantly more likely to report anxiety (p = 0.04), depression (p = 0.03) and posttraumatic stress symptoms (p = 0.02) compared to older CPVT patients. Further, young patients with an implantable cardioverter defibrillator (ICD) reported significantly worse device-related distress (p = 0.04) and shock anxiety (p = 0.003). Patients with a genetic diagnosis had worse psychological adaptation than those patients without a gene result. Parents perceived their affected children to have poor quality of life across all subdomains compared to healthy age-matched children, however quality of life of parents and at-risk relatives was comparable to population norms. Ongoing psychosocial care is required for young people with CPVT. Those with an ICD and/or undergoing genetic testing may require additional support. The challenges of CPVT management should extend beyond the clinical and genetic aspects of care to incorporate greater psychosocial support, and further reinforces the need for a multidisciplinary approach to care.
儿茶酚胺能多形性室性心动过速(CPVT)是一种罕见的遗传性致心律失常疾病,具有较高的心源性猝死风险。其对健康相关生活质量(HR-QoL)和心理社会结局的影响尚不清楚。我们试图首次描述成年CPVT患者、患病儿童的父母以及高危亲属的HR-QoL和心理社会状况。通过澳大利亚遗传性心脏病登记处招募参与者,并邀请他们完成一项横断面调查,该调查包括一些经过验证的量表和开放式问题。35名参与者完成了调查(回复率65%),其中包括19名CPVT患者、10名CPVT患儿的未患病父母以及7名高危亲属(一名参与者同时被视为患者和父母)。与年龄较大的CPVT患者相比,年龄<40岁的年轻患者更有可能报告焦虑(p = 0.04)、抑郁(p = 0.03)和创伤后应激症状(p = 0.02)。此外,植入式心脏复律除颤器(ICD)的年轻患者报告的与设备相关的困扰(p = 0.04)和电击焦虑(p = 0.003)明显更严重。基因诊断的患者心理适应比未得到基因检测结果的患者更差。与年龄匹配的健康儿童相比,父母认为他们患病的孩子在所有子领域的生活质量都很差,然而父母和高危亲属的生活质量与人群规范相当。CPVT的年轻患者需要持续的心理社会护理。那些植入ICD和/或正在进行基因检测的患者可能需要额外的支持。CPVT管理的挑战应超越护理的临床和基因方面,纳入更多的心理社会支持,并进一步强化多学科护理方法的必要性。