目的:植入式心律转复除颤器(ICD)预防心源性猝死。焦虑,抑郁症,创伤后应激障碍(PTSD)是未被重视的症状。我们旨在系统地综合情绪障碍和症状严重程度的患病率估计,ICD插入前和后。与对照组进行比较,以及ICD患者的适应症(原发性与secondary),性别,休克状态,随着时间的推移。
方法:数据库(Medline,PsycINFO,PubMed,和Embase)从开始到2022年8月31日不受限制地搜索;确定了4661篇文章,109例(39954例患者)符合标准。
结果:随机效应荟萃分析显示,在插入后的所有时间点中,有22.58%(95CI18.26-26.91%)的ICD患者的临床相关焦虑和15.42%(95CI11.90-18.94%)的抑郁。创伤后应激障碍发生率为12.43%(95CI6.90-17.96%)。比率相对于适应症组没有变化。临床相关的焦虑和抑郁在经历电击的ICD患者中更可能[焦虑比值比(OR)=3.92(95CI1.67-9.19);抑郁OR=1.87(95CI1.34-2.59)]。插入后女性的焦虑症状高于男性[Hedges\'g=0.39(95CI0.15-0.62)]。插入后的前5个月抑郁症状减轻[Hedges\'g=0.13(95CI0.03-0.23)],6个月后焦虑症状减轻[Hedges\'g=0.07(95CI0-0.14)]。
结论:抑郁和焦虑在ICD患者中非常普遍,尤其是那些经历冲击的人。特别值得关注的是ICD植入后PTSD的患病率。心理评估,监测,作为常规护理的一部分,应向ICD患者及其伴侣提供治疗.
Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time.
Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria.
Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced
shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges\' g = 0.39 (95%CI 0.15-0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges\' g = 0.13 (95%CI 0.03-0.23)] and anxiety symptoms after 6 months [Hedges\' g = 0.07 (95%CI 0-0.14)].
Depression and anxiety are highly prevalent in ICD patients, especially in those who experience
shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.