Thylén Ingela, Jaarsma Tiny, Ingadottir Brynja
J Cardiovasc Nurs. 2022;37(3):221-230. doi: 10.1097/JCN.0000000000000795.
Little is known about risk factors for poor adjustment to the device after cardiac resynchronization therapy (CRT) implantation in patients with heart failure.
The aim of this study was to explore device adjustment and the postoperative recovery of patients with heart failure undergoing elective CRT device implantation.
In this prospective multicenter longitudinal study, data were collected before implantation and after 2 weeks, 6 months, and 1 year, using validated self-reported instruments and investigator-designed, CRT-specific questions.
A total of 133 patients, 79% male, with a mean age of 70 ± 10 years, were included. Patients adjusted to the device over time (P < .001), but 20% of patients had difficulties after 2 weeks, and 11% had difficulties at the 1-year follow-up. Fatigue was the most common health problem before surgery (87%), which was reduced to 65% after 1 year, P < .001. Patients' recovery improved over time (P < .001). Device-specific problems with hiccups (7% vs 14%), pulsation around the device (29% vs 24%), tachycardia (28% vs 29%), appearance of the scar (21% vs 17%), and the device bulging out (65% vs 61%) remained unchanged over time, whereas stiffness in the shoulder (64% vs 28%, P < .001) and wound healing (9% vs 2%, P < .05) improved.
Most patients with heart failure recover and adjust early after their CRT implantation and improve even more during follow-up. However, recovery and adjustment are problematic for some patients, and many experience bodily discomforts because of the device. Early screening for poor adjustment and psychological distress can lead to appropriate interventions and timely referrals. This is important in the era of remote monitoring with less face-to-face contact.
对于心力衰竭患者心脏再同步治疗（CRT）植入术后对设备适应不良的风险因素知之甚少。
本研究旨在探讨接受择期CRT设备植入的心力衰竭患者的设备适应情况及术后恢复情况。
在这项前瞻性多中心纵向研究中，使用经过验证的自我报告工具和研究者设计的CRT特定问题，在植入前以及植入后2周、6个月和1年收集数据。
共纳入133例患者，男性占79%，平均年龄为70±10岁。患者随时间推移逐渐适应设备（P<.001），但20%的患者在2周后仍有困难，11%的患者在1年随访时有困难。疲劳是手术前最常见的健康问题（87%），1年后降至65%，P<.001。患者的恢复情况随时间改善（P<.001）。与设备相关的问题，如打嗝（7%对14%）、设备周围搏动（29%对24%）、心动过速（28%对29%）、疤痕外观（21%对17%）以及设备突出（65%对61%）随时间保持不变，而肩部僵硬（64%对28%，P<.001）和伤口愈合（9%对2%，P<.05）有所改善。
大多数心力衰竭患者在CRT植入术后早期恢复并适应，且在随访期间改善更为明显。然而，部分患者的恢复和适应存在问题，许多患者因设备而出现身体不适。早期筛查适应不良和心理困扰可导致适当干预和及时转诊。在远程监测且面对面接触较少的时代，这一点很重要。
