Correlational Research Of Anxiety/depression And Health Relatedquality Of Life In Paced Patients

Objective1. Assess HRQoL and anxiety/depression with patients with implanted cardiac pacemaker in our hospital through the scale of the investigation.2. Assess the quality of life and mental health with different cardiac pacing modes in patients in follow-up period.MethodHRQoL was assessed consecutively in patients (50 men, 48 women, mean age 52.70±14.132 years) with implanted pacemaker (PM) from June to December 2009 in our hospital. 22 patients received VVI pacemaker, 26 received VVIR pacemaker, 26 received DDD pacemaker and 24 received DDDR pacemaker. Pacemakers were implanted in 53 patients with sick sinus syndrome and in 45 patients with atrioventricular block. There were no significant clinical and demographic differences between patients with single chamber and dual-chamber pacemakers.The 98 patients had to meet the following requirements: a permanent pacemaker implanted for arrhythmia patients, postoperative pacemaker working properly, in stable condition, no lead dislocation, infection and other complications; with a post-primary culture and reading skills; no other serious physical and mental illnesses such as acute cerebral infarction, acute myocardial infarction, surgery, peptic ulcer, etc., no cancer, no history of mental disorders.Questionnaires were administered in the form of interview and by face-to-face contact by a trained psychologist 3 to 5 days before pacemaker implantation and 1 month after. Through regular telephone follow-up the patient's condition changes can be understood; if any changes arise, the patient can be sent to hospital in a timely manner. The outpatients were followed up in detail when asked about postoperative symptoms and illness self-conscious change. We used pacemakers programmed device, pacing ECG and Holter monitoring to understand a patient's heart rhythm and pacemaker working situation, and adjusted the operating parameters of the pacemaker according to the patient's condition.Statistical significance in demographic characteristics was tested by chi-square test. Differences in HRQoL scores were evaluated by Students t test and One-Way ANOVA. Correlations were done by the Pearson method. P value less than 0.05 was considered significant.ResultsBefore the pacemaker implantation, no significant differences in HRQoL measured by SF-36 and Aquarel questionnaires nor mental health measured by SAS and SDS questionnaires were observed between patients with single chamber and dual chamber PM. Similarly there were no differences between rate-responsive and non-rate-responsive PM.After the pacemaker implantation, significant differences were noted between patients with single chamber and dual chamber PM. Patients with dual chamber PM had higher scores in SF-36 subscales reflecting PF, RP, GH, VT and MH .However, there are no significant differences in HRQoL measured by Aquarel questionnaires nor mental health measured by SAS and SDS questionnaires between patients with single chamber and dual chamber PM.Significant differences were noted between patients with non-rate-adaptive and rate-adaptive pacing. Patients with rate-adaptive pacing had higher scores in SF-36 subscales reflecting GH, VT, SF and MH.Patients with rate-adaptive pacing scored better in Aquarel scales: Chest pain, Dyspnea and Arrhytmia. Furthermore, they have lower score in SAS and SDS.By subgroup analysis differences between rate-adaptive and non-rate-adaptive pacing, significant differences were observed in the group of dual chamber pacemakers. Patients with dual chamber rate-adaptive pacing showed higher scores in SF-36. In the same way higher scores in Aquarel and lower degree of anxiety and depression were shown in DDDR pacemakers compared with DDD pacemakers.By subgroup analysis differences in rate-adaptive pacing, significant differences were observed between patients with single chamber and dual chamber PM. Significant improvement in SF-36 was observed with DDDR pacing compared with VVIR pacing, but not in other SF-36 subscales, the Aquarel questionnaires, or SAS and SDS questionnaires.There was a strong and significant correlation between the degree of anxiety and the score in SF-36 dimensions and score in Aquarel.In the same way, there was a strong and significant correlation between the degree of depression and the score in SF-36 dimensions, and the scores in Aquarel.Conclusions1. Cardiac pacemaker implantation eliminates somatic symptoms in patients, in the same time, eliminates patient anxiety and depression, change negative coping styles, can effectively improve the patient quality of life.2. After pacemaker implantation, rate-adaptive pacing offers better HRQoL and psychological profile than non-rate-adaptive pacing, especially in GH, VT, SF, MH, Chest pain, Dyspnea and Arrhytmia.3. After pacemaker implantation, dual chamber rate-adaptive pacing offers better HRQoL and psychological profile than dual chamber non-rate-adaptive pacing.4. Significant improvement in five SF-36 subscales was observed with DDDR pacing compared with VVIR pacing.5. Anxiety and depression are important factors in the HRQoL of patients with implanted pacemakers. Early detection and intervention in patients with psychological problems are imperative.