Januszkiewicz Łukasz, Barra Sérgio, Providencia Rui, Conte Giulio, de Asmundis Carlo, Chun Julian K R, Farkowski Michał M, Guerra Jose M, Marijon Eloi, Boveda Serge
1st Department of Cardiology, Medical University of Warsaw, Poland.
Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal.
Europace. 2022 May 3;24(5):860-867. doi: 10.1093/europace/euac011.
Implantable cardioverter-defibrillator (ICD) may impact patients' life significantly. The aim of this survey was to analyse the impact of the ICD on quality of life (QoL) metrics from the patient's perspective. 'Living with an ICD' was a prospective, multicentre study with an online questionnaire submitted to the European Heart Rhythm Association (EHRA) Research Network centres as well as patient associations from 10 European countries; it was filled-in directly and personally by the patients that were invited to participate, with a minimal interaction or influence from the healthcare professionals. Overall, the questionnaire was completed by 1809 patients (624 women, 34.5%). Patients in their 60s and 70s and from Western Europe were the most represented. The median time from first ICD implantation was 5 years (IQR 2-10). Device-related complications were reported by 505 patients (22.4%), including one or more inappropriate shocks (n = 209, 11.6%). Almost half the respondents reported improved QoL, with a more favourable impact for those receiving cardiac resynchronization therapy-defibrillator (CRT-D), and only a 10th experienced a significant decrease in QoL. The occurrence of complications remained a major predictor of deteriorated QoL (odds ratio 2.1, 95% confidence interval 1.4-3.0, P < 0.001). In conclusion, most patients have a globally positive view and acceptance of ICD therapy, reporting preserved to improved QoL after device implantation. Complications, namely inappropriate shocks, affect the expectation of living a normal life post-implant and are associated with a significant decrease in QoL. Our findings also highlight the importance of a detailed informed consent process and the involvement of the patient in the decision-making process.
植入式心脏复律除颤器（ICD）可能会对患者的生活产生重大影响。本调查的目的是从患者的角度分析ICD对生活质量（QoL）指标的影响。“与ICD共存”是一项前瞻性、多中心研究，通过在线问卷的形式提交给欧洲心律协会（EHRA）研究网络中心以及来自10个欧洲国家的患者协会；问卷由受邀参与的患者直接亲自填写，医疗保健专业人员的干预或影响最小。总体而言，1809名患者完成了问卷（624名女性，占34.5%）。60多岁和70多岁以及来自西欧的患者占比最高。首次植入ICD后的中位时间为5年（四分位间距2 - 10年）。505名患者（22.4%）报告了与设备相关的并发症，包括一次或多次不适当电击（n = 209，11.6%）。几乎一半的受访者报告生活质量有所改善，接受心脏再同步治疗除颤器（CRT - D）的患者改善更为明显，只有十分之一的患者生活质量显著下降。并发症的发生仍然是生活质量恶化的主要预测因素（比值比2.1，95%置信区间1.4 - 3.0，P < 0.001）。总之，大多数患者对ICD治疗总体持积极看法并接受，报告称设备植入后生活质量得以维持或改善。并发症，即不适当电击，会影响植入后正常生活的期望，并与生活质量的显著下降相关。我们的研究结果还强调了详细的知情同意过程以及患者参与决策过程的重要性。
