患者对可植入心脏转换器除器发电机交换的看法
Sarah C Montembeau1, Faisal M Merchant1, Candace Speight1
1Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (S.C.M., F.M.M., C.S., N.W.D., B.R.R.).
Circulation. Cardiovascular quality and outcomes
|July 26, 2023
概括
患者经常继续植入式心脏转换器除器 (ICD) 发生器交换,尽管突然心脏死亡风险下降. 对ICD发电机交换的共享决策需要改进,解决治疗惯性和误解.
科学领域:
- 心脏病学 心脏病学
- 医疗决策的制定 医疗决策的制定
- 健康心理学 心理健康心理学
背景情况:
- 共享决策是初级预防植入式心脏转换器除器 (ICD) 的标准.
- 关于ICD生成器交换的决定得到了较少的关注,尽管患者的风险,预后和生活质量可能发生变化.
- 这项研究探讨了ICD生成器交换的患者决策过程.
研究的目的:
- 为了研究患者如何做出关于ICD发电机交换的决定.
- 了解接受发电机更换的患者福利门.
- 识别ICD生成器交换的共享决策中的障碍和促进者.
主要方法:
- 对50名初级预防ICD患者进行了定性访谈.
- 患者被介绍了涉及不同突发心脏病死亡风险的假设场景,以评估发电机交换的意愿.
- 采访被转录和编码使用多层模板分析方法.
主要成果:
- 随着心脏突然死亡风险降低 (48/42/33名患者的10%/5%/1%风险) 愿意进行发电机更换的意愿下降.
- 医生的建议,先前的ICD治疗经验和风险厌恶显著影响了患者的决策.
- 治疗惯性和对ICD治疗的误解被确定为常见障碍.
结论:
- 缺陷可能有利于持续发电机交换,即使在较低风险的患者中.
- 更新的风险分层和针对临床医生的干预措施可以减少非常低风险个体的不必要交换.
- 解决治疗惯性的干预措施对于改善ICD管理中的共享决策至关重要.
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