Barsky A J, Cleary P D, Coeytaux R R, Ruskin J N
Department of Psychiatry, Harvard Medical School, Boston, USA.
Arch Intern Med. 1995 Sep 11;155(16):1782-8.
The aim of this study was to describe the longitudinal course of patients who were referred for ambulatory electrocardiographic monitoring because of palpitations.
A prospective, follow-up examination was conducted of patients who had been studied 6 months previously when referred for monitoring. The inception cohort consisted of 145 consecutive patients with palpitations and 70 asymptomatic, nonpatient volunteers. At follow-up, the patients completed the same research battery as at inception, consisting of structured interviews and self-report questionnaires. These assessed cardiac symptoms, medical care use, role impairment, somatization, hypochondriacal fears and beliefs, and psychiatric disorder.
At 6 months' follow-up, 130 patients with palpitations (89.7% of the original cohort) and 69 nonpatients (98.6%) were reinterviewed. Eighty-four percent of the patients had recurrent palpitations during the 6-month follow-up period. At follow-up, patients with palpitations scored significantly higher than the comparison group on measures of cardiac symptoms and role impairment, and had made more physician visits in the preceding 6 months. They had a higher prevalence of panic disorder and more psychopathologic symptoms, somatized more, and were more hypochondriacal. Psychiatric symptoms and the tendency to amplify bodily sensation, measured at inception, were significant but modest predictors of subsequent palpitations. There was considerable confusion and misunderstanding among patients as to the findings of their ambulatory electrocardiogram and the presence or absence of panic disorder.
Patients with palpitations remain symptomatic and functionally impaired and have increased rates of physician visits in the 6 months following Holter monitoring. They also continue to have elevated rates of panic disorder and to evidence some confusion about the cause of their symptoms.
本研究旨在描述因心悸而接受动态心电图监测的患者的纵向病程。
对6个月前因监测而接受研究的患者进行前瞻性随访检查。初始队列包括145例连续的心悸患者和70例无症状的非患者志愿者。在随访时，患者完成了与初始时相同的研究项目，包括结构化访谈和自我报告问卷。这些评估了心脏症状、医疗护理使用情况、角色损害、躯体化、疑病恐惧和信念以及精神障碍。
在6个月的随访中，对130例心悸患者（占原始队列的89.7%）和69例非患者（98.6%）进行了再次访谈。84%的患者在6个月的随访期内心悸复发。在随访时，心悸患者在心脏症状和角色损害测量方面的得分显著高于对照组，并且在之前的6个月内看医生的次数更多。他们惊恐障碍的患病率更高，有更多的精神病理症状，躯体化更严重，且更疑病。在初始时测量的精神症状和放大身体感觉的倾向是随后心悸的显著但适度的预测因素。患者对其动态心电图的结果以及惊恐障碍的有无存在相当多的困惑和误解。
心悸患者在动态心电图监测后的6个月内仍有症状且功能受损，看医生的次数增加。他们惊恐障碍的发生率也持续升高，并且对其症状的原因仍存在一些困惑。
