Knight Cardiovascular Institute Oregon Health & Science University Portland OR.
J Am Heart Assoc. 2022 Aug 2;11(15):e025301. doi: 10.1161/JAHA.122.025301. Epub 2022 Jul 29.
Background Ventricular arrhythmias (VAs) and their treatment have been associated with psychological distress and diminished quality of life (QOL). We administered a battery of patient-reported outcome measures (PROMs) to patients seeing an electrophysiologist and psychologist in a multidisciplinary VA clinic for patients referred for consideration of catheter ablation for sustained VAs or implantable cardioverter-defibrillator therapies. Methods and Results In this retrospective study of the initial VA clinic visit, we analyzed PROMs of: anxiety and depression symptoms, visual analog scales for physical health status and quality of life, cardiac anxiety, implantable cardioverter-defibrillator acceptance, and implantable cardioverter-defibrillator shock anxiety. We quantitated baseline PROM score means and performed correlation analysis with clinical makers of cardiac and VA disease severity. We also performed an item-level analysis of each PROM question to quantify most frequent patient concerns. A total of 66 patients (56±15 years; 77% men) were included; 70% had prior implantable cardioverter-defibrillator shock, and 44% with prior VA ablation. Elevated symptoms of anxiety (53%) and depression (20%) were common. Younger patients had greater symptom burden of general health anxiety, cardiac anxiety, and shock anxiety, and lower device acceptance, but indices of VA burden such as number of ICD shocks and time since last ICD shock did not predict anxiety or depression. Item-level review of cardiac-specific PROMs revealed that >40% of patients expressed concern regarding resumption of physical activity, sex and employment. Conclusions Clinicians can expect elevated symptoms of depression, and cardiac and device-related anxiety among patients with VAs. Routine use of PROMs may elicit these symptoms, which were otherwise not predicted by arrhythmia burden. Review of individual PROM items can facilitate targeting specific patient concerns, which commonly involved physical activity.
室性心律失常（VA）及其治疗与心理困扰和生活质量（QOL）下降有关。我们为在多学科 VA 诊所就诊的电生理学家和心理学家治疗的患者，发放了一系列患者报告的结局测量量表（PROMs）。这些患者因持续性 VA 或植入式心脏复律除颤器治疗而接受导管消融治疗。
在这项 VA 诊所初次就诊的回顾性研究中，我们分析了 PROMs，包括：焦虑和抑郁症状、健康状况和生活质量的视觉模拟量表、心脏焦虑、植入式心脏复律除颤器的接受程度和植入式心脏复律除颤器电击焦虑。我们量化了 PROM 基线评分的平均值，并与心脏和 VA 疾病严重程度的临床指标进行了相关性分析。我们还对每个 PROM 问题进行了项目级分析，以量化患者最常见的关注点。共纳入 66 例患者（56±15 岁；77%为男性）；70%的患者有植入式心脏复律除颤器电击史，44%的患者有 VA 消融史。焦虑（53%）和抑郁（20%）症状常见。年轻患者的一般健康焦虑、心脏焦虑和电击焦虑症状负担更大，设备接受度更低，但 ICD 电击次数和上次 ICD 电击后时间等 VA 负担指标并不能预测焦虑或抑郁。对心脏特定 PROM 的项目级审查显示，超过 40%的患者对恢复体力活动、性生活和就业表示担忧。
VA 患者会出现抑郁、心脏和与设备相关的焦虑等症状。常规使用 PROMs 可能会引起这些症状，而这些症状不能通过心律失常负担来预测。审查单个 PROM 项目可以帮助确定患者的具体关注点，这些关注点通常涉及体力活动。
