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Miao X, Zheng Y, Huang X, Jiang H. Effective process quality control management for constipation prevention in hospitalized patients with acute coronary syndrome: An observational study. Health Sci Rep 2024; 7:e2248. [PMID: 39139460 PMCID: PMC11320560 DOI: 10.1002/hsr2.2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/11/2024] [Accepted: 06/30/2024] [Indexed: 08/15/2024] Open
Abstract
Objective To evaluate the effectiveness of monitoring and managing process quality control indicators in the prevention of constipation among hospitalized patients with acute coronary syndrome (ACS). Methods A total of 512 hospitalized patients diagnosed with ACS between January and June 2022 were screened for inclusion in the study. Ultimately, 456 eligible participants were enrolled and divided into two groups based on the chronological order of admission: the control group and the observation group. Upon admission, both groups of patients received routine constipation prevention measures in the department. However, the observation group was subjected to targeted process quality control management, which included monitoring and managing five indicators related to constipation prevention: correctness of bowel movement recording; usage rate of laxatives; execution rate of physical interventions; implementation rate of constipation prevention education; completion rate of dietary structure and habit assessments. Data were analyzed using SPSS, with t tests and χ 2 tests for group comparisons. Results In comparison to the control group, the observation group demonstrated significant advantages in terms of constipation incidence, completion rates of the five process quality control indicators, occurrence rates of adverse cardiac events during defecation, and PHQ-9 scores before discharge. These disparities demonstrated statistical significance with a p value < 0.05. Conclusion Target-oriented process quality control management is shown to be effective in reducing constipation incidence and adverse cardiac events during constipation episodes, as well as alleviating depressive symptoms among ACS patients, thus providing a safe and effective approach to constipation prevention.
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Affiliation(s)
- Xing Miao
- Department of Cardiology/Endocrinolog, Fujian Provincial Hospital South Branch, Shengli Clinical Medical College of Fujian Medical UniversityFuzhou University Affiliated Provincial HospitalFuzhouChina
| | - Yan Zheng
- Department of Cardiology, Fujian Provincical Hospital, Shengli Clinical Medical College of Fujian Medical UniversityFuzhou University Affiliated Provincial HospitalFuzhouChina
| | - Xiufang Huang
- Department of Cardiology, Fujian Provincical Hospital, Shengli Clinical Medical College of Fujian Medical UniversityFuzhou University Affiliated Provincial HospitalFuzhouChina
| | - Hui Jiang
- Department of Cardiology, Fujian Provincical Hospital, Shengli Clinical Medical College of Fujian Medical UniversityFuzhou University Affiliated Provincial HospitalFuzhouChina
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Wang S, Fang R, Huang L, Zhou L, Liu H, Cai M, Sha’aban A, Yu C, Akkaif MA. Acupuncture in Traditional Chinese Medicine: A Complementary Approach for Cardiovascular Health. J Multidiscip Healthc 2024; 17:3459-3473. [PMID: 39050695 PMCID: PMC11268752 DOI: 10.2147/jmdh.s476319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Cardiovascular diseases (CVDs) are increasingly prevalent in clinical settings. With the continuous improvement of people's living standards, the gradual acceleration of the pace of life, and the deterioration of the living environment in recent years, the incidence of CVDs is increasing annually. The prevalence of CVDs among individuals aged 50 and above is notably elevated, posing a significant risk to patients' well-being and lives. At this juncture, numerous clinical treatment choices are available for managing CVDs, with traditional Chinese medicine (TCM) therapy standing out as a practical, safe, and reliable option. Over the recent years, there has been growing acknowledgement among both medical professionals and patients. With the expanding integration of TCM in the treatment of various clinical conditions, the use of TCM in managing CVDs has gained significant attention within the medical community, potentially emerging as an efficacious approach for addressing cardiovascular diseases. This article conducts a comprehensive review of the TCM approach, particularly acupuncture, as a supplementary treatment for CVDs, highlighting its ability to effectively lower blood pressure, decrease coronary artery events, mitigate arrhythmias, and enhance cardiac function when used alongside conventional medication. The review underscores the promise of acupuncture in enhancing cardiovascular health, although variations in research methodologies necessitate standardized applications.
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Affiliation(s)
- Shengfeng Wang
- Rehabilitation Department of Chinese Medicine, The Fourth People’s Hospital of Kunshan, Kunshan City, Jiangsu Province, People’s Republic of China
| | - Ruxue Fang
- Rehabilitation Department of Chinese Medicine, The Fourth People’s Hospital of Kunshan, Kunshan City, Jiangsu Province, People’s Republic of China
| | - Lei Huang
- Rehabilitation Department of Chinese Medicine, The Fourth People’s Hospital of Kunshan, Kunshan City, Jiangsu Province, People’s Republic of China
| | - Liping Zhou
- Rehabilitation Department of Chinese Medicine, The Fourth People’s Hospital of Kunshan, Kunshan City, Jiangsu Province, People’s Republic of China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Pulau Pinang, Malaysia
| | - Haibo Liu
- Department of Cardiology, QingPu Branch of Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Meiling Cai
- Department of Obstetrics and Gynecology, Qingpu Branch, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Abubakar Sha’aban
- Health and Care Research Wales Evidence Centre, Cardiff University, Heath Park, Cardiff, UK
| | - Chunxiang Yu
- Rehabilitation Department of Chinese Medicine, The Fourth People’s Hospital of Kunshan, Kunshan City, Jiangsu Province, People’s Republic of China
| | - Mohammed Ahmed Akkaif
- Department of Cardiology, QingPu Branch of Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
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Zhao W, Wang J, Chen D, Ding W, Hou J, Gui Y, Liu Y, Li R, Liu X, Sun Z, Zhao H. Triglyceride-glucose index as a potential predictor of major adverse cardiovascular and cerebrovascular events in patients with coronary heart disease complicated with depression. Front Endocrinol (Lausanne) 2024; 15:1416530. [PMID: 39006364 PMCID: PMC11240118 DOI: 10.3389/fendo.2024.1416530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Background Triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance and metabolic abnormalities, which is closely related to the prognosis of a variety of diseases. Patients with both CHD and depression have a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) and worse outcome. TyG index may be able to predict the adverse prognosis of this special population. Methods The retrospective cohort study involved 596 patients with both CHD and depression between June 2013 and December 2023. The primary outcome endpoint was the occurrence of MACCE, including all-cause death, stroke, MI and emergent coronary revascularization. The receiver operating characteristic (ROC) curve, Cox regression analysis, Kaplan-Meier survival analysis, and restricted cubic spline (RCS) analysis were used to assess the correlation between TyG index and MACCE risk of in patients with CHD complicated with depression. Results With a median follow-up of 31 (15-62) months, MACCE occurred in 281(47.15%) patients. The area under the ROC curve of TyG index predicting the risk of MACCE was 0.765(0.726-0.804) (P<0.01). Patients in the high TyG index group(69.73%) had a significantly higher risk of developing MACCE than those in the low TyG index group(23.63%) (P<0.01). The multifactorial RCS model showed a nonlinear correlation (nonlinear P<0.01, overall P<0.01), with a critical value of 8.80 for the TyG index to predict the occurrence of MACCE. The TyG index was able to further improve the predictive accuracy of MACCE. Conclusions TyG index is a potential predictor of the risk of MACCE in patients with CHD complicated with depression.
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Affiliation(s)
- Weizhe Zhao
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Junqing Wang
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Dong Chen
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Wanli Ding
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jiqiu Hou
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - YiWei Gui
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yunlin Liu
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Ruiyi Li
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xiang Liu
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Zhiqi Sun
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Haibin Zhao
- The Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
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Rezaee M, Darroudi H, Etemad L, Shad AN, Zardast Z, Kohansal H, Ghayour-Mobarhan M, Sadeghian F, Moohebati M, Esmaily H, Darroudi S, Ferns GA. Anxiety, a significant risk factor for coronary artery disease: what is the best index. BMC Psychiatry 2024; 24:443. [PMID: 38877499 PMCID: PMC11177367 DOI: 10.1186/s12888-024-05798-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/28/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is known as the leading cause of disability and death globally. Anxiety disorders are also recognized as common types of mental disorders that substantially impact global health. Iran ranks among the countries with a high incidence of CAD and anxiety disorders. Therefore, the present study aims to determine the potential association and epidemiological aspects of anxiety and CAD within the population of Mashhad, the second most popoulos city in Iran. METHODS The present study is based on extracted data from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) study which is a 10-year prospective cohort study intended to assess the effects of various CAD risk factors among Mashhad city residents. Anxiety scores were assessed at the baseline using Beck Anxiety Inventory and individuals were classified based on the BAI 4-factor structure model which included autonomic, cognitive, panic, and neuromotor components. Accordingly, the association between baseline anxiety scores and the BAI four-factor model with the risk of CAD events was analyzed using SPSS software version 21. RESULTS Based on the results, 60.4% of the sample were female, and 5.6% were classified as having severe forms of anxiety. Moreover, severe anxiety was more prevalent in females. Results showed a 1.7% risk of CAD (p-value < 0.001) over 10 years with one unit increase in anxiety score. Based on the 4-factor model structure, we found that only panic disorder could significantly increase the risk of CAD by 1.1% over the 10-year follow-up (p-value < 0.001). CONCLUSION Anxiety symptoms, particularly panic disorder, are independently and significantly associated with an increased overall risk of developing CAD over a 10-year period. Therefore, further studies are warranted to investigate the mechanisms through which anxiety may cause CAD, as well as possible interventions to mitigate these processes.
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Affiliation(s)
- Mojtaba Rezaee
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Leila Etemad
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of MedicalSciences, Mashhad, Iran
- Medical Toxicology Research Center, Faculty of Medicine. Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arya Nasimi Shad
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Zardast
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houra Kohansal
- Biochemistry Department, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- Department of Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome research center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sadeghian
- Department of Biochemistry and Biophysics, Faculty of Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Mohsen Moohebati
- Department of Cardiovascular, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Darroudi
- Metabolic Syndrome research center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Vascular and Endovascular Surgery Research Center, Mashhad University of medical sciences, Mashhad, Iran.
| | - Gordon A Ferns
- Brighton and Sussex Medical School, Division of Medical Education, Sussex BN1 9PH, U, Falmer, Brighton, UK
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Kang L, Wang S, Li Y, Zhao X, Chu Q, Li R. Knowledge domain and emerging trends in anxiety and depression after myocardial infarction research during 2002-2022: Bibliometric and visualized analysis. Heliyon 2024; 10:e30348. [PMID: 38737252 PMCID: PMC11088254 DOI: 10.1016/j.heliyon.2024.e30348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 04/13/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose This study aimed to analyze developmental trends in anxiety and depression after myocardial infarction (ADMI) research in the past 20 years through bibliometrics analysis and predict future research directions. Methods ADMI-related publications were retrieved from the Web of Science Core Collection. Bibliometric, VOSviewer, CiteSpace, and Bibliometrix software packages were used for bibliometric analysis and visualization. Results Overall, 3220 ADMI-related publications were identified. The United States, China, and the Netherlands were the countries with the most publications. Carney RM, De Jonge P, and Blumenthal JA were the most influential researchers. In 2004, Van Melle JP, from the University of Groningen, published in Psychosomatic Medicine the most cited article. "Cardiac rehabilitation" was the primary focus area. "Cardiac rehabilitation," "management," "acute coronary syndrome," and "outcome" were the top four keywords in emerging research hotspots. Notably, the effect of traditional Chinese medicine on ADMI is an area of potential research value. Conclusion Numerous studies have underscored the significance of cardiac rehabilitation. Present research focuses on managing anxiety and depression post-acute coronary syndrome and enhancing clinical outcomes through cardiac rehabilitation technology. Additionally, the therapeutic potential of traditional Chinese medicine for ADMI is expected to attract increased attention from researchers in the future.
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Affiliation(s)
- Liang Kang
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaoyu Wang
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yihua Li
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinjun Zhao
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qingmin Chu
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Rong Li
- Department of Cardiovascular Disease, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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6
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Xu L, Zhai X, Shi D, Zhang Y. Depression and coronary heart disease: mechanisms, interventions, and treatments. Front Psychiatry 2024; 15:1328048. [PMID: 38404466 PMCID: PMC10884284 DOI: 10.3389/fpsyt.2024.1328048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Coronary heart disease (CHD), a cardiovascular condition that poses a significant threat to human health and life, has imposed a substantial economic burden on the world. However, in contrast to conventional risk factors, depression emerges as a novel and independent risk factor for CHD. This condition impacts the onset and progression of CHD and elevates the risk of adverse cardiovascular prognostic events in those already affected by CHD. As a result, depression has garnered increasing global attention. Despite this growing awareness, the specific mechanisms through which depression contributes to the development of CHD remain unclear. Existing research suggests that depression primarily influences the inflammatory response, Hypothalamic-pituitary-adrenocortical axis (HPA) and Autonomic Nervous System (ANS) dysfunction, platelet activation, endothelial dysfunction, lipid metabolism disorders, and genetics, all of which play pivotal roles in CHD development. Furthermore, the effectiveness and safety of antidepressant treatment in CHD patients with comorbid depression and its potential impact on the prognosis of CHD patients have become subjects of controversy. Further investigation is warranted to address these unresolved questions.
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Affiliation(s)
- Linjie Xu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Xu Zhai
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Dazhuo Shi
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Zhang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
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Pogosova NV, Ausheva AK, Saner H, Boytsov SA. Stress, Anxiety and Depressive Symptoms are Predictors of Worse Outcomes in Outpatients With Arterial Hypertension and Coronary Heart Disease: Results of 1.5 Years Follow-up From the COMETA Multicenter Study. KARDIOLOGIIA 2023; 63:3-10. [PMID: 38156484 DOI: 10.18087/cardio.2023.12.n2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/23/2023] [Indexed: 12/30/2023]
Abstract
Aim To study associations between the risk of severe adverse cardiovascular outcomes (SACVO) and all-cause death with psychosocial risk factors (PS RFs), such as stress, anxiety and depressive symptoms, low level of education, low income, social isolation, and type D personality, in patients with arterial hypertension (AH) and ischemic heart disease (IHD) managed in primary health care institutions in a multi-year prospective study.Material and methods PS RFs were assessed in patients with AH or IHD, who participated in a multi-year prospective COMETA study, using the Hospital Anxiety and Depression Scale (HADS), DS-14 questionnaire, and a visual analogue scale (VAS) for assessment of stress level. Associations of PS FRs with SACVO and all-cause death after a 1.5-year follow-up were analyzed using multivariate Cox regression models.Results At 1.5 years after patients were included in the study, it was possible to obtain data for 2,538 patients (age at baseline, 66.6 ± 7.8 years, 28.1% men), 106 of whom died during that period. The incidence of SACVO was 40.0 per 1000 person-years. According to the results of multivariate regression analysis, a very high level of anxiety symptoms (HADS-A≥14) was significantly associated with SACVO (odds ratio (OR), 1.81; 95% confidence interval (CI), 1.04-3.15; p=0. 02). The composite endpoint that included all-cause death and/or SACVO was significantly associated with a high (VAS score ≥8) stress level (OR, 1.53; 95% CI, 1.00-2.33; p=0.04) and a very high (HADS-D≥14) level of depressive symptoms (OR, 2.11; 95% CI, 1.22-3.62; p=0.02). A low level of education adjusted for gender and age increased the likelihood of SACVO by 1.7 (95% CI, 1.19-2.43) times. No significant associations were found between the analyzed outcomes and type D personality or with social isolation.Conclusion In patients with AH or IHD, the presence of high-grade stress and severe depressive symptoms increased the likelihoods of all-cause death and SACVO while a low level of education and severe anxiety symptoms were associated with SACVO. The study results showed that PS RFs for cardiovascular diseases keep the PS RF prognostic significance in the conditions of modern treatment of AH and IHD. Due to the negative impact on the prognosis, PS RFs should be taken into account when taking measures for secondary prevention of AH and IHD.
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Affiliation(s)
- N V Pogosova
- Chazov National Medical Research Center of Cardiology, Moscow; Patrice Lumumba Russian University of Peoples' Friendship, Moscow
| | - A K Ausheva
- Chazov National Medical Research Center of Cardiology, Moscow; Patrice Lumumba Russian University of Peoples' Friendship, Moscow
| | - H Saner
- Institute of Social and Preventive Medicine, Bern
| | - S A Boytsov
- Chazov National Medical Research Center of Cardiology, Moscow
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Bouchard K, Gareau A, Sztajerowska K, Greenman PS, Lalande K, Tulloch H. Better together: Relationship quality and mental health among cardiac patients and spouses. FAMILY PROCESS 2023; 62:1624-1639. [PMID: 36404415 DOI: 10.1111/famp.12836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Reductions in marital relationship quality are pervasive post-cardiac event. It is not yet understood how relationship quality is linked to mental health outcomes in couples where one member has established cardiovascular disease (CVD) and the interdependence within dyads is seldom measured. This research is required as psychological distress has been independently linked to CVD incidence, morbidity, and mortality. This study assessed associations of relationship quality with depression and anxiety among patients with CVD and their spouses. Participants completed questionnaires measuring four dimensions of relationship quality and mental health. Data were analyzed using an Actor-Partner Interdependence Model with hierarchical moderation analyses. 181 dyads (N = 362 participants) comprised the study sample. Most patients had coronary artery disease (66.3%) and 25.9% were female. Patients reported higher relationship satisfaction and fewer anxiety symptoms than did spouses. Patients and spouses with high dyadic consensus and affectional expression reported fewer mental health symptoms, but only when the other partner also perceived high levels of consensus and affectional expression in the relationship. Patients and spouses with low dyadic cohesion reported worse mental health symptoms (actor effects), but those effects were no longer significant when both the patient and the spouse appraised the relationship as having high levels of dyadic cohesion. Taken together, relationship quality is linked to mental health symptoms in patients with CVD and their spouses. Longitudinal and experimental studies are now warranted to further substantiate the cross-sectional findings of this study.
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Affiliation(s)
- Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Paul S Greenman
- Université du Québec en Outaouais, Gatineau, Québec City, Canada
| | | | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
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Johnsen NF, Jensen SN, Christensen KB, Pedersen SS, Helmark C, Zwisler AD, Gislason GH. Screening for anxiety and depression in clinical practice: translating scores from World Health Organization-5/Anxiety Symptom Scale-2/Major Depression Inventory-2 to Hospital Anxiety and Depression Scale. Eur J Prev Cardiol 2023; 30:1689-1701. [PMID: 37235731 DOI: 10.1093/eurjpc/zwad180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 05/28/2023]
Abstract
AIMS The aim of this study was to evaluate if a combination of World Health Organization-5 (WHO-5), Anxiety Symptom Scale-2 (ASS-2), and Major Depression Inventory-2 (MDI-2) can replace the Hospital Anxiety and Depression Scale (HADS) as screening tool for anxiety and depression in cardiac patients across diagnoses and whether it is feasible to generate crosswalks (translation tables) for use in clinical practice. METHODS AND RESULTS We used data from the Danish 'Life with a heart disease' survey, in which 10 000 patients with a hospital contact and discharge diagnosis of ischaemic heart disease, heart failure, heart valve disease, or atrial fibrillation in 2018 were invited. Potential participants received an electronic questionnaire including 51 questions on health, well-being, and evaluation of the health care system. Crosswalks between WHO-5/ASS-2 and HADS anxiety dimension (HADS-A) and between WHO-5/MDI-2 and HADS depression dimension (HADS-D) were generated and tested using item response theory (IRT). A total of 4346 patients responded to HADS, WHO-5, ASS-2, and MDI-2. Model fit of the bi-factor IRT models illustrated appropriateness of a bi-factor structure and thus of essential uni-dimensionality [root mean square error of approximation (RMSEA) (P value) range 0.000-0.053 (0.0099-0.7529) for anxiety and 0.033-0.061 (0.0168-0.2233) for depression]. A combination of WHO-5 and ASS-2 measured the same trait as HADS-A, and a combination of WHO-5 and MDI-2 measured the same trait as HADS-D. Consequently, crosswalks (translation tables) were generated. CONCLUSIONS Our study shows that it is feasible to use crosswalks between HADS-A and WHO-5/ASS-2 and HADS-D and WHO-5/MDI-2 for screening cardiac patients across diagnoses for anxiety and depression in clinical practice.
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Affiliation(s)
- Nina Føns Johnsen
- Analysis and Research, The Danish Heart Foundation, Vognmagergade 7.3, Copenhagen 1120, Denmark
| | - Sidsel Normann Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, REHPA, Odense, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, REHPA, Odense, Denmark
- The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Gunnar H Gislason
- Analysis and Research, The Danish Heart Foundation, Vognmagergade 7.3, Copenhagen 1120, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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10
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Dammen T, Tunheim K, Munkhaugen J, Klungsøyr O, Papageorgiou C. Attention training technique delivered in groups as treatment for anxiety and depression in patients with coronary heart disease: study protocol for a waiting-list randomized controlled trial. Front Psychol 2023; 14:1226539. [PMID: 37790218 PMCID: PMC10544325 DOI: 10.3389/fpsyg.2023.1226539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Clinically significant symptoms of depression and anxiety in coronary heart disease (CHD) patients are common and associated with adverse outcomes. Psychological treatments have shown limited effectiveness and more effective treatments have been requested. Attention training technique (ATT), a component of metacognitive therapy, can potentially be effective as a stand-alone treatment for anxiety and depression. In an open study, ATT delivered face-to-face in a group format was feasible and potentially effective for improving depression and anxiety symptoms in CHD patients. The next progressive step is to test the effectiveness of ATT in a randomized controlled trial. This paper describes the methodology of this trial. Methods ATT-CHD is a randomized wait-list (WL) controlled study. Eligible CHD patients from two hospitals with Hospital Anxiety and Depression Scale (HADS)-Anxiety and/or HADS-Depression subscales scores ≥8 will be randomized into ATT (n = 32) or WL control (n = 32). After 6-8 weeks, WL patients will be allocated to ATT. Participants will be evaluated pre-, mid- and post-treatment, and at 6-months follow-up using changes in HADS as primary outcome. Secondary outcomes will be changes in psychiatric disorders, rumination, worry, type D-personality, metacognitions, insomnia, quality of life, and C-Reactive protein (CRP). Discussion To our knowledge, this will be the first WL-controlled randomized study testing the effectiveness of group-based ATT as treatment of symptoms of anxiety and depression in CHD patients. It will also explore correlations between changes in psychological distress and CRP. A qualitative analysis will reveal patients' experience with ATT including processes that may facilitate or serve as barriers to effectiveness. Recruitment into the study commenced in December 2022. Ethics and dissemination The Regional Committees for Medical and Health Research Ethics (REK), Norway has granted approval for the study (ID 52002). The trial results will be published in peer-reviewed journals. According to Norwegian legislation, the Norwegian Data Protection Authority, and the Committee of Ethics, we are not allowed to share original study data publicly. Clinical trial registration ClinicalTrials.gov, identifier NCT05621408 pre-inclusion. There were no significant changes of methods or outcomes after study start.
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Affiliation(s)
- Toril Dammen
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Tunheim
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Trust, Drammen, Norway
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Ole Klungsøyr
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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11
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Lee CT, Harty S, Adegoke A, Palacios J, Gillan CM, Richards D. The Effectiveness of Low-Intensity Psychological Interventions for Comorbid Depression and Anxiety in Patients with Long-Term Conditions: A Real-World Naturalistic Observational Study in IAPT Integrated Care. Int J Behav Med 2023:10.1007/s12529-023-10215-9. [PMID: 37697142 DOI: 10.1007/s12529-023-10215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Low-intensity psychological interventions may be a cost-effective, accessible solution for treating depression and anxiety in patients with long-term conditions, but evidence from real-world service settings is lacking. This study examined the effectiveness of low-intensity psychological interventions provided in the Improving Access to Psychological Therapies programme in England for patients with and without long-term conditions. METHODS A retrospective analysis was conducted on patients (total N = 21,051, long-term conditions n = 4024) enrolled in three low-intensity psychological interventions, i.e. Internet-delivered cognitive behavioural therapy (iCBT), guided self-help (GSH), and psychoeducational group therapy (PGT) within a Talking Therapies service from 2016 to 2020. Primary outcomes included pre-post-treatment changes in depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). RESULTS Overall, both cohorts significantly improved on all outcomes post-treatment, with large effect sizes. Patients with long-term conditions experienced a greater reduction in depression while those without experienced a greater reduction in anxiety, but these differences were marginal (< 1 score difference on both measures). No difference between the cohorts was shown when comparing the differential effectiveness across interventions, but those engaging in iCBT showed greater reduction in depression and anxiety than those in GSH and PGT, while those in GSH improved more than PGT. CONCLUSIONS Low-intensity psychological interventions, particularly iCBT, were effective in treating depression and anxiety in patients with long-term conditions in a real-world service setting. Our large-scale study supports the continued and increased implementation of low-intensity psychological interventions for this subpopulation via integrated care.
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Affiliation(s)
- Chi Tak Lee
- School of Psychology, Trinity College Dublin, Dublin, Ireland.
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - Siobhan Harty
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Adedeji Adegoke
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Jorge Palacios
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
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12
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Bikmoradi A, Omidvar S, Roshanaei G, Khatiban M, Harorani M. The impact of telenursing on level of depression, stress and anxiety in discharged patients after coronary artery bypass graft surgery: A randomized clinical trial. JOURNAL OF VASCULAR NURSING 2023; 41:89-94. [PMID: 37684095 DOI: 10.1016/j.jvn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND After coronary artery bypass graft surgery patients are susceptible to mental disorders such as stress, anxiety, and depression following discharge from the hospital and often require post-discharge support and follow-up. Telenursing is an accessible method that may reduce stress, anxiety, and depression experienced by patients. This study aimed to investigate the impact of telenursing on depression, stress, and anxiety in discharged patients after CABG surgery. MATERIALS AND METHODS A randomized clinical trial was carried out. Eligible patients were divided randomly into intervention (n=40) and control (n=40) groups. Depression Anxiety Stress Scale-21 (DASS21) questionnaire was filled out by both groups one day before discharge from the hospital. The intervention group received SMS reminders of their treatment plan, referrals to the cardiac rehabilitation clinic, and routine care three times a week for six weeks, while the control group received routine care provided by the hospital only. In the week following the completion of the intervention period, both groups returned to fill out the questionnaire, and the data were analyzed using SPSS version 16.0, descriptive and inferential statistics, and independent and paired T-tests. RESULT The mean scores of depression, stress, and anxiety before intervention in the intervention group were 11.95, 18.75, and 18.17, and in the control group were 11.55, 18.37, and 17.4 respectively. The mean scores of depression, stress, and anxiety after intervention in the intervention group were 7.85, 10.5, and 10.45, and in the control group were 10.56, 17.9, and 16.5 respectively. No significant differences were seen between the two groups before the intervention (P>0.05), but the results showed significant differences between the two groups' mean scores of depression, stress, and anxiety after intervention (P<0.001). CONCLUSION Telenursing can reduce stress, anxiety, and depression in discharged patients after coronary artery bypass graft surgery by providing proper and cost-effective follow-up.
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Affiliation(s)
- Ali Bikmoradi
- Healthcare Management, Hamedan University of Medical Science, Hamedan, Iran.
| | - Safoora Omidvar
- School of Nursing and Midwifery, Hamedan University of Medical Science, Hamedan, Iran.
| | - Ghodratollah Roshanaei
- Modelling Non-Communicable Diseases Research Center and Department of Biostatistics and Epidemiology, School of Public Health, Hamedan University of Medical Science, Hamedan, Iran.
| | - Mahnaz Khatiban
- Healthcare Management, Hamedan University of Medical Science, Hamedan, Iran
| | - Mehdi Harorani
- Department of Nursing, Shazand School of Nursing, Arak University of Medical Sciences, Arak, Iran
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13
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Gryksa K, Schmidtner AK, Masís-Calvo M, Rodríguez-Villagra OA, Havasi A, Wirobski G, Maloumby R, Jägle H, Bosch OJ, Slattery DA, Neumann ID. Selective breeding of rats for high (HAB) and low (LAB) anxiety-related behaviour: A unique model for comorbid depression and social dysfunctions. Neurosci Biobehav Rev 2023; 152:105292. [PMID: 37353047 DOI: 10.1016/j.neubiorev.2023.105292] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023]
Abstract
Animal models of selective breeding for extremes in emotionality are a strong experimental approach to model psychopathologies. They became indispensable in order to increase our understanding of neurobiological, genetic, epigenetic, hormonal, and environmental mechanisms contributing to anxiety disorders and their association with depressive symptoms or social deficits. In the present review, we extensively discuss Wistar rats selectively bred for high (HAB) and low (LAB) anxiety-related behaviour on the elevated plus-maze. After 30 years of breeding, we can confirm the prominent differences between HAB and LAB rats in trait anxiety, which are accompanied by consistent differences in depressive-like, social and cognitive behaviours. We can further confirm a single nucleotide polymorphism in the vasopressin promotor of HAB rats causative for neuropeptide overexpression, and show that low (or high) anxiety and fear levels are unlikely due to visual dysfunctions. Thus, HAB and LAB rats continue to exist as a reliable tool to study the multiple facets underlying the pathology of high trait anxiety and its comorbidity with depression-like behaviour and social dysfunctions.
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Affiliation(s)
- Katharina Gryksa
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Anna K Schmidtner
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Marianella Masís-Calvo
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Odir A Rodríguez-Villagra
- Centro de Investigación en Neurosciencias, Universidad de Costa Rica, San Pedro, San José, Costa Rica.
| | - Andrea Havasi
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Gwendolyn Wirobski
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Rodrigue Maloumby
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - Herbert Jägle
- Department of Ophthalmology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
| | - Oliver J Bosch
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
| | - David A Slattery
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Heinrich-Hoffmann-Straße 10, 60528 Frankfurt am Main, Germany.
| | - Inga D Neumann
- Department of Behavioural and Molecular Neurobiology, Regensburg Center of Neuroscience, University of Regensburg, Universitaetsstr. 31, 93053 Regensburg, Germany.
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14
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Ramos-Petersen L, Rodríguez-Sánchez JA, Cortés-Martín J, Reinoso-Cobo A, Sánchez-García JC, Rodríguez-Blanque R, Coca JR. A Qualitative Study Exploring the Experiences and Perceptions of Patients with Hemophilia Regarding Their Health-Related Well-Being, in Salamanca. J Clin Med 2023; 12:5417. [PMID: 37629458 PMCID: PMC10455868 DOI: 10.3390/jcm12165417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hemophilia is a chronic, congenital/hereditary and X-linked disease, characterized by an insufficiency of factors VIII or IX, which are necessary for blood clotting. Those affected by hemophilia often suffer from particular psychosocial problems, both in the acceptance, coping, treatment and self-management of their disease and in their family and social relationships, which are often mediated by these circumstances. The aim of this study was to explore the experiences of people with hemophilia or their family members, of in a specific region of Spain, regarding the impact of having hemophilia. Structured interviews were conducted and developed, using the studies of the World Federation of Hemophilia and Osorio-Guzmán et al. as a guide, as well as a literature review of qualitative work on hemophilia. Data were analyzed using a six-step thematic analysis. A total of 34 interviews were thematically analyzed. The results showed that three key themes emerged from the data: (1) the daily impact of having hemophilia, (2) uncertainty about the disease, (3) the role of associations and (4) support from institutions. The results make it clear that the disease has a major impact on their lives (work, family, leisure and personal environment). The main conclusion is that hemophilia has a negative impact on the daily lives of patients, families and caregivers.
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Affiliation(s)
- Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Antonio Rodríguez-Sánchez
- Department of Biomedical Sciences and Diagnosis, University of Salamanca, C/Alfonso X el Sabio S/N, 37007 Salamanca, Spain;
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
- San Cecilio Clinical University Hospital, 18016 Granada, Spain
| | - Juan R. Coca
- Social Research Unit on Health and Rare Diseases, Sociology and Social Work Department, University of Valladolid, 47002 Valladolid, Spain;
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15
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Salamanca-Bautista P, Romero-Correa M, Formiga F, Antequera-Martín-Portugués I, Llàcer P, Marrero-Medina IG, Calderón-Jiménez P, Moreno-Palanco MÁ, Armengou-Arxe A, Gonzalo-Pascua S, Piñeiro-Parga P, Aramburu-Bodas Ó. Safety of benzodiazepines in patients with acute heart failure: A propensity score-matching study. Int J Cardiol 2023; 382:40-45. [PMID: 37062342 DOI: 10.1016/j.ijcard.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/28/2023] [Accepted: 04/07/2023] [Indexed: 04/18/2023]
Abstract
AIM Benzodiazepines (BZDs) are one of the most used drugs to control symptoms in patients with acute heart failure (HF). However, the evidence on its safety is inconclusive. The objective was to describe the characteristics of patients admitted for HF and treated with BZDs and to assess the relationship of this treatment and mortality. PATIENTS AND METHODS We performed a cross-sectional, multicentre (74 Spanish hospitals), cohort study. Patients admitted for HF were divided depending on whether they were treated with BZDs or not. Propensity score analysis matched patients in both groups in a 1:1 manner according to different factors. The primary outcome was mortality at day 7. Secondary outcomes were mortality at days 30 and 180, as well as readmissions and emergency room visits at 180 days. RESULTS We included 1855 patients: 639 (34.4%) had prescribed BZDs treatment versus 1216 (65.6%) who had not been treated. Patients receiving BZDs had advanced heart disease, severe symptoms, need more HF intensive treatment and higher mortality. After propensity matching 381 balanced paired cases were included in each group. Treatment with BZDs was not associated with greater risk of mortality at day 7 of index hospitalization (7.6% vs 5.2%, adjusted OR 1.49, 95% CI 0.83-2.68, p = 0.186). There were also no differences between groups in terms of mortality at day 30 and 180, readmissions or visits to the emergency room. CONCLUSIONS Our data support that benzodiazepines could be safely used for improving symptoms. in patients admitted for acute HF in terms of short-medium term mortality.
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Affiliation(s)
- Prado Salamanca-Bautista
- Internal Medicine Deparment, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; Department of Medicine, Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain.
| | | | | | | | - Pau Llàcer
- Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | | | | | | | | | | | | | - Óscar Aramburu-Bodas
- Internal Medicine Deparment, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; Department of Medicine, Universidad de Sevilla, San Fernando, 4, 41004 Sevilla, Spain
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16
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Askari F, Seidi J, Naqshbandi MK, Kashefi H, Shami S. Evaluation of Saffron (Crocus Sativus L) Effects on Anxiety in Hospitalized Patients with Acute Coronary Syndrome. Adv Biomed Res 2023; 12:100. [PMID: 37288021 PMCID: PMC10241615 DOI: 10.4103/abr.abr_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 06/09/2023] Open
Abstract
Background Anxiety is a common psychiatric condition in cardio-vascular diseases. Saffron appears to have a wide range of therapeutic effects on psychiatric conditions and cardio-vascular disorders. The aim of this study was to determine the effect of saffron on anxiety in hospitalized patients with acute coronary syndrome (ACS). Materials and Methods In this clinical investigation, we selected 80 patients with ACS from Tohid Medical Center, Sanandaj. Patients were divided randomly into two groups, intervention group (n = 41), and control group (n = 39), based on how they received saffron and placebo every 12 hours for 4 days, respectively. The Spielberger Anxiety Inventory was completed before and after the intervention in both groups. Results There was no significant difference between the intervention and control groups regarding the mean scores of the trait and state anxiety before and after the intervention (P > 0.05). Conclusion The present study did not corroborate the therapeutic effects of saffron on reducing anxiety in patients with ACS.
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Affiliation(s)
- Fariba Askari
- Department of Nursing, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Kurdistan, Iran
| | - Jamal Seidi
- Department of Nursing, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Kurdistan, Iran
| | | | - Hajar Kashefi
- Research Center for Environmental Factors Affecting Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sholeh Shami
- School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Kurdistan, Iran
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17
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Liu BP, Jia CX. The associations of physical activity and lifetime depression with all-cause and cause-specific mortality: evidence from a prospective cohort study. Psychiatry Res 2023; 324:115206. [PMID: 37098300 DOI: 10.1016/j.psychres.2023.115206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 04/27/2023]
Abstract
This study aims to explore the joint associations of physical activity and lifetime depression with all-cause and cause-specific mortality. The present study using data from UK Biobank, included 316568 participants aged 37 to 73 years recruited from 22 centers between 2006 and 2010. Total physical activity (TPA), moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), assessed by metabolic equivalent task (MET) were used and Cox-proportional hazard models were performed in this study. The incidence rate of all-cause, CVD, and cancer mortality was 4.35(95%CI: 4.29-4.42), 0.69 (95%CI: 0.67-0.72), and 2.23 (95%CI: 2.19-2.28) per 1000 person-years after an average follow-up time of 12.49 years. Lower levels of TPA, MVPA, and VPA were all independently associated with elevated risk of all-cause and cancer mortality. Lifetime depression was significantly associated with increased risk of all-cause (HR=1.46, 95%CI: 1.40-1.52), CVD (HR=1.48, 95%CI: 1.33-1.64), and cancer mortality (HR=1.13, 95%CI: 1.06-1.21). Significant interactive effect of low levels of TPA, MVPA, and VPA and lifetime depression on all-cause mortality were found in this study. The risk of all-cause mortality associated with lifetime depression was deteriorated with low levels of physical activity. Relevant interventions for regular PA should be performed among depressed population.
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Affiliation(s)
- Bao-Peng Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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18
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Bigalke JA, Durocher JJ, Greenlund IM, Keller-Ross M, Carter JR. Blood pressure and muscle sympathetic nerve activity are associated with trait anxiety in humans. Am J Physiol Heart Circ Physiol 2023; 324:H494-H503. [PMID: 36800506 PMCID: PMC10259854 DOI: 10.1152/ajpheart.00026.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023]
Abstract
Chronic anxiety is prevalent and associated with an increased risk of cardiovascular disease. Prior studies that have reported a relationship between muscle sympathetic nerve activity (MSNA) and anxiety have focused on participants with anxiety disorders and/or metabolic syndrome. The present study leverages a large cohort of healthy adults devoid of cardiometabolic disorders to examine the hypothesis that trait anxiety severity is positively associated with resting MSNA and blood pressure. Resting blood pressure (BP) (sphygmomanometer and finger plethysmography), MSNA (microneurography), and heart rate (HR; electrocardiogram) were collected in 88 healthy participants (52 males, 36 females, 25 ± 1 yr, 25 ± 1 kg/m2). Multiple linear regression was performed to assess the independent relationship between trait anxiety, MSNA, resting BP, and HR while controlling for age and sex. Trait anxiety was significantly correlated with systolic arterial pressure (SAP; r = 0.251, P = 0.018), diastolic arterial pressure (DAP; r = 0.291, P = 0.006), mean arterial pressure (MAP; r = 0.328, P = 0.002), MSNA burst frequency (BF; r = 0.237, P = 0.026), and MSNA burst incidence (BI; r = 0.225, P = 0.035). When controlling for the effects of age and sex, trait anxiety was independently associated with SAP (β = 0.206, P = 0.028), DAP (β = 0.317, P = 0.002), MAP (β = 0.325, P = 0.001), MSNA BF (β = 0.227, P = 0.030), and MSNA BI (β = 0.214, P = 0.038). Trait anxiety is associated with increased blood pressure and MSNA, demonstrating an important relationship between anxiety and autonomic blood pressure regulation.NEW & NOTEWORTHY Anxiety is associated with development of cardiovascular disease. Although the sympathetic nervous system is a likely mediator of this relationship, populations with chronic anxiety have shown little, if any, alteration in resting levels of directly recorded muscle sympathetic nerve activity (MSNA). The present study is the first to reveal an independent relationship between trait anxiety, resting blood pressure, and MSNA in a large cohort of healthy males and females devoid of cardiometabolic comorbidities.
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Affiliation(s)
- Jeremy A Bigalke
- Department of Health and Human Development, Montana State University, Bozeman, Montana, United States
- Department of Psychology, Montana State University, Bozeman, Montana, United States
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
| | - John J Durocher
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
- Department of Biological Sciences and Integrative Physiology and Health Sciences Center, Purdue University Northwest, Hammond, Indiana, United States
| | - Ian M Greenlund
- Department of Psychology, Montana State University, Bozeman, Montana, United States
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Manda Keller-Ross
- Division of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jason R Carter
- Department of Health and Human Development, Montana State University, Bozeman, Montana, United States
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, Michigan, United States
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States
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19
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Tremblay MA, Denis I, Turcotte S, DeGrâce M, Tully PJ, Foldes-Busque G. Cognitive-Behavioral Therapy for Panic Disorder in Patients with Stable Coronary Artery Disease: A Feasibility Study. J Clin Psychol Med Settings 2023; 30:28-42. [PMID: 35543901 PMCID: PMC9093559 DOI: 10.1007/s10880-022-09876-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/18/2022]
Abstract
Implementing cognitive-behavioral therapy (CBT), the first-line psychological treatment for panic disorder (PD), may be challenging in patients with comorbid coronary artery disease (CAD).This study aimed at assessing the feasibility and acceptability of a CBT for PD protocol that was adapted to patients suffering from comorbid CAD. It also aimed at evaluating the efficacy of the intervention to reduce PD symptomatology and psychological distress and improve quality of life. This was a single-case experimental design with pre-treatment, post-treatment and 6-month follow-up measures. Patients with PD and stable CAD received 14 to 17 individual, 1-h sessions of an adapted CBT for PD protocol. They completed interviews and questionnaires at pre-treatment, post-treatment and at a 6-month follow-up assessing intervention acceptability, PD symptomatology, psychological distress and quality of life. A total of 6 patients out of 7 completed the intervention and 6-month follow-up, indicating satisfactory feasibility. Acceptability was high (medians of ≥ 8.5 out of 9 and ≥ 80%) both at pre and post treatment. Remission rate was of 83% at post-treatment and 6-month follow-up. The intervention appeared to have positive effects on comorbid anxiety and depression symptoms and quality of life. The intervention appeared feasible and acceptable in patients with comorbid CAD. The effects of the adapted CBT protocol on PD symptoms, psychological distress and quality of life are promising and were maintained at the 6-month follow-up. Further studies should aim at replicating the present results in randomized-controlled trials.
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Affiliation(s)
- Marie-Andrée Tremblay
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Stéphane Turcotte
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Michel DeGrâce
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada
| | - Phillip J Tully
- Faculty of Health and Medical Sciences, The University of Adelaide, 30 Frome Road, Adelaide, SA, 5000, Australia
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325 rue des Bibliothèques, Quebec, QC, G1V 0A6, Canada.
- Research Center of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, 143 rue Wolfe, Lévis, QC, G6V 3Z1, Canada.
- Research Center of the Quebec Heart and Lung Institute, 2725, chemin Sainte-Foy, Quebec, QC, G1V 4G5, Canada.
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Tenbult N, Asten IV, Traa S, Brouwers RWM, Spee RF, Lu Y, Brini A, Kop W, Kemps H. Determinants of information needs in patients with coronary artery disease receiving cardiac rehabilitation: a prospective observational study. BMJ Open 2023; 13:e068351. [PMID: 36854593 PMCID: PMC9980372 DOI: 10.1136/bmjopen-2022-068351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES Knowledge on information needs in cardiac rehabilitation (CR) patients is scarce. This study investigates determinants of information needs in patients with coronary artery disease (CAD). DESIGN Prospective observational study. PARTICIPANTS A total of 259 patients participated. SETTING CR centre serving a general hospital in The Netherlands. METHODS Patients with a coronary event and/or revascularisation referred for CR completed questionnaires assessing their level of information needs with respect to nutrition, physical activity, smoking, medication use and psychological well-being, and potential determinants of information needs (sociodemographic characteristics, health literacy, illness perceptions, anxiety, depression, Type D personality and quality of life). RESULTS The majority (63%) of patients indicated a need for information on at least one of the four topics (nutrition, physical activity, medication use, psychological well-being), with considerable inter-individual variation. Female sex, being employed, higher socioeconomic status, higher levels of anxiety and higher illness perception were associated with higher information needs on specific topics. CONCLUSIONS The majority of CR patients with CAD have a need for information, with considerable inter-individual variability. Several demographic, socioeconomic and psychosocial characteristics were related to their preference for information topics. These results underline the need for personalised information strategies in patients undergoing CR.
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Affiliation(s)
- Nicole Tenbult
- Department of Cardiology/Cardiac Rehabilitation, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Industrial Design, University of Technology Eindhoven, Eindhoven, The Netherlands
| | - Isabelle van Asten
- Department of Cardiology/Cardiac Rehabilitation, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Simone Traa
- Department of Medical Psychology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Rutger W M Brouwers
- Department of Cardiology/Cardiac Rehabilitation, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Industrial Design, University of Technology Eindhoven, Eindhoven, The Netherlands
| | - Ruud F Spee
- Department of Cardiology/Cardiac Rehabilitation, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Yuan Lu
- Department of Industrial Design, University of Technology Eindhoven, Eindhoven, The Netherlands
| | - Alberto Brini
- Department of Mathematics and Computer Science, University of Technology Eindhoven, Eindhoven, The Netherlands
| | - Willem Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Hareld Kemps
- Department of Cardiology/Cardiac Rehabilitation, Maxima Medical Centre, Eindhoven, The Netherlands
- Department of Industrial Design, University of Technology Eindhoven, Eindhoven, The Netherlands
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Donelli D, Meneguzzo F, Antonelli M, Ardissino D, Niccoli G, Gronchi G, Baraldi R, Neri L, Zabini F. Effects of Plant-Emitted Monoterpenes on Anxiety Symptoms: A Propensity-Matched Observational Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2773. [PMID: 36833470 PMCID: PMC9957398 DOI: 10.3390/ijerph20042773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 06/12/2023]
Abstract
Immersive experiences in green areas, particularly in forests, have long been known to produce beneficial effects for human health. However, the exact determinants and mechanisms leading to healthy outcomes remain to be elucidated. The purpose of this observational cohort study was to investigate whether inhaling plant-emitted biogenic volatile compounds, namely monoterpenes (MTs), can produce specific effects on anxiety symptoms. Data from 505 subjects participating in 39 structured forest therapy sessions at different Italian sites were collected. The air concentration of monoterpenes was measured at each site. STAI state questionnaires were administered before and after the sessions as a measure of anxiety. A propensity score matching analysis was then performed, considering an above-average exposure to inhalable air MTs as the treatment. The estimated effect was -1.28 STAI-S points (95% C.I. -2.51 to -0.06, p = 0.04), indicating that the average effect of exposure to high MT air concentrations during forest therapy sessions was to decrease anxiety symptoms.
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Affiliation(s)
- Davide Donelli
- Department of Medicine and Surgery, University of Parma, I-43121 Parma, Italy
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, I-43126 Parma, Italy
| | - Francesco Meneguzzo
- Institute of Bioeconomy, National Research Council, 10 Via Madonna del Piano, I-50019 Sesto Fiorentino, Italy
- Central Scientific Committee, Italian Alpine Club, 19 Via E. Petrella, I-20124 Milano, Italy
| | - Michele Antonelli
- Department of Public Health, AUSL-IRCCS of Reggio Emilia, I-42122 Reggio Emilia, Italy
| | - Diego Ardissino
- Department of Medicine and Surgery, University of Parma, I-43121 Parma, Italy
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, I-43126 Parma, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, I-43121 Parma, Italy
- Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, I-43126 Parma, Italy
| | - Giorgio Gronchi
- Section of Psychology, Department of Neuroscience, Psychology, Drug Research and Child’s Health (NEUROFARBA), University of Florence, 12 Via di San Salvi, I-50135 Firenze, Italy
| | - Rita Baraldi
- Institute of Bioeconomy, National Research Council, 10 Via Madonna del Piano, I-50019 Sesto Fiorentino, Italy
| | - Luisa Neri
- Institute of Bioeconomy, National Research Council, 10 Via Madonna del Piano, I-50019 Sesto Fiorentino, Italy
| | - Federica Zabini
- Institute of Bioeconomy, National Research Council, 10 Via Madonna del Piano, I-50019 Sesto Fiorentino, Italy
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22
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Bashir Z, Misquith C, Shahab A, Has P, Bukhari S. The impact of Virtual Reality on Anxiety and Functional Capacity in Cardiac Rehabilitation: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101628. [PMID: 36736604 DOI: 10.1016/j.cpcardiol.2023.101628] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND The overall utilization of cardiac rehabilitation (CR) is low despite its proven benefits in secondary prevention. Virtual reality (VR), a novel method of rehabilitation, may increase overall compliance. The purpose of this systematic review and meta-analysis is to synthesize evidence and report whether the addition of VR leads to an improvement in anxiety and functional capacity (FC) compared to standard CR. METHODS A comprehensive search strategy was used to search the online databases for the randomized controlled trials (RCTs) on VR-CR. Statistical analysis was performed using Stata SE version 17.0 (College Station, TX) and RevMan5. RESULTS A total of 747 study participants were part of 7 studies included in the meta-analysis. Three studies were part of the narrative synthesis. Anxiety showed significant improvement in VR-CR compared to standard CR (SMD -0.32, 95% CI -0.61, -0.03). There was no significant improvement in FC between VR-CR and the standard CR (SMD 0.077, 95% CI -1.24, 1.32). CONCLUSION VR-CR significantly improved CR-related anxiety compared to standard CR. However, no significant improvement in FC was found in VR-CR compared to the standard CR. Further studies are needed to assess the impact of non-immersive and immersive VR on FC.
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Affiliation(s)
- Zubair Bashir
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Ahmed Shahab
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, RI, USA
| | - Syed Bukhari
- Department of Medicine, Temple University, Philadelphia, PA, USA.
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23
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Ma R, Romano E, Vancampfort D, Firth J, Stubbs B, Koyanagi A. Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries. J Affect Disord 2023; 320:544-551. [PMID: 36209777 PMCID: PMC10166713 DOI: 10.1016/j.jad.2022.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs. METHODS Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category. RESULTS 237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01). CONCLUSION Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.
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Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AB, UK.
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AB, UK
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven 3000, Belgium; University Psychiatric Centre KU Leuven, Kortenberg 3000, Belgium
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK; NICM Health Research Institute, Western Sydney University, Westmead 2751, Australia
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London SE5 8AB, UK; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, ISCIII, 08830 Barcelona, Spain; Institució Catalana de Recerca i Estudis Avancats (ICREA), Pg. Lluis Companys 23, 08010 Barcelona, Spain
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24
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Changes in the Anxiety Levels of Patients Undergoing Percutaneous Coronary Intervention. Dimens Crit Care Nurs 2023; 42:15-21. [DOI: 10.1097/dcc.0000000000000560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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25
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Yossef M, Amer R, Elsokkary H, Shama G. Psychiatric symptoms in patients with non-valvular atrial fibrillation. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is one of the leading causes of hospitalization and even death worldwide. Complex bidirectional associations have been suggested between psychiatric disorders and AF disease. This study was conducted to investigate the prevalence of psychiatric symptoms in a cohort of Egyptian population presented with symptomatic non-valvular AF (NVAF) and to identify the high-risk subjects in need for professional psychiatric consultation. A total of 100 eligible symptomatic NVAF patients were recruited in this cross-sectional study. Each patient was subjected to: (1) cardiac evaluation included electrocardiogram, trans-esophageal echocardiography, and the European Heart Rhythm Association (EHRA). (2) Psychiatric evaluation consisted of clinical psychiatric interviewing, Hospital Anxiety and Depression Scales (HADS), Mini–Mental State Examination (MMSE), type-D personality screening, and the short form-36 (SF-36) health survey for the assessment of health-related quality of life (HRQoL).
Results
Forty-four percent of our enrolled AF patients had anxiety symptoms, 32% had depressive symptoms, 24% had mild cognitive impairment, and 32% had type-D personality. Linear regression analysis demonstrated that the left atrial dimension (LAD) and the age were the main significant predictors of MMSE, while the main predictors of HADS were SF-36 (physical functioning and general health) and the age. Neither psychiatric symptoms, nor type-D personality was a significant predictor for the evaluated cardiac parameters.
Conclusions
Mild cognitive impairment as well as depressive and anxiety symptoms is not uncommon associates with NVAF patients. Assessment of cognitive function and HRQoL is strongly advised for AF patients presented with enlarged LAD particularly among old adults.
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Cortés-Martín J, Sánchez-García JC, Rodríguez-Blanque R. Health Care on Rare Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:395. [PMID: 36612717 PMCID: PMC9819633 DOI: 10.3390/ijerph20010395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
Rare diseases are a subject of great scientific and health interest that has been on the rise in recent years [...].
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Affiliation(s)
- Jonathan Cortés-Martín
- Andalusia Research Plan, Junta de Andalucía, Research Group CTS1068, School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Juan Carlos Sánchez-García
- Andalusia Research Plan, Junta de Andalucía, Research Group CTS1068, School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Raquel Rodríguez-Blanque
- Andalusia Research Plan, Junta de Andalucía, Research Group CTS1068, School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- School of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
- Hospital Universitario Clínico San Cecilio, 18071 Granada, Spain
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The Relationship between Depressive Symptoms, Anxiety and Sociodemographic Characteristics in Individuals with Chronic Diseases. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1037380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: This study aims to reveal the relationship between depressive symptoms, anxiety level and socio-demographic characteristics of individuals with chronic diseases.
Methods: The study sample consisted of 149 individuals over the age of 18 who agreed to participate in the study and had a chronic disease. Each of the participants completed a questionnaire that revealed their socio-demographic characteristics, a Beck Depression Inventory and a Generalized Anxiety Inventory-7.
Results: The participants’ mean BDI score was 14.56±10.08 and the average score of GAD-7 test was 7.40±5.57. 34% of the patients are at risk of moderate and 8.7% at risk of severe depression. 22.8% of individuals are under high and 11.4% under serious anxiety threat. Average total scores of depression and anxiety scales are significantly higher in those with lower incomes than normal or higher incomes and in singles when compared to married people. In addition, the GAD-7 test scale mean score of those who did not comply with the treatment was higher. In addition, a positive linear relationship was found between BDI and GAD-7.
Conclusions: Depression and anxiety levels are significantly higher in patients with chronic disease. It is recommended that, individuals at risk among those with chronic diseases should be identified and supported psycho-socially.
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28
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Broome CM, Hooda N, Su J, Jiang X, Nicholson G, Frankenfeld CL, Iglesias-Rodriguez M, Fryzek J, Patel P. Medically-attended anxiety and depression is increased among newly diagnosed patients with cold agglutinin disease: Analysis of an integrated claim-clinical cohort in the United States. PLoS One 2022; 17:e0276617. [PMID: 36520848 PMCID: PMC9754177 DOI: 10.1371/journal.pone.0276617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cold agglutinin disease (CAD) is a rare, chronic form of autoimmune hemolytic anemia. Clinical manifestations can include classical complement pathway-mediated chronic hemolysis, anemia, and profound fatigue. Research has shown that patients with other anemias may develop anxiety and depression, but this has not been studied previously in patients with CAD. METHODS CAD patients were identified in the Optum Claims-Clinical dataset (between January 1, 2006-June 30, 2016) and matched to comparison patients without CAD by patient factors. Adjusted Cox regression models estimated time to anxiety and depression, defined by three different outcomes: medication use, hospitalization, and therapy related to anxiety and depression. Subset analyses were performed for primary CAD. Patients were followed until they had anxiety and depression, they left the Optum system, death, or the study period ended (June 30, 2016). RESULTS Patients with CAD (n = 384) were more likely to have medically attended anxiety and depression (adjusted hazard ratio [aHR]: 1.6; 95% confidence interval [CI]: 1.3-2.1), to be prescribed antidepressants or psychotherapy after their CAD diagnosis (aHR: 1.8; 95% CI: 1.2-2.9), or to be hospitalized for an anxiety and depression-related event along with medication or psychotherapy (aHR: 2.0; 95% CI: 1.4-2.9) relative to matched comparisons (n = 2789), during the follow-up period. Patients with primary CAD were at increased risk for medically attended anxiety and depression (aHR: 1.8; 95% CI: 1.4-2.4), with the highest risk for prescription medication or therapy (aHR: 2.7; 95% CI: 1.6-4.6). CONCLUSIONS Our study indicates that medically attended anxiety and depression manifest at a higher rate in CAD patients than in a matched non-CAD cohort. Study findings suggest that CAD patients may experience a greater burden on mental health that may negatively contribute to their overall quality of life. Further investigation on this topic is warranted.
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Affiliation(s)
- Catherine M. Broome
- Division of Hematology, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Naushin Hooda
- EpidStrategies, Rockville, Maryland, United States of America
| | - Jun Su
- Sanofi, Cambridge, Massachussetts, United States of America
| | - Xiaohui Jiang
- EpidStrategies, Rockville, Maryland, United States of America
| | - Gina Nicholson
- EpidStrategies, Rockville, Maryland, United States of America
| | | | | | - Jon Fryzek
- EpidStrategies, Rockville, Maryland, United States of America
| | - Parija Patel
- Sanofi, Cambridge, Massachussetts, United States of America
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Liu Q, Yin H, Jiang C, Xu M, Liu Y, Liu A, Wang H, Bai B, Liu F, Guo L, Ma H, Geng Q. Underestimated prognostic value of depression in patients with obstructive coronary artery disease. Front Cardiovasc Med 2022; 9:961545. [PMID: 36531718 PMCID: PMC9755582 DOI: 10.3389/fcvm.2022.961545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/22/2022] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE The aim of this study was to explore the different predictive values of depression among patients with different cardiac systolic function levels. METHODS Four hundred eighty-three consecutive patients with obstructive coronary artery disease (CAD) were included the depressive state was assessed using the Chinese version of the Patient Health Questionnaire 9 (PHQ-9). Depression was defined as have depressive symptoms with a PHQ-9 score ≥5. The level of cardiac systolic function was classified as left ventricular ejection fraction (LVEF) ≥50 and <50%. RESULTS Over a median of 26.2 months, 421 patients completed the follow-up and experienced 101 major adverse cardiovascular events (MACEs), 45 non-cardiac rehospitalizations, and 17 deaths. Predictors for clinical outcomes in patients with different cardiac systolic function levels were not the same. For participants with preserved LVEF, depression was associated with increased risks for cardiovascular events and composite outcomes. However, when focusing the whole population, predictive values of depression for MACEs, non-cardiac rehospitalizations, and composite endpoints all dropped. Receiver operating characteristic (ROC) analyses further confirmed that depression was the one of the main predictors for all clinical outcomes. With the combination of other simple features, area under curve (AUC) could reach 0.64-0.67. CONCLUSIONS Inconsistent with the general impression, depression is found to have a closer linkage with clinical outcomes in CAD patients with preserved LVEF rather than in those with decreased LVEF. These findings appeal for more attention on CAD patients with depressive symptoms and comparatively normal LVEF. Including psychological factors may be a good attempt when constructing risk prediction models.
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Affiliation(s)
- Quanjun Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Han Yin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mingyu Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Yuting Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Anbang Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Haochen Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bingqing Bai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Fengyao Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Lan Guo
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan Ma
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiac Rehabilitation, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingshan Geng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
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Deng F, Li X, Tang C, Chen J, Fan B, Liang J, Zhen X, Tao R, Zhang S, Cong Z, Du W, Zhao H, Xu L. Mechanisms of Xiong-Pi-Fang in treating coronary heart disease associated with depression: A systematic pharmacology strategy and in vivo pharmacological validation. JOURNAL OF ETHNOPHARMACOLOGY 2022; 298:115631. [PMID: 35987411 DOI: 10.1016/j.jep.2022.115631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/18/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) and depression are very common and often co-existing disorders. Xiong-Pi-Fang (XPF), a therapeutic classical traditional Chinese medicine (TCM) formula, has shown satisfactory efficacy in treating CHD associated with depression. However, its mechanism of action is still unknown. PURPOSE To employ a systematic pharmacology approach for identifying the action mechanisms of XPF in treating CHD associated with depression. METHODS We used a systematic pharmacology approach to identify the potential active mechanisms of XPF in treating CHD with depression. Potential active compounds in XPF and the diseases targets were screened using relevant databases to build corresponding pathways, following the experiments that were conducted to confirm whether the presumptive results of systemic pharmacology were correct. RESULTS Network pharmacology predicted 42 key targets and 20 signaling pathways involved in XPF-mediated treatment, with IL-6/JAK2/STAT3/HIF-1α/VEGF-A pathway significantly affected. The common influences were hypothalamic-pituitary-adrenal axis (HPA axis) and glucocorticoid signaling, validated through chronic unexpected mild stress (CUMS) with isoprenaline (ISO) for inducing CHD within the depression model in rats. In addition, XPF intake reduced depressive-like behaviors and improved ECG ischemic changes. Furthermore, XPF exerted some anti-inflammatory effects by inhibiting the interleukin-6 (IL-6) induced phosphorylation of janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3), ultimately downregulating hypoxia-inducible factor 1-α (HIF-1α) and vascular endothelial growth factor-A (VEGF-A) activation. The dysfunctional HPA axis feedback loop was also regulated, which enhanced the glucocorticoid receptor (GR) expression. In contrast, it improved glucocorticoid resistance by reducing the mineralocorticoid receptor expression. CONCLUSIONS Suppressing IL-6 release and maintaining the HPA feedback loop balance could be the primary mechanism of XPF against CHD with depression. The significance of the IL-6 and HPA axis identified indicates their potential as essential targets for CHD therapy with depression.
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Affiliation(s)
- Fangjuan Deng
- Graduate School, Tianjin University of TCM, Tianjin, 301617, China
| | - Xiaofeng Li
- Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin, 300150, China
| | - Cheng Tang
- School of Pharmacy, Tianjin Medical University, Tianjin, 300070, China
| | - Jinhong Chen
- Graduate School, Tianjin University of TCM, Tianjin, 301617, China
| | - Boya Fan
- Graduate School, Tianjin University of TCM, Tianjin, 301617, China
| | - Jiayu Liang
- Graduate School, Tianjin University of TCM, Tianjin, 301617, China
| | - Xin Zhen
- Graduate School, Tianjin University of TCM, Tianjin, 301617, China
| | - Rui Tao
- Department of TCM, Tianjin University of TCM, Tianjin, 301617, China
| | - Shaoqiang Zhang
- Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin, 300150, China
| | - Zidong Cong
- Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin, 300150, China
| | - Wuxun Du
- Department of Cardiology, The Second Affiliated Hospital of Tianjin University of TCM, Tianjin, 300150, China.
| | - Hucheng Zhao
- Department of Aeronautics and Astronautics, Tsinghua University, Beijing, 100084, China.
| | - Liang Xu
- School of Pharmacy, Tianjin Medical University, Tianjin, 300070, China; Tianjin Medical College, Tianjin, 300222, China.
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Yang XL, Xie WY, Cai YM, Tang HY, Tao MY, Shen ZM, Chen HJ. Investigation of the Negative Emotions Exhibited in Patients with Coronary Heart Disease After PCI and Any Influencing Factors. Psychol Res Behav Manag 2022; 15:3027-3037. [PMID: 36281272 PMCID: PMC9587531 DOI: 10.2147/prbm.s379422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To understand existing negative emotions in patients with coronary heart disease after percutaneous coronary stent implantation (PCI) and analyse its influencing factors. Methods Patients with coronary heart disease after PCI in three tertiary hospitals in Changsha City from April to September 2018 were selected as the research subjects. The self-designed general information questionnaire assessed irritability, depression and anxiety (IDA) on a self-rating scale. It was used to examine patients’ existing negative emotions with coronary heart disease after PCI and analyse the influencing factors. Results 203 questionnaires were distributed, and 202 valid questionnaires were recovered, with an effective recovery rate of 99.5%. The IDA score of patients with coronary heart disease after PCI was 17.01±7.60 points, the incidence of negative emotions was 63.8%, and the incidences of depression, anxiety and irritability were 39.6%, 8.4% and 15.8%, respectively. Negative emotion was taken as the dependent variable and a patient’s general data, such as lifestyle and disease, as the independent variables. A univariate analysis was conducted to obtain gender, age, educational level, marital status, work status, per capita monthly household income, sleep status, etc. Seven factors were identified as the influencing factors of negative emotions in patients with coronary heart disease after PCI, and the difference was statistically significant (P<0.05). Conclusion Most patients with coronary heart disease after PCI tend to exhibit negative emotions such as anxiety and depression. Medical staff should attach great importance to evaluating any negative feelings in this group and take timely targeted intervention measures to prevent and mitigate the occurrence and development of these adverse emotions in patients with coronary heart disease after PCI.
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Affiliation(s)
- Xiao-Li Yang
- Department of Liver Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China
| | - Wen-Yao Xie
- Interventional Operating Room, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China
| | - Yi-Min Cai
- Department of Nursing, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China,Correspondence: Yi-Min Cai, Nursing department, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), No. 61, Jiefang West Road, Changsha, 410005, People’s Republic of China, Tel +86 13787129085, Fax +0731-83928047, Email
| | - Hong-Ying Tang
- Department of Liver Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China
| | - Mei-Yi Tao
- Department of Nursing, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China
| | - Zhou-Min Shen
- Department of Nursing, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410005, People’s Republic of China
| | - Hong-Jiao Chen
- Medical College of Hunan Normal University, Changsha, 410013, People’s Republic of China
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Polak M, Nowicki GJ, Naylor K, Piekarski R, Ślusarska B. The Prevalence of Depression Symptoms and Their Socioeconomic and Health Predictors in a Local Community with a High Deprivation: A Cross-Sectional Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811797. [PMID: 36142069 PMCID: PMC9517619 DOI: 10.3390/ijerph191811797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 06/01/2023]
Abstract
Depression is a heterogeneous and etiologically complex psychiatric syndrome thatshows a strong sexual dimorphism and often impacts people with a low socioeconomic status (SES). The aim of the study was to estimate the occurrence of depression symptoms in a local community with a high deprivation rate, the example being the inhabitants of the JanówLubelski County in eastern Poland. A cross-sectional study was carried out on 3752 people aged between 35 and 64. The prevalence of depression symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. In the screening for depression symptoms in the entire population we studied, the risk of depression symptoms was 16.1% (n = 605), with women having a significantly higher mean score than men (p < 0.001). Significant predictors associated with the achievement of 10 points and more in the PHQ-9 assessment in the case of women and men were: living alone, education and having comorbidities. Moreover, female participants living in rural areas were significantly more likely to exhibit depression symptoms, whereas smoking was a significant predictor of depressive symptoms in men. It was observed that in the case of obese women, the chance of being in the higher category of the PHQ-9 assessment was 1.41 times higher than in women with normal body weight. However, in the case of men, an increase in age by one year increased the chance of being in a higher category by 1.02 times. Moreover, the odds of falling into a higher category, as assessed by the PHQ-9 questionnaire, among men who drink alcohol more than once a week was 1.7 times higher than in men who do not drink or consume alcohol occasionally. Summarising the results of studies conducted in a local community characterised by a high deprivation rate, socioeconomic and health variables related to SES significantly impacted the incidence of depression, but they differ in terms of gender.
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Affiliation(s)
- Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Skawińska 8 Str., PL-31-066 Krakow, Poland
| | - Grzegorz Józef Nowicki
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., PL-20-081 Lublin, Poland
| | - Katarzyna Naylor
- Department of Didactics and Medical Simulation, Medical University of Lublin, Chodźki 4 Str., PL-20-093 Lublin, Poland
| | - Robert Piekarski
- Diabetology with Endocrine—Metabolic Laboratory, Department of Paediatric Endocrinology, Medical University of Lublin, Gębali 6 Str., 20-093 Lublin, Poland
| | - Barbara Ślusarska
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., PL-20-081 Lublin, Poland
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Chen M, Liu M, Guo X, Zhou J, Yang H, Zhong G, Men L, Xie Y, Tong G, Liu Q, Luan J, Zhou H. Effects of Xinkeshu tablets on coronary heart disease patients combined with anxiety and depression symptoms after percutaneous coronary intervention: A meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154243. [PMID: 35717809 DOI: 10.1016/j.phymed.2022.154243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/17/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Xinkeshu tablets (XKS), a well-known Chinese patent drug, have been administered to coronary heart disease (CHD) patients with anxiety and depression after percutaneous coronary intervention (PCI). PURPOSE This meta-analysis aimed to systematically evaluate the clinical effects of XKS for treating CHD patients with anxiety and depression after PCI. METHODS Randomized controlled trials (RCTs) about XKS alone or combined with conventional drugs for the treatment of CHD patients with anxiety and depression after PCI were retrieved from 7 databases (MEDLINE, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM) and Wanfang Database) through November 2021. First, the studies were reviewed and screened by two independent assessors according to the eligibility criteria. Second, the methodological quality of the eligible studies was evaluated based on the Cochrane Collaboration's tool for assessing the risk of bias. Subsequently, meta-analysis was performed by using RevMan 5.4 software, and publication bias was evaluated by Stata 12.0 software. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the quality of the evidence. RESULTS In total, 11 clinical RCTs involving 1000 patients were included in this study. This meta-analysis found that compared with conventional treatment alone, XKS combined with conventional treatment significantly improved the anxiety scale scores (SMD = -1.97, 95% CI -3.13 to -0.82; p = 0.0008; I2 = 98%), the depression scores (SMD = -2.80, 95% CI -4.49 to -1.10; p = 0.001; I2 = 98%), the scores on the Medical Outcomes Study 36 Item Short Form Health Survey (SF36) (MD = 11.22, 95% CI 4.19 to 18.26; p =0.002; I2 = 95%) and the blood lipid levels of total cholesterol (TC) (MD = -0.38, 95% CI -0.62 to -0.13; p = 0.003; I2 = 0%) and triglyceride (TG) (MD = -0.31, 95% CI -0.46 to -0.17; p < 0.0001; I2 = 0%). CONCLUSION The current evidence suggests that XKS might benefit CHD patients experiencing anxiety and depression after PCI by helping to improve their depression symptoms, TC and TG blood lipid levels. However, due to insufficient methodological quality of the studies, several risks of bias and inadequate reporting of the clinical data, more rigorous, multicenter, sufficient-sample and double-blind randomized clinical trials are warranted.
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Affiliation(s)
- Mingtai Chen
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China; Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China.
| | - Mengnan Liu
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; National Traditional Chinese Medicine Clinical Research Base and Department of Cardiovascular, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, PR China
| | - Xin Guo
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Jie Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Huayi Yang
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Guofu Zhong
- Intensive Care Unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Ling Men
- Department of Neurology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Ying Xie
- School of Pharmacy and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, PR China
| | - Guangdong Tong
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; Department of Liver Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Qiang Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China
| | - Jienan Luan
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China
| | - Hua Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, Macau University of Science and Technology, Taipa, Macao, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, PR China.
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Psychological distress is independently related to new coronary events at 8 years' follow-up in elderly primary care patients with hypertension. J Psychosom Res 2022; 160:110980. [PMID: 35779439 DOI: 10.1016/j.jpsychores.2022.110980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Occurrence of psychological distress in hypertensive patients could have a negative synergistic effect on future cardiovascular events (CVEs). The aim of this study was to determine the association between anxiety or depressive symptoms in elderly hypertensive primary care patients and the development of new CVEs and all-cause mortality. METHODS A prospective cohort study was conducted in five Dutch general practices between June 2010 and January 2012. Patients with primary care managed hypertension, aged 60-85 years, were included and completed the GAD-7 and PHQ-9, measuring anxiety and depressive symptoms respectively. The incidence of new CVEs (coronary event, cerebrovascular disease, atrial fibrillation and heart failure) and all-cause mortality at 8 years' follow-up was recorded by data extraction of the digital information systems. RESULTS Among the 555 included participants (mean age 70 ± 6.6 years; 56% female), 29 (5.2%) had a new coronary event, 42 (7.6%) a cerebrovascular disease, 57 (10.3%) atrial fibrillation, 22 (4%) heart failure and 68 (12.3%) died. Elevated anxiety and depression scores increased the risk of a coronary event independently and significantly by 12% (HR 1.12; 95% CI [1.04-1.22], p = 0.005) and 18% (HR 1.18; 95% CI [1.08-1.28], p < 0.0001), respectively, adjusted for relevant (Framingham) baseline covariates. No associations were found with regard to other CVEs and all-cause mortality. CONCLUSION In a random sample of elderly primary care hypertension patients there was a significant association between psychological distress and the occurrence of new coronary events after 8 years' follow-up but not with other CVEs and all-cause mortality.
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Ironson G, Hylton E, Verhagen R. A New Attitude Towards Treatment Measure Predicts Survival Over 17 Years. J Gen Intern Med 2022; 37:2351-2357. [PMID: 35296979 PMCID: PMC9360262 DOI: 10.1007/s11606-021-07245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND For patients diagnosed with chronic illness, attitude towards treatment may play an important role in health and survival. For example, negative attitudes towards treatment have been related to poorer adherence to treatment recommendations and prescribed medication across a range of chronic illnesses. In addition, prior research has shown that attitude towards treatment assessed through a psychiatric interview predicted survival at 1 year after bone marrow transplantation with great accuracy (> 90%). OBJECTIVE The purpose of this study was to determine the relationship between a self-report attitude to a treatment measure that operationalized a psychiatric interview, and survival over 17 years in a sample of people living with HIV (PLWH). PARTICIPANTS AND DESIGN Participants (N = 177) who were in the mid-range of HIV illness at baseline (CD4s 150 to 500, no prior AIDS-defining clinical symptom) were administered the Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale and followed longitudinally to determine survival at 17 years. MEASURES The Montreal-Miami Attitude to Treatment (MMAT-20/HIV) scale is a 20-item self-report questionnaire designed to survey multiple factors that contribute to an overall psychological construct of the treatment process. RESULTS The MMAT-20/HIV predicted survival over 17 years controlling for biomedical (baseline CD4, viral load, antiretroviral medications, age) and psychosocial (race, education, antiretroviral medications) variables. Those in the top half on the MMAT-20/HIV were almost twice as likely to survive than those in the lower half. Scores on the MMAT-20/HIV were significantly but modestly correlated with adherence (r = .20, p < .05), but adherence was not a mediator of the relationship between the MMAT-20/HIV and survival. CONCLUSIONS An individual's attitude towards the treatment process predicted survival, raising the possibility that optimal clinical management would include ways to probe these attitudes and intervene where possible. The ease of administering the MMAT-20 and adaptability to other illnesses could facilitate this endeavor.
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Affiliation(s)
| | - Emily Hylton
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA
| | - Rachel Verhagen
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, USA
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Dammen T, Tunheim K, Munkhaugen J, Papageorgiou C. The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study. Front Psychol 2022; 13:948081. [PMID: 35967654 PMCID: PMC9363691 DOI: 10.3389/fpsyg.2022.948081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Depression and anxiety symptoms are highly prevalent in coronary heart disease (CHD) patients and associated with poor outcome. Most psychological treatments have shown limited effectiveness on anxiety and depression in these patients. This study evaluates the feasibility of the attention training technique (ATT) in CHD patients with symptoms of anxiety and/or depression. Methods Five consecutive CHD patients with significant depression and anxiety symptoms with Hospital Anxiety and Depression rating scale (HADS) -anxiety or -depression subscale score > 8 received 6 weekly group-sessions of ATT in an open trial. Outcomes included feasibility and symptoms measured by HADS, at baseline, post-treatment and at 6 months follow-up. We also assessed psychiatric diagnoses, type D personality, insomnia, worry, and rumination. Results The sample comprised five men with a mean age of 59.9 (SD 4.4) years. Four of the patients attended all six sessions, and one patient attended all but one session. Mean HADS-A scores at baseline, post-treatment, and follow-up were 9.4 (SD 3.0), 4.2 (SD 3.0), and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (SD 3.7), and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Statistically significant changes were found from pre- to post-treatment scores for HADS-A and worry, which were maintained at follow-up, and HADS-D scores significantly decreased from pre-treatment to 6-months follow-up. Conclusions ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients. An adequately powered randomized controlled trial is warranted.
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Affiliation(s)
- Toril Dammen
- Department of Behavioural Medicine, Faculty of Medicine, Insitute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Tunheim
- Department of Behavioural Medicine, Faculty of Medicine, Insitute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
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He CJ, Zhai CL, Huang SD, Fan HY, Qian YZ, Zhu CY, Hu HL. Anxiety Predicts Poor Prognosis in Patients With Hypertrophic Cardiomyopathy. Front Cardiovasc Med 2022; 9:890506. [PMID: 35665258 PMCID: PMC9162169 DOI: 10.3389/fcvm.2022.890506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHypertrophic cardiomyopathy (HCM) is the prevalent inherited cardiomyopathy and a major contributor to sudden death and heart failure in young adults. Although depression has been associated with poor prognosis in patients with cardiovascular disease, the relationship between anxiety and HCM clinical outcomes has not been addressed. We aimed to determine the prevalence of anxiety symptoms in patients with HCM and the association between anxiety and adverse prognosis in this population.MethodsA total of 793 patients with HCM were prospectively enrolled and followed up for a mean of 4.1 years from March 2014 to January 2018. The primary endpoint was sudden cardiac death (SCD) events, and the secondary endpoint was HCM-related heart failure events. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) during outpatient visits or hospital stays.ResultsElevated scores on the HADS anxiety subscale (HADS-A ≥ 8) were defined as clinically significant anxiety. SCD and HCM-related heart failure events occurred in 76 and 149 patients, respectively, during the follow-up period. Kaplan–Meier survival curves demonstrated the significant association of anxiety with SCD events (log-rank P = 0.012) and HCM-related heart failure events (log-rank P = 0.001). Multivariable Cox regression analysis showed anxiety as a predictor of SCD events and HCM-related heart failure events (adjusted hazard ratio [HR] = 1.42, 95% confidence interval [CI] = 1.12–2.04, P = 0.03; adjusted HR = 2.9,2 95% CI = 1.73–4.03, P < 0.001), independent of conventional risk factors and depression. Besides, patients with comorbid anxiety and depression showed a fourfold higher risk of heart failure events and 3.5-fold higher risk of SCD versus those with neither (adjusted HR = 4.08, 95% CI = 2.76–5.91, P < 0.001; adjusted HR = 3.52, 95% CI = 2.24–4.67, P < 0.001, respectively).ConclusionsAnxiety was prevalent among Chinese patients with HCM, and it was independently associated with a higher risk of SCD and HCM-related heart failure events, particularly when comorbid with depression. Psychological assessment and intervention should be considered to alleviate anxiety symptoms in this population.Clinical Trial Registrationhttp://www.chictr.org.cn, identifier: ChiCTR2000040759.
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Affiliation(s)
- Chao-Jie He
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chang-Lin Zhai
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Shao-Dai Huang
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Hong-Yan Fan
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ye-Zhou Qian
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chun-Yan Zhu
- Department of Anesthesiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- *Correspondence: Chun-Yan Zhu
| | - Hui-Lin Hu
- Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
- Hui-Lin Hu
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Merlo AC, Troccolo A, Piredda E, Porto I, Gil Ad V. Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities. Front Cardiovasc Med 2022; 9:895053. [PMID: 35586651 PMCID: PMC9108150 DOI: 10.3389/fcvm.2022.895053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA), despite a lower burden of coronary atherosclerosis, has a non-negligible prognostic impact. The label of MINOCA includes an array of different aetiologies and pathologic conditions, thus the identification of the underlying disease is crucial to patient management. Myocardial infarction with obstructive coronary artery disease and MINOCA share only some risk factors and comorbid conditions. While traditional cardiovascular risk factors have a lower prevalence in MINOCA patients, atypical ones—e.g., anxiety, depression, and autoimmune diseases—are much more frequent in this population. Other conditions—e.g., pregnancy, cancer, and anti-cancer therapy—can predispose to or even induce MINOCA through various mechanisms. The evidence of such risk factors for MINOCA is still scarce and contradicting, as no randomised controlled trials exist in this field. In our work, we performed a review of registries, clinical studies, and case reports of MINOCA, in order to summarise the available data and analyse its possibile pathogenic mechanisms.
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Affiliation(s)
- Andrea Carlo Merlo
- Division of Cardiovascular Diseases, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Alessandro Troccolo
- Division of Cardiovascular Diseases, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Elisa Piredda
- Division of Cardiovascular Diseases, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Italo Porto
- Division of Cardiovascular Diseases, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
| | - Vered Gil Ad
- Cardiology Unit, DICATOV - Cardiothoracic and Vascular Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genoa, Italy
- *Correspondence: Vered Gil Ad
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Association of patient-reported psychosocial healthcare and risk of readmissions and mortality in patients with ischemic heart disease: A population-based cohort study. J Psychosom Res 2022; 156:110776. [PMID: 35276588 DOI: 10.1016/j.jpsychores.2022.110776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Psychosocial risk factors are common in patients with ischemic heart disease (IHD) and linked to poor prognosis. Psychosocial healthcare is recommended in international guidelines and has demonstrated positive effects, primarily on psychosocial symptoms. We examined the association between patient-reported psychosocial healthcare and hospital readmissions and mortality in patients with IHD. METHODS A population-based cohort study with register-based follow-up. Patient-reported psychosocial healthcare was measured by seven items in a survey sent to a random sample of patients with incident IHD in Denmark in 2014. We used multivariable Cox proportional hazards models and Poisson regression to examine the association between psychosocial healthcare and readmissions and all-cause mortality. RESULTS In total, 1083 (57%) patients were followed up to 4½ years. Low psychosocial support was reported by 53.4%, medium by 26.2% and high by 20.4% patients. The hazard of acute cardiac readmission for patients reporting low psychosocial healthcare was 2.08 higher than for patients reporting high psychosocial healthcare (95%CI:1.01-4.30). No association was found with time to first all-cause readmission. The acute cardiac readmission rate was 3.24 (95%CI:1.66-6.29) and 4.23 (95%CI:2.15-8.33) times higher among patients reporting low and medium psychosocial healthcare compared to high, and the all-cause readmission rate was 1.30 (95%CI:1.16-1.46) and 1.32 (95%CI:1.17-1.49) times higher. The hazard of death was 2.86 (95%CI:1.23-6.69) and 2.88 (95%CI:1.18-7.04) times higher among patients reporting low and medium psychosocial healthcare compared to high. CONCLUSION In patients with IHD, a high level of patient-reported psychosocial healthcare was significantly associated with reduced hospital readmissions and all-cause mortality.
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Dorrington S, Carr E, Stevelink SAM, Dregan A, Woodhead C, Das-Munshi J, Ashworth M, Broadbent M, Madan I, Hatch SL, Hotopf M. Multimorbidity and fit note receipt in working-age adults with long-term health conditions. Psychol Med 2022; 52:1156-1165. [PMID: 32895068 DOI: 10.1017/s0033291720002937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. METHODS Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. RESULTS We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73-12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60-4.87), chronic pain and depression (HR 4.14; 95% CI 3.69-4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36-4.95). CONCLUSIONS Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
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Affiliation(s)
- Sarah Dorrington
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alex Dregan
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Charlotte Woodhead
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London SE1 1UL, UK
| | | | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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41
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Gundugurti PR, Bhattacharyya R, Koneru A. Management of Psychiatric Disorders in Patients with Cardiovascular Diseases. Indian J Psychiatry 2022; 64:S355-S365. [PMID: 35602356 PMCID: PMC9122167 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_42_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Prasad Rao Gundugurti
- Division of Schizophrenia and Psychopharmacology, Asha Hospital, Hyderabad, Telangana, India
| | - Ranjan Bhattacharyya
- Department of Psychiatry, Murshidabad Medical College and Hospital & Charak Square Diagnostic and Research Center, Berhampore, West Bengal, India
| | - Amulya Koneru
- Department of Reproductive Psychiatry, Asha Hospital, Hyderabad, Telangana, India E-mail:
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42
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Narvaez Linares N, Munelith-Souksanh K, Tanguay A, Plamondon H. The impact of myocardial infarction on basal and stress-induced heart rate variability and cortisol secretion in women: A pilot study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 9:100113. [PMID: 35755922 PMCID: PMC9216611 DOI: 10.1016/j.cpnec.2022.100113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 10/24/2022] Open
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43
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Luan S, Wu X, Yin S. Anxiety faintly and depression remarkably correlate with recurrence in acute ischemic stroke patients: A study with 3-year longitude evaluation and follow-up. Medicine (Baltimore) 2022; 101:e28521. [PMID: 35060506 PMCID: PMC8772667 DOI: 10.1097/md.0000000000028521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/16/2021] [Indexed: 01/05/2023] Open
Abstract
Clinical value of anxiety and depression in acute ischemic stroke (AIS) is rarely studied. Thus, the aim of this study was to explore longitudinal changes of anxiety and depression, as well as their correlation with recurrence in AIS.A total of 120 AIS patients and 120 controls were enrolled in the study. Furthermore, comparison of the hospital anxiety and depression scale (HADS) score or rate between AIS and controls was determined by Mann-Whitney U test or Chi-square test. In AIS patients, change of HADS scores or linear trend of anxiety and depression rate over time were determined by Friedman test or Mantel-Haenszel Chi-square test. Moreover, correlation of anxiety and depression with the recurrence rate was analyzed by log-rank test.HADS for anxiety score, anxiety rate, HADS for depression score and depression rate were all elevated in AIS patients compared with controls (all P < .001). In AIS patients, HADS for anxiety score was elevated from discharged from hospital (M0) to month (M) 36 (P = .027), while anxiety rate was not (P = .107). Besides, HADS-D score and rate were both increased from M0 to M36 (both P < .001). Moreover, accumulating recurrence rate was 6.7%, 11.7%, and 17.5% at 1 year, 2 years, and 3 years, respectively. Additionally, anxiety at M24 (P = .033), depression at M0, M12, M24, and M36 (all P < .05) were all correlated with increased accumulating recurrence rate.Continuous monitoring of anxiety and depression might be beneficial for the management of AIS prognosis.
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Affiliation(s)
- Shaoqun Luan
- Third Department of Neurology, Xingtai Peopleʼs Hospital of Hebei Province, Xingtai, PR China
| | - Xin Wu
- Department of Anesthesia Recovery Room, Xingtai Peopleʼs Hospital of Hebei Province, Xingtai, PR China
| | - Shaohua Yin
- Third Department of Neurology, Xingtai Peopleʼs Hospital of Hebei Province, Xingtai, PR China
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44
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Iyer AS, Parekh TM, O’Toole J, Bhatt SP, Eakin MN, Krishnan JA, Yohannes AM, Woodruff PG, Cooper CB, Kanner RE, Hanania NA, Dransfield MT, Regan EA, Hoth KF, Kim V. Clinically Significant and Comorbid Anxiety and Depression Symptoms Predict Severe Respiratory Exacerbations in Smokers: A Post Hoc Analysis of the COPDGene and SPIROMICS Cohorts. Ann Am Thorac Soc 2022; 19:143-146. [PMID: 34343034 PMCID: PMC9797036 DOI: 10.1513/annalsats.202103-240rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Anand S. Iyer
- University of Alabama at
BirminghamBirmingham, Alabama
| | | | | | | | | | | | | | | | | | | | | | - Mark T. Dransfield
- University of Alabama at
BirminghamBirmingham, Alabama
- Birmingham Veterans Affairs Medical
CenterBirmingham, Alabama
| | | | | | - Victor Kim
- Temple UniversityPhiladelphia,
Pennsylvania
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45
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Lebherz C, Frick M, Panse J, Wienstroer P, Brehmer K, Kerst G, Marx N, Mathiak K, Hövels-Gürich H. Anxiety and Depression in Adults With Congenital Heart Disease. Front Pediatr 2022; 10:906385. [PMID: 35799689 PMCID: PMC9253420 DOI: 10.3389/fped.2022.906385] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Anxiety and depression can worsen outcome in patients with heart disease. We elucidate the prevalence of anxiety and depression in a cohort of adults with congenital heart disease (ACHD). MATERIALS AND METHODS Prospective screening for anxiety or depression was performed in 204 consecutive patients of the outpatient clinic of our tertiary care center using the Hospital Anxiety and Depression Scale (HADS) questionnaire and the distress thermometer (DT) as a potential ultra-short screening test. Functional data were assessed at liberty of the responsible physician. HADS scores ≥ 8 were considered doubtful and scores ≥ 11 as confirmed cases of anxiety or depression, respectively. HADS results were compared with a historical group of 100 patients with non-Hodgkin Lymphoma (NHL) as well as German reference values from the literature. RESULTS Patients from the ACHD cohort were 28 ± 10 years old (mean ± SD, 54% male), 34% had a simple, 51% a moderate, including 52 patients with transposition of the great arteries after arterial switch operation, and 15% a heart defect of severe complexity. Prevalence of depression in ACHD was comparable to the German normal population (5.9% ACHD vs. 5.4% control). In contrast, prevalence of anxiety was higher than expected from reference values (12.7% ACHD vs. 5.6% control). There was a positive association between psychological distress and NYHA class [anxiety: OR 2.67 (95% CI, 1.50-4.76) p = 0.001; depression: OR 2.93 (95% CI, 1.60-5.35) p = 0.0005], but not with age, gender, or heart defect severity. Percentages of patients with ACHD with anxiety were significantly higher than in a cohort of patients with indolent non-Hodgkin lymphoma (NHL) but comparable to those with aggressive NHL (HADS-A ≥ 11: ACHD 12.7%, indolent NHL 2.2%, aggressive NHL 13.2%; p = 0.037 ACHD vs. indolent NHL; p = 0.929 ACHD vs. aggressive NHL). The distress thermometer screening test had only a fair discriminatory ability (AUC 0.708; p = 0.002) and is therefore of limited usability. CONCLUSION Adults with congenital heart disease exhibit an increased risk for anxiety disorders independently of the severity of the underlying heart defect. Anxiety prevalence was comparable to a historical cohort of patients with aggressive NHL underlining the importance of a routine screening for psychosocial distress in adults with congenital heart disease.
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Affiliation(s)
- Corinna Lebherz
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Frick
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf (CIO-ABCD), Aachen, Germany
| | - Philipp Wienstroer
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Katrin Brehmer
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany.,Department of Cardiology, DIAK Hospital, Schwäbisch Hall, Germany
| | - Gunter Kerst
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Hedwig Hövels-Gürich
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
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46
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Bigalke JA, Carter JR. Sympathetic Neural Control in Humans with Anxiety-Related Disorders. Compr Physiol 2021; 12:3085-3117. [PMID: 34964121 DOI: 10.1002/cphy.c210027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Numerous conceptual models are used to describe the dynamic responsiveness of physiological systems to environmental pressures, originating with Claude Bernard's milieu intérieur and extending to more recent models such as allostasis. The impact of stress and anxiety upon these regulatory processes has both basic science and clinical relevance, extending from the pioneering work of Hans Selye who advanced the concept that stress can significantly impact physiological health and function. Of particular interest within the current article, anxiety is independently associated with cardiovascular risk, yet mechanisms underlying these associations remain equivocal. This link between anxiety and cardiovascular risk is relevant given the high prevalence of anxiety in the general population, as well as its early age of onset. Chronically anxious populations, such as those with anxiety disorders (i.e., generalized anxiety disorder, panic disorder, specific phobias, etc.) offer a human model that interrogates the deleterious effects that chronic stress and allostatic load can have on the nervous system and cardiovascular function. Further, while many of these disorders do not appear to exhibit baseline alterations in sympathetic neural activity, reactivity to mental stress offers insights into applicable, real-world scenarios in which heightened sympathetic reactivity may predispose those individuals to elevated cardiovascular risk. This article also assesses behavioral and lifestyle modifications that have been shown to concurrently improve anxiety symptoms, as well as sympathetic control. Lastly, future directions of research will be discussed, with a focus on better integration of psychological factors within physiological studies examining anxiety and neural cardiovascular health. © 2022 American Physiological Society. Compr Physiol 12:1-33, 2022.
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Affiliation(s)
- Jeremy A Bigalke
- Department of Psychology, Montana State University, Bozeman, Montana, USA
| | - Jason R Carter
- Department of Psychology, Montana State University, Bozeman, Montana, USA.,Department of Health and Human Development, Montana State University, Bozeman, Montana, USA
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47
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Berg SK, Herning M, Schjødt I, Thorup CB, Juul C, Svendsen JH, Jorgensen MB, Risom SS, Christensen SW, Thygesen L, Rasmussen TB. The heart & mind trial: intervention with cognitive-behavioural therapy in patients with cardiac disease and anxiety: randomised controlled trial protocol. BMJ Open 2021; 11:e057085. [PMID: 34862302 PMCID: PMC8647551 DOI: 10.1136/bmjopen-2021-057085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Patients with cardiac disease often experience anxiety (prevalence about 20%-25%) and have a doubled mortality risk when suffering from anxiety compared with patients without anxiety. This calls for interventions aiming to reduce anxiety. METHODS AND ANALYSIS The Heart & Mind Trial consists of three parts: (1) screening of all hospitalised and outpatient cardiac patients with arrhythmia, heart failure or ischaemic heart disease at four university hospitals in Denmark using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A); Patients scoring ≥8 is invited to participate; (2) Assessment of the type of anxiety by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders and (3) Randomised clinical superiority trial with blinded outcome assessment, with 1:1 randomisation to cognitive-behavioural therapy (CBT) performed by a CBT-trained cardiac nurse plus usual care or, usual care alone. The primary outcome is anxiety measured with HADS-A at 5 months. Secondary outcomes include anxiety symptoms measured with Becks Anxiety Inventory and heart rate variability. Exploratory outcomes measured at 12 months include blood cortisol (stress response), blood C reactive protein (stress response), health-related quality of life, readmission, mortality and attributable direct costs. A total of 336 patients will be included. The primary analyses are based on the intention-to-treat principle. For the primary outcome, we will use a linear regression model. For the long-term outcomes, mixed regression models will be used including repeated measurements. ETHICS AND DISSEMINATION The trial is performed in accordance with the Declaration of Helsinki. All patients must give informed consent prior to participation and the trial is initiated after approval by the Danish Data Protection Agency (P-2020-894) and the National Committee on Health Research Ethics (H-20066739). Positive, neutral and negative results of the trial will be published. TRIAL REGISTRATION NUMBER NCT04582734.
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Affiliation(s)
- Selina Kikkenborg Berg
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, 1455, Denmark
| | - Margrethe Herning
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
| | - Inge Schjødt
- Department of Cardiology, Aarhus University Hospital, Aarhus, 8200, Denmark
| | - Charlotte Brun Thorup
- Clinical Nursing Research Unit and Department of Cardiology, Aalborg University Hospital, Aalborg, 9000, Denmark
| | - Carsten Juul
- Psychological consulting, Heypeople, Copenhagen K, 1260, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
| | - Martin Balslev Jorgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
| | - Signe Stelling Risom
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
- University College Copenhagen, Institute of Nursing and Nutrition, Copenhagen N, 2200, Denmark
| | - Signe Westh Christensen
- The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen O, 2100, Denmark
| | - Lau Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, 1455, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, 2200, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, 2900, Denmark
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48
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Uhlenbusch N, Swaydan J, Höller A, Löwe B, Depping MK. Affective and anxiety disorders in patients with different rare chronic diseases: a systematic review and meta-analysis. Psychol Med 2021; 51:2731-2741. [PMID: 34583798 DOI: 10.1017/s0033291721003792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We aimed to identify the prevalence of affective and anxiety disorders across different rare disease and identify correlates of psychopathology. We performed a systematic review and meta-analysis. We systematically searched Medline, PSYNDEX, PsycINFO for observational studies examining clinically diagnosed affective and/or anxiety disorders in adults with rare chronic diseases. Two researchers reviewed titles and abstracts independently and, for eligible studies, independently extracted data. The prevalence rates were pooled using a random intercept logistic regression model. We published a review protocol (http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018106614CRD42018106614). We identified and screened 34 402 records for eligibility and considered 39 studies in the qualitative and 37 studies in the quantitative analysis, including N = 5951 patients with 24 different rare diseases. Heterogeneity between studies was large. Prevalence rates ranged widely between studies, with pooled prevalence estimates of 13.1% (95% CI 9.6-17.7%; I2 = 87%, p < 0.001) for current and 39.3% (95% CI 31.7-47.4%; I2 = 84%, p < 0.001) for lifetime major depressive disorder, 21.2% (95% CI 15.4-28.6%; I2 = 90%, p < 0.001) for current and 46.1% (95% CI 35.8-56.8%; I2 = 90%, p < 0.001) for lifetime affective disorders, and 39.6% (95% CI 25.5-55.6%; I2 = 96%, p < 0.001) for current and 44.2% (95% CI 27.0-62.9%; I2 = 94%, p < 0.001) for lifetime anxiety disorders. Sensitivity analyses excluding studies of low quality revealed nearly the same results. We conducted the first systematic review examining affective and anxiety disorders in adults with different rare diseases and found high prevalence rates. Supporting patients in disease adjustment can be crucial for their overall health and well-being.
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Affiliation(s)
- N Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246Hamburg, Germany
| | - J Swaydan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246Hamburg, Germany
| | - A Höller
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246Hamburg, Germany
| | - B Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246Hamburg, Germany
| | - M K Depping
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246Hamburg, Germany
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49
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Cromhout PF, Christensen AV, Jørgensen MB, Ekholm O, Juel K, Svendsen JH, Osler M, Rasmussen TB, Borregaard B, Mols RE, Thrysoee L, Thorup CB, Berg SK. Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality. Eur J Cardiovasc Nurs 2021; 21:612-619. [PMID: 35020894 DOI: 10.1093/eurjcn/zvab111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/27/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022]
Abstract
AIMS Comorbid psychiatric disorders and the use of psychotropic medication are common among cardiac patients and have been found to increase the risk of mortality. The aims of this study were: (i) to describe the use of psychotropic medication among cardiac patients with and without symptoms of anxiety, (ii) to estimate the association between use of psychotropic medication prior to hospital admission and all-cause, 1-year mortality following discharge, and (iii) to estimate the risk of mortality among users and non-users of psychotropic medication with or without self-reported symptoms of anxiety. METHODS AND RESULTS Cardiac patients from the DenHeart survey were included, providing information on self-reported symptoms of anxiety. From national registers, information on the use of psychotropic medication 6 months prior to hospitalization and mortality was obtained. By logistic regression analyses, the association between the use of psychotropic medication, anxiety, and all-cause, 1-year mortality was estimated. The risk of subsequent incident use of psychotropic medication among patients with and without anxiety was furthermore explored. All analyses were fully adjusted. A total of 12 913 patients were included, of whom 18% used psychotropic medication, and 3% died within 1 year. The use of psychotropic medication was found to be associated with increased 1-year all-cause mortality [odds ratio 1.90 (95% confidence interval, 1.46-2.46)]. Patients with symptoms of anxiety were significantly more likely to use psychotropic medication following hospital discharge [2.47 (2.25-2.72)]. CONCLUSION The use of psychotropic medication was associated with 1-year mortality. Thus, the use of psychotropic medication might explain some of the association between anxiety and mortality; however, the association is probably mainly a reflection of the underlying mental illness, rather than the use of psychotropic medication.
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Affiliation(s)
- Pernille Fevejle Cromhout
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Vinggaard Christensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Psychiatric Centre Copenhagen, Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark.,Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiac Surgery & Clinical Nursing Research Unit, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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50
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Blumenthal JA, Smith PJ, Jiang W, Hinderliter A, Watkins LL, Hoffman BM, Kraus WE, Liao L, Davidson J, Sherwood A. Effect of Exercise, Escitalopram, or Placebo on Anxiety in Patients With Coronary Heart Disease: The Understanding the Benefits of Exercise and Escitalopram in Anxious Patients With Coronary Heart Disease (UNWIND) Randomized Clinical Trial. JAMA Psychiatry 2021; 78:1270-1278. [PMID: 34406354 PMCID: PMC8374738 DOI: 10.1001/jamapsychiatry.2021.2236] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Anxiety is common among patients with coronary heart disease (CHD) and is associated with worse health outcomes; however, effective treatment for anxiety in patients with CHD is uncertain. OBJECTIVE To determine whether exercise and escitalopram are better than placebo in reducing symptoms of anxiety as measured by the Hospital Anxiety and Depression-Anxiety Subscale (HADS-A) and in improving CHD risk biomarkers. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between January 2016 and May 2020 in a tertiary care teaching hospital in the US and included 128 outpatients with stable CHD and a diagnosed anxiety disorder or a HADS-A score of 8 or higher who were older than 40 years, sedentary, and not currently receiving mental health treatment. INTERVENTIONS Twelve weeks of aerobic exercise 3 times per week at an intensity of 70% to 85% heart rate reserve, escitalopram (up to 20 mg per day), or placebo pill equivalent. MAIN OUTCOMES AND MEASURES The primary outcome was HADS-A score. CHD biomarkers included heart rate variability, baroreflex sensitivity, and flow-mediated dilation, along with 24-hour urinary catecholamines. RESULTS The study included 128 participants. The mean (SD) age was 64.6 (9.6) years, and 37 participants (29%) were women. Participants randomized to the exercise group and escitalopram group reported greater reductions in HADS-A (exercise, -4.0; 95% CI, -4.7 to -3.2; escitalopram, -5.7; 95% CI, -6.4 to -5.0) compared with those randomized to placebo (-3.5; 95% CI, -4.5 to -2.4; P = .03); participants randomized to escitalopram reported less anxiety compared with those randomized to exercise (-1.67; 95% CI, -2.68 to -0.66; P = .002). Significant postintervention group differences in 24-hour urinary catecholamines were found (exercise z score = 0.05; 95% CI, -0.2 to 0.3; escitalopram z score = -0.24; 95% CI, -0.4 to 0; placebo z score = 0.36; 95% CI, 0 to 0.7), with greater reductions in the exercise group and escitalopram group compared with the placebo group (F1,127 = 4.93; P = .01) and greater reductions in the escitalopram group compared with the exercise group (F1,127 = 4.37; P = .04). All groups achieved comparable but small changes in CHD biomarkers, with no differences between treatment groups. CONCLUSIONS AND RELEVANCE Treatment of anxiety with escitalopram was safe and effective for reducing anxiety in patients with CHD. However, the beneficial effects of exercise on anxiety symptoms were less consistent. Exercise and escitalopram did not improve CHD biomarkers of risk, which should prompt further investigation of these interventions on clinical outcomes in patients with anxiety and CHD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02516332.
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Affiliation(s)
- James A. Blumenthal
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Wei Jiang
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alan Hinderliter
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Lana L. Watkins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Benson M. Hoffman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - William E. Kraus
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lawrence Liao
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jonathan Davidson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
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