心搏骤停后和初始植入式心脏复律除颤器（ICD）治疗中的社会认知理论干预对身体功能、心理调整和自我效能的影响：一项随机对照试验的二次分析。
Physical function, psychological adjustment, and self-efficacy following sudden cardiac arrest and an initial implantable cardioverter defibrillator (ICD) in a social cognitive theory intervention: secondary analysis of a randomized control trial.
机构信息
School of Nursing, Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, Box 357266, Seattle, WA, 98195, USA.
Evidera PPD, London, England, UK.
出版信息
BMC Cardiovasc Disord. 2022 Aug 10;22(1):369. doi: 10.1186/s12872-022-02782-8.
BACKGROUND
Sudden cardiac arrest (SCA) survivorship results in unique issues in return to physical and psychological function. The purpose of the study was to compare recovery across the first year between SCA survivors and other arrhythmia patients who received a first-time implantable cardioverter defibrillator (ICD) for secondary prevention, participating in a social cognitive theory (SCT) intervention.
METHODS
168 (129 males, 39 females) who received an ICD for secondary prevention (SCA N = 65; other arrhythmia N = 103) were randomized to one of two study conditions: SCT intervention (N = 85) or usual care (N = 83). Outcomes were measured at baseline hospital discharge, 1, 3, 6, & 12 months: (1) Physical Function: Patient Concerns Assessment (PCA), SF-36 (PCS); (2) Psychological Adjustment: State Trait Anxiety (STAI), CES-D depression, SF-36 (MCS); (3) Self-Efficacy: Self-Efficacy (SCA-SE), Self-management Behaviors (SMB), Outcome Expectations (OE). Outcomes were compared over 12 months for intervention condition x ICD indication using general estimating equations.
RESULTS
Participants were Caucasian (89%), mean age 63.95 ± 12.3 years, EF% 33.95 ± 13.9, BMI 28.19 ± 6.2, and Charlson Index 4.27 ± 2.3. Physical symptoms (PCA) were higher over time for SCA survivors compared to the other arrhythmia group (p = 0.04), ICD shocks were lower in SCA survivors in the SCT intervention (p = 0.01); psychological adjustment (MCS) was significantly lower in SCA survivors in the SCT intervention over 6 months, which improved at 12 months (p = 0.05); outcome expectations (OE) were significantly lower for SCA survivors in the SCT intervention (p = 0.008).
CONCLUSIONS
SCA survivors had greater number of physical symptoms, lower levels of mental health and outcome expectations over 12 months despite participation in a SCT intervention. Trial registration Clinicaltrials.gov: NCT04462887.
背景
心脏骤停（SCA）幸存者在恢复身体和心理功能方面会出现一些独特的问题。本研究的目的是比较 SCA 幸存者和因其他心律失常而接受首次植入式心律转复除颤器（ICD）二级预防的患者在 SCT 干预后的第一年的恢复情况。
方法
168 名（男性 129 名，女性 39 名）因心律失常接受 ICD 二级预防（SCA N=65；其他心律失常 N=103）的患者被随机分配到两种研究条件之一：SCT 干预组（N=85）或常规护理组（N=83）。在基线出院时、1、3、6 和 12 个月时测量以下结果：（1）身体功能：患者关注评估量表（PCA）、SF-36（PCS）；（2）心理调整：状态特质焦虑量表（STAI）、CES-D 抑郁量表、SF-36（MCS）；（3）自我效能：SCA 自我效能（SCA-SE）、自我管理行为（SMB）、结果期望（OE）。使用广义估计方程比较干预条件 x ICD 指征对 12 个月内的结果的影响。
结果
参与者为白种人（89%），平均年龄 63.95±12.3 岁，EF%为 33.95±13.9，BMI 为 28.19±6.2，Charlson 指数为 4.27±2.3。与其他心律失常组相比，SCA 幸存者的身体症状（PCA）随时间推移呈上升趋势（p=0.04），SCA 幸存者的 ICD 电击在 SCT 干预中较低（p=0.01）；在 6 个月时，SCA 幸存者的心理调整（MCS）在 SCT 干预中显著降低，12 个月时改善（p=0.05）；SCT 干预中 SCA 幸存者的结果期望（OE）显著降低（p=0.008）。
结论
尽管接受了 SCT 干预，但 SCA 幸存者在 12 个月内仍存在更多的身体症状、更低的心理健康水平和结果期望。
试验注册
Clinicaltrials.gov：NCT04462887。
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