因植入心脏除颤器后驾驶受限导致生活质量下降。
Decreased Quality of Life Due to Driving Restrictions After Cardioverter Defibrillator Implantation.
机构信息
Ivy Timmermans, MSc PhD student and Medical Psychologist, Department of Cardiology, University Medical Center Utrecht, and Department of Medical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands. Niels Jongejan, MSc Physician Assistant, Department of Cardiology, University Medical Center Utrecht, The Netherlands. Mathias Meine, MD, PhD Physician, Department of Cardiology, University Medical Center Utrecht, The Netherlands. Pieter Doevendans, MD, PhD Department of Cardiology, University Medical Center Utrecht, and Netherlands Heart Institute, Utrecht, The Netherlands. Anton Tuinenburg, MD, PhD Physician, Department of Cardiology, University Medical Center Utrecht, The Netherlands. Henneke Versteeg, PhD Assistant Professor and Medical Psychologist, Department of Cardiology, University Medical Center Utrecht, The Netherlands.
出版信息
J Cardiovasc Nurs. 2018 Sep/Oct;33(5):474-480. doi: 10.1097/JCN.0000000000000474.
BACKGROUND
Driving restrictions for patients with an implantable cardioverter defibrillator (ICD) may require significant lifestyle adjustment and affect patients' psychological well-being. This study explored the prevalence of, and factors associated with, patient-reported decrease in quality of life due to driving restrictions in the first 2 months postimplantation.
METHODS
Dutch ICD patients (N = 334; median age, 64 [interquartile range, 55-70) years; 81% male) completed questionnaires at the time of implantation and 4 months postimplantation, assessing their sociodemographic, psychological, and driving-related characteristics. Clinical baseline data were retrieved from patients' medical records.
RESULTS
Nearly half of the patients (49%) reported decreased quality of life due to driving restrictions. Patient-reported reasons included dependency on others/public transport, (social) isolation, and inability to work. Patients reporting decreased quality of life were more likely to be younger (P = .01), to feel that the restriction lasts too long (P = .004), to have considered ICD refusal because of the restrictions (P = .03), and to have Type D personality (P = .02), anxiety (P = .05), depression (P = .003), and ICD-related concerns (P = .02). Multivariable analysis showed that being younger than 60 years (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.09-4.88; P = .03), feeling the driving restriction lasts too long (OR, 1.77; 95% CI, 1.23-2.55; P = .002), and depression (OR, 3.21; 95% CI, 1.09-9.47; P = .035) were independently associated with decreased quality of life due to driving restrictions.
CONCLUSIONS
This study indicated that a significant group of ICD patients may experience decreased quality of life because of the driving restrictions postimplantation. The restrictions seem to particularly affect patients who are younger and distressed and patients who feel that the restriction lasts too long.
背景
植入式心脏复律除颤器 (ICD) 患者的驾驶限制可能需要重大的生活方式调整，并影响患者的心理健康。本研究探讨了植入后 2 个月内患者因驾驶限制而报告的生活质量下降的发生率和相关因素。
方法
荷兰 ICD 患者（N=334；中位年龄 64 [四分位距 55-70] 岁；81%为男性）在植入时和植入后 4 个月完成了问卷，评估他们的社会人口统计学、心理和驾驶相关特征。临床基线数据从患者的病历中检索。
结果
近一半的患者（49%）报告因驾驶限制而导致生活质量下降。患者报告的原因包括依赖他人/公共交通工具、（社交）隔离和无法工作。报告生活质量下降的患者更年轻（P=0.01），认为限制持续时间过长（P=0.004），更考虑因限制而拒绝 ICD（P=0.03），且具有 D 型人格（P=0.02）、焦虑（P=0.05）、抑郁（P=0.003）和 ICD 相关问题（P=0.02）。多变量分析显示，年龄小于 60 岁（优势比 [OR]，2.30；95%置信区间 [CI]，1.09-4.88；P=0.03）、感觉驾驶限制持续时间过长（OR，1.77；95% CI，1.23-2.55；P=0.002）和抑郁（OR，3.21；95% CI，1.09-9.47；P=0.035）与因驾驶限制而导致的生活质量下降独立相关。
结论
本研究表明，相当一部分 ICD 患者可能因植入后驾驶限制而导致生活质量下降。这些限制似乎特别影响年轻、焦虑和感觉限制持续时间过长的患者。
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