851
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Abstract
Depression and heart disease affect millions of people worldwide. Studies have shown that depression is a significant risk factor for new heart disease and that it increases morbidity and mortality in established heart disease. Many hypothesized and studied mechanisms have linked depression and heart disease, including serotonergic pathway and platelet dysfunction, inflammation, autonomic nervous system and hypothalamic-pituitary-adrenal axis imbalance, and psychosocial factors. Although the treatment of depression in cardiac patients has been shown to be safe and modestly efficacious, it has yet to translate into reduced cardiovascular morbidity and mortality. Understanding the impact and mechanisms behind the association of depression and heart disease may allow for the development of treatments aimed at altering the devastating consequences caused by these comorbid illnesses.
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Affiliation(s)
- Yelizaveta Sher
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, 401 Quarry Road, Suite 2336, Stanford, CA 94305, USA
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852
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Riemer S, Maes M, Christophe A, Rief W. Lowered omega-3 PUFAs are related to major depression, but not to somatization syndrome. J Affect Disord 2010; 123:173-80. [PMID: 19720401 DOI: 10.1016/j.jad.2009.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies indicated a depletion of omega-3 fatty acid levels and an imbalance between omega-3 and omega-6 PUFAs in depressive patients. Depletion of omega-3 PUFAs may be related to the immune and serotonergic pathophysiologies of depression by alterations in membrane fluidity and modulation of membrane receptors, enzyme activities and carriers. Previous studies also found serotonergic and immunological disturbances in subjects with somatoform symptoms. Based on these findings we aimed to investigate PUFA concentrations and its relations to other biological systems in depressed patients and in patients with somatoform symptoms. METHODS We examined 150 subjects divided in 4 groups, i.e. somatization syndrome; depression; depression and somatization syndrome; controls. Blood samples were analyzed for fatty acids, markers of the serotonergic system and the immune system. RESULTS The study was able to replicate earlier findings in patients with depression (lowered omega-3 PUFAs, increased omega-6/omega-3 ratios in serum cholesteryl esters). The somatization syndrome group showed no abnormalities in the mentioned fatty acid levels. Only depressive patients revealed associations between fatty acids with serotonergic and immunological markers. LIMITATIONS We used current state diagnoses, and the consideration of lifetime diagnoses and longitudinal studies could highlight further aspects of the reported results. CONCLUSIONS The findings are further confirming that the concepts of depression and somatoform disorders should not be merged indiscriminately together, even though they often occur together. We conclude that in depression and somatoform syndrome different biological mechanisms seem to be involved.
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Affiliation(s)
- Sabine Riemer
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Germany.
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853
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Abstract
Coronary heart disease is one of the most frequent causes of death in Germany. Psychosocial factors can be considered cofactors in the development of coronary heart disease. These factors also play a particularly important role in triggering acute coronary syndrome or acute myocardial infarction. Heart disease itself can result in manifest anxiety, tendencies toward denial, and depressive disorders. Especially the latter worsen the disease course and prognosis. In addition to somatic treatment, behavioral interventions to control risk factors are available as well as psychotherapy and antidepressants. The aim of this contribution is to describe the psychosomatic aspects of coronary heart disease and to delineate the principles of a holistic approach to treatment.
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Affiliation(s)
- C Herrmann-Lingen
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Göttingen, Georg August Universität, Von-Siebold-Strasse 5, Göttingen, Germany.
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854
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Air pollution and daily emergency department visits for depression. Int J Occup Med Environ Health 2010; 22:355-62. [PMID: 20197262 DOI: 10.2478/v10001-009-0031-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To investigate the potential correlation between ambient air pollution exposure and emergency department (ED) visits for depression. MATERIALS AND METHODS A hierarchical clusters design was used to study 27 047 ED visits for depression in six cities in Canada. The data used in the analysis contain the dates of visits, daily numbers of diagnosed visits, and daily mean concentrations of air pollutants as well as the meteorological factors. The generalized linear mixed models technique was applied to data analysis. Poisson models were fitted to the clustered counts of ED visits with a single air pollutant, temperature and relative humidity. RESULTS Statistically significant positive correlations were observed between the number of ED visits for depression and the air concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and particulate matter (PM10). The percentage increase in daily ED visits was 15.5% (95% CI: 8.0-23.5) for CO per 0.8 ppm and 20.0% (95% CI: 13.3-27.2) for NO2 per 20.1 ppb, for same day exposure in the warm weather period (April-September). For PM10, the largest increase, 7.2% (95% CI: 3.0-11.6) per 19.4 ug/m3, was observed for the cold weather period (October-March). CONCLUSIONS The results support the hypothesis that ED visits for depressive disorder correlate with ambient air pollution, and that a large majority of this pollution results from combustion of fossil fuels (e.g. in motor vehicles).
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855
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Sowden G, Mastromauro CA, Januzzi JL, Fricchione GL, Huffman JC. Detection of depression in cardiac inpatients: feasibility and results of systematic screening. Am Heart J 2010; 159:780-7. [PMID: 20435186 DOI: 10.1016/j.ahj.2010.02.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/25/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND A recent American Heart Association (AHA) Prevention Committee report recommended depression screening of all coronary heart disease patients using 2- and 9-item instruments from the Patient Health Questionnaire (PHQ-2 and PHQ-9) to identify patients who may need further assessment and treatment. Our objective was to assess the feasibility and results of such screening on inpatient cardiac units. METHODS In September 2007, the PHQ-2 was added to the nursing interview dataset on 3 cardiac units in a general hospital; this screen was completed as part of routine clinical care. Rates and results of depression screening, reasons for patients not being screened, and results of a nursing satisfaction survey were tabulated, and differences in baseline characteristics between screened and unscreened patients were analyzed via chi(2) and independent-samples t tests. RESULTS For a 12-month period, 4,783 patients were admitted to the cardiac units; 3,504 (73.3%) received PHQ-2 depression screening. Approximately 9% of screened patients had a PHQ-2 score > or =3 and were approached for further depression evaluation (PHQ-9) by a social worker; 74.1% of the positive-screen patients had a PHQ-9 score of > or =10, suggestive of major depression. Nurses (n = 66) reported high satisfaction with the screening process, and mean reported PHQ-2 screening time was 1.4 (+/-1.1) minutes. CONCLUSIONS Systematic depression screening of cardiac patients using methods outlined by the AHA Prevention Committee is feasible, well-accepted, and does not appear markedly resource-intensive. Future studies should link these methods to an efficient and effective program of depression management in this vulnerable population.
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856
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Davidson KW, Burg MM, Kronish IM, Shimbo D, Dettenborn L, Mehran R, Vorchheimer D, Clemow L, Schwartz JE, Lespérance F, Rieckmann N. Association of anhedonia with recurrent major adverse cardiac events and mortality 1 year after acute coronary syndrome. ARCHIVES OF GENERAL PSYCHIATRY 2010; 67:480-8. [PMID: 20439829 PMCID: PMC3058237 DOI: 10.1001/archgenpsychiatry.2010.36] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Depression consistently predicts recurrent events and mortality in patients with acute coronary syndrome (ACS), but it has 2 core diagnostic criteria with distinct biological correlates-depressed mood and anhedonia (loss of pleasure or interest). OBJECTIVE To determine if depressed mood and/or anhedonia predict 1-year medical outcomes for patients with ACS. DESIGN Observational cohort study of post-ACS patients hospitalized between May 2003 and June 2005. Within 1 week of admission, patients underwent a structured psychiatric interview assessing clinically impairing depressed mood, anhedonia, and major depressive episode (MDE). Also assessed were the Global Registry of Acute Coronary Events risk score, Charlson comorbidity index, left ventricular ejection fraction, antidepressant use, and depressive symptom severity using the Beck Depression Inventory. SETTING Cardiac units of 3 university hospitals in New York and Connecticut. PARTICIPANTS Consecutive sample of 453 patients with ACS (age, 25-93 years; 42% women). MAIN OUTCOMES MEASURES All-cause mortality (ACM) and documented major adverse cardiac events (MACEs)-myocardial infarction, hospitalization for unstable angina, or urgent/emergency coronary revascularization)-actively surveyed for 1 year after admission. RESULTS There were 67 events (16 deaths and 51 MACEs; 14.8%): 108 (24%) and 77 (17%) patients had anhedonia and depressed mood, respectively. Controlling for sex, age, and medical covariates, anhedonia (adjusted hazard ratio, 1.58; 95% confidence interval, 1.16-2.14; P < .01) was a significant predictor of combined MACE and ACM, but depressed mood was not. Anhedonia continued to significantly predict outcomes (P < .05) when additionally controlling for MDE diagnosis or depressive symptom severity. Findings were confirmed using depressed mood and anhedonia subscores from the Beck Depression Inventory in place of clinician interview ratings. CONCLUSIONS Anhedonia identifies risk of MACE and ACM beyond that of established medical prognostic indicators, including MDE and depressive symptom severity. Correlates of anhedonia may add to the understanding of the link between depression and heart disease.
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Affiliation(s)
- Karina W Davidson
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
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857
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Nursing care practices following a percutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses. J Cardiovasc Nurs 2010; 25:75-84. [PMID: 20134285 DOI: 10.1097/jcn.0b013e3181bb419d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although there is high-level evidence to guide optimal medical care for percutaneous coronary interventions, there are less explicit guidelines to support nurses in providing care. AIM This study describes the practice standards and priorities of care of cardiovascular nurses in Australia and New Zealand. METHOD Item generation for the survey was informed by an integrative literature review and existing clinical guidelines. A 116-item Web-based survey was administered to cardiovascular nurses, via electronic mail lists of professional cardiovascular nursing organizations, using a secure online data collection system. RESULTS Data were collected from March 2008 to March 2009. A total of 148 respondents attempted the survey, with 110 (74.3%) completing all items. All respondents were registered nurses with an average of 12.3 (SD, 7.61) years of clinical experience in the cardiovascular setting. A range of practice patterns was evident in ambulation time after percutaneous coronary intervention, methods of sheath removal, pain relief, and patient positioning. Respondents consistently rated psychosocial care a lower priority than other tasks and also identified a knowledge deficit in this area. CONCLUSION This survey identified diversity of practice patterns and a range of educational needs. Increasing evidence to support evidence-based practice and guideline development is necessary to promote high-quality care and improved patient outcomes.
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858
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Scuteri A, Spazzafumo L, Cipriani L, Gianni W, Corsonello A, Cravello L, Repetto L, Bustacchini S, Lattanzio F, Sebastiani M. Depression, hypertension, and comorbidity: disentangling their specific effect on disability and cognitive impairment in older subjects. Arch Gerontol Geriatr 2010; 52:253-7. [PMID: 20416961 DOI: 10.1016/j.archger.2010.04.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 03/29/2010] [Accepted: 03/30/2010] [Indexed: 11/25/2022]
Abstract
We aimed to demonstrate that depression and hypertension are associated independently of each other with disability and cognitive impairment in older subjects and that such an association is not attributable to number and severity of comorbidities. An observational study was performed on elderly patients admitted to the Hospital Network of the Italian National Research Center on Aging (INRCA) from January 2005 to December 2006. Depression was defined according to 15-item geriatric depression scale (GDS) score; physical disability according to activities of daily living (ADL) and instrumental activities of daily living (IADL) scores; cognitive impairment on the mini-mental state examination (MMSE) test; the number and severity of comorbidities by means of physician-administered cumulative illness rating scale (CIRS). Among 6180 older subjects (age=79.3 ± 5.8 years; 47% men), 48.3% were normotensive, 21.8% normotensive depressed, 21.7% hypertensive, and 8.2% hypertensive and depressed. Both depression and hypertension remained significantly associated with functional disability and cognitive impairment. When controlling for age, gender, the number and severity of comorbidities, hypertension was associated with a significantly higher likelihood of having functional disability or cognitive impairment only in the presence of depression (odds ratio=OR=2.02, 95% confidence interval=95%CI=1.60-2.54, p<0.001 for functional disability; OR=2.21, 95%CI=1.79-2.74, p<0.001 for cognitive impairment) as compared to normotensive controls without depression. We conclude that depression per se' or co-occurrence of hypertension and depression is associated with higher functional disability and cognitive impairment in older subjects. This effect is not attributable to the number or to the severity of comorbidities.
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Affiliation(s)
- Angelo Scuteri
- UO Geriatria, INRCA IRCCS, Via Cassia 1167, I-00189 Roma, Italy.
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859
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Davidson KW, Rieckmann N, Clemow L, Schwartz JE, Shimbo D, Medina V, Albanese G, Kronish I, Hegel M, Burg MM. Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. ARCHIVES OF INTERNAL MEDICINE 2010; 170:600-8. [PMID: 20386003 PMCID: PMC2882253 DOI: 10.1001/archinternmed.2010.29] [Citation(s) in RCA: 246] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Depressive symptoms are an established predictor of mortality and major adverse cardiac events (defined as nonfatal myocardial infarction or hospitalization for unstable angina or urgent/emergency revascularizations) in patients with acute coronary syndrome (ACS). This study was conducted to determine the acceptability and efficacy of enhanced depression treatment in patients with ACS. METHODS A 3-month observation period to identify patients with ACS and persistent depressive symptoms was followed by a 6-month randomized controlled trial. From January 1, 2005, through February 29, 2008, 237 patients with ACS from 5 hospitals were enrolled, including 157 persistently depressed patients randomized to intervention (initial patient preference for problem-solving therapy and/or pharmacotherapy, then a stepped-care approach; 80 patients) or usual care (77 patients) and 80 nondepressed patients who underwent observational evaluation. The primary outcome was patient satisfaction with depression care. Secondary outcomes were depressive symptom changes (assessed with the Beck Depression Inventory), major adverse cardiac events, and death. RESULTS At the end of the trial, the proportion of patients who were satisfied with their depression care was higher in the intervention group (54% of 80) than in the usual care group (19% of 77) (odds ratio, 5.4; 95% confidence interval [CI], 2.2-12.9 [P < .001]). The Beck Depression Inventory score decreased significantly more (t(155) = 2.85 [P = .005]) for intervention patients (change, -5.7; 95% CI, -7.6 to -3.8; df = 155) than for usual care patients (change, -1.9; 95% CI, -3.8 to -0.1; df = 155); the depression effect size was 0.59 of the standard deviation. At the end of the trial, 3 intervention patients and 10 usual care patients had experienced major adverse cardiac events (4% and 13%, respectively; log-rank test, chi(2)(1) = 3.93 [P = .047]), as well as 5 nondepressed patients (6%) (for the intervention vs nondepressed cohort, chi(2)(1) = 0.48 [P = .49]). CONCLUSION Enhanced depression care for patients with ACS was associated with greater satisfaction, a greater reduction in depressive symptoms, and a promising improvement in prognosis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00158054.
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Affiliation(s)
- Karina W Davidson
- Department of Medicine, Columbia University College of Physicians and Surgeons, PH9 Center, 622 W 168th St, Room 948, New York, NY 10032, USA.
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860
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Einvik G, Dammen T, Omland T. [Depression and cardiovascular disease--is there an association?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:729-32. [PMID: 20379333 DOI: 10.4045/tidsskr.08.0361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Depression is associated with an increased risk of cardiovascular events. This review presents data from recent cohort- and interventional studies, and possible pathogenetic mechanisms. MATERIAL AND METHODS The article is based on literature from the period 1998 - 2008 identified through a non-systematic search in Medline. RESULTS Epidemiological studies of patients (outside of hospitals) with clinical depression suggest they have an increased risk of cardiovascular events. Possible mechanisms responsible for this increased cardiovascular risk are: an increased prevalence of unhealthy lifestyle factors, systemic inflammation, endocrine or autonomic dysfunction, increased platelet reactivity or endothelial dysfunction. Treatment with antidepressive drugs has not reduced the risk of cardiovascular events. INTERPRETATION Clinicians should be aware of the influence of depression on cardiovascular risk.
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Affiliation(s)
- Gunnar Einvik
- Medisinsk divisjon, Akershus universitetssykehus, 1478 Lørenskog, og Institutt for sykehusmedisin, Universitetet i Oslo, Norway.
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861
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Abstract
Patients with established coronary heart disease (CHD) have a high risk of subsequent cardiovascular events, including myocardial infarction (MI), stroke, and death from cardiovascular disease. Adherence to evidence-based secondary prevention therapies for CHD has improved in recent years but still remains suboptimal. Mortality from CHD in the United States (US) has decreased substantially in recent decades. The decline in US deaths from CHD from 1980 through 2000 has been attributed to reductions in major risk factors and utilization of evidence-based medical therapies. It has been estimated that optimization of secondary prevention strategies could save as many as 80,000 more lives per year in the US. The American College of Cardiology (ACC) and American Heart Association (AHA) updated its guidelines for secondary prevention for patients with atherosclerotic vascular disease in 2006. The guidelines emphasize evidence-based developments in the field of CHD secondary prevention and also reinforce the need to implement these recommendations in actual clinical practice through programs such as the ACC's Guidelines Applied to Practice and the AHA's Get With The Guidelines. This review will discuss the epidemiology and risk assessment of CHD, current pharmacologic and nonpharmacologic strategies available for the secondary prevention of CHD, and summarize the guidelines and evidence that support these treatment options. There will be an emphasis on antiplatelet therapy given the important role of thrombosis in clinical cardiovascular events.
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862
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Ehrenthal JC, Herrmann-Lingen C, Fey M, Schauenburg H. Altered cardiovascular adaptability in depressed patients without heart disease. World J Biol Psychiatry 2010; 11:586-93. [PMID: 20218928 DOI: 10.3109/15622970903397714] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Despite its clinical importance and relevance for health care policy, the pathways between depression and stress regulation remain poorly understood. The objective of our study was to compare cardiovascular and autonomic responses to brief psychosocial stress in a group of severely depressed subjects without heart disease and a non-depressed control-group. METHODS We recorded cardiovascular and autonomic reactions to two different stress tasks including anger recall and mental arithmetic in a sample of 25 severely depressed and 25 non-depressed subjects. Aggregated data were compared with repeated-measures MANOVA. We used contrasts to evaluate different response patterns concerning cardiovascular and autonomic reactivity vs. recovery. RESULTS Depressed subjects showed overall reduced high-frequency heart rate variability and an altered cardiovascular adaptability concerning heart rate, blood pressure, cardiac output, and, on a trend level, peripheral resistance. With few exceptions, we found no differences between reactivity vs. recovery response patterns. CONCLUSIONS Our results provide further evidence for altered cardiovascular reactivity and impaired cardiac autonomic functioning in depression. Further research is needed on psychophysiological response to either more disease-oriented or more personality-oriented stressors.
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Affiliation(s)
- Johannes C Ehrenthal
- Clinic for Psychosomatic and General Clinical Medicine, University of Heidelberg, Thibautstrasse 2, Heidelberg, Germany.
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863
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Nabi H, Kivimäki M, Suominen S, Koskenvuo M, Singh-Manoux A, Vahtera J. Does depression predict coronary heart disease and cerebrovascular disease equally well? The Health and Social Support Prospective Cohort Study. Int J Epidemiol 2010; 39:1016-24. [PMID: 20360321 DOI: 10.1093/ije/dyq050] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The relationship between depression and cerebrovascular disease (CBVD) continues to be debated although little research has compared the predictive power of depression for coronary heart disease (CHD) with that for CBVD within the same population. This study aimed to compare the importance of depression for CHD and CBVD within the same population of adults free of apparent cardiovascular disease. METHODS A random sample of 23,282 adults (9507 men, 13,775 women) aged 20-54 years were followed up for 7 years. Fatal and first non-fatal CHD and CBVD events were documented by linkage to the National-hospital-discharge and mortality registers. RESULTS Sex-age-education-adjusted hazard ratio (HR) for CHD was 1.66 [95% confidence interval (CI) 1.24-2.24] for participants with mild to severe depressive symptoms, i.e. those scoring > or =10 on the 21-item Beck Depression Inventory, and 2.04 (1.27-3.27) for those who filled antidepressant prescriptions compared with those without depression markers in 1998, i.e. at study baseline. For CBVD, the corresponding HRs were 1.01 (0.67-1.53) and 1.77 (0.95-3.29). After adjustment for behavioural and biological risk factors these associations were reduced but remained evident for CHD, the adjusted HRs being 1.47 (1.08-1.99) and 1.72 (1.06-2.77). For CBVD, the corresponding multivariable adjusted HRs were 0.87 (0.57-1.32) and 1.52 (0.81-2.84). CONCLUSIONS Self-reported depression using a standardized questionnaire and clinical markers of mild to severe depression were associated with an increased risk for CHD. There was no clear evidence that depression is a risk factor for CBVD, but this needs further confirmation.
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864
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Godfrey JR, Wenger NK. Toward Optimal Health: Advances in the Cardiovascular Care of Women. J Womens Health (Larchmt) 2010; 19:659-64. [DOI: 10.1089/jwh.2010.1957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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865
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Thombs BD, Adeponle AB, Kirmayer LJ, Morgan JF. A brief scale to assess hospital doctors' attitudes toward collaborative care for mental health. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:264-7. [PMID: 20416150 DOI: 10.1177/070674371005500410] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Collaborative care may improve mental health management in hospital settings. However, no scales assess doctors' attitudes toward its 2 core components: mental health management by nonpsychiatric physicians and psychiatric consultation. Our objective was to develop and assess the reliability and validity of the Doctors' Attitudes Toward Collaborative Care for Mental Health (DACC-MH) Scale. METHOD Fifteen items assessing doctors' attitudes toward management of mental health problems (10 items) and psychiatric consultation (5 items) were administered to 225 physicians and surgeons from a London hospital. Item responses were dichotomous (agree or disagree). Confirmatory factor analysis models were conducted using Mplus for dichotomous data to identify items for inclusion in the DACC-MH and to test the validity of the 2 hypothesized factors. Known-groups validity was tested by comparing scores of surgeons and physicians, as physicians have been shown to view mental health management and psychiatric consultation more favourably. RESULTS The 8-item DACC-MH included a 4-item Attitudes Toward Management of Mental Health Problems factor (Cronbach's a = 0.65) and a 4-item Attitudes Toward Psychiatric Consultation factor (alpha = 0.67; overall scale alpha = 0.70). Model fit was good (chi2 = 12.7, df = 11, P = 0.31; Comparative Fit Index = 0.99; Tucker-Lewis Index = 0.99; root mean square error of approximation = 0.03) with all factor loadings of 0.46 or greater. As hypothesized, physician scores were significantly higher than surgeon scores on both subscales, indicating more positive attitudes toward management of mental health problems and psychiatric consultation. CONCLUSIONS Preliminary evidence was found for the validity of the DACC-MH, which will facilitate efforts to evaluate readiness of doctors to engage in collaborative mental health care.
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Affiliation(s)
- Brett D Thombs
- Department: Psychiatry, McGill University, Montreal, Quebec.
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866
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867
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Kuczmarski MF, Cremer Sees A, Hotchkiss L, Cotugna N, Evans MK, Zonderman AB. Higher Healthy Eating Index-2005 scores associated with reduced symptoms of depression in an urban population: findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study. ACTA ACUST UNITED AC 2010; 110:383-9. [PMID: 20184988 DOI: 10.1016/j.jada.2009.11.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 08/31/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression affects more than 15 million Americans in a given year. Compared to physical health, less is known about the affect of diet quality on symptoms of depression. OBJECTIVE This study investigated the relationship between diet quality and reported symptoms of depression in a low-income urban population. SUBJECTS/SETTING Subjects included 1,118 African-American and white adults, aged 30 to 64 years, living in Baltimore, MD, and represented a subsample of the initial examination and recruitment phase of the Healthy Aging in Neighborhoods of Diversity across the Life Span study. METHODS Nutrition data were based on two 24-hour dietary recalls collected by trained interviewers using the US Department of Agriculture Automated Multiple Pass Method. Diet quality was calculated using the US Department of Agriculture Healthy Eating Index (HEI)-2005. Depressive symptoms were assessed by a trained interviewer using the Center for Epidemiologic Studies Depression scale. STATISTICAL ANALYSIS Both linear and logistic regression analyses were used to examine whether or not diet quality was associated with depressive symptoms. The dependent variable was depressive symptoms and independent variables included HEI-2005, race, sex, age, education, income, and food-assistance program participation. RESULTS Mean HEI-2005 score was 52.17+/-0.40 (out of 100). Mean Center for Epidemiologic Studies Depression scale score was 11.64+/-0.25 (out of 40). Diet quality was significantly associated with reported symptoms of depression. However, income was a significantly stronger predictor of depression compared to diet quality, education, and sex. CONCLUSIONS Registered dietitians should be aware of relationships between psychological status and nutritional health when assisting clients to better manage their food choices to improve their overall health and quality of life.
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Affiliation(s)
- Marie Fanelli Kuczmarski
- Department of Health, Nutrition, and Exercise Sciences, University of Delaware, Newark, DE 19716, USA
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868
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Mauro AMP. Long-term follow-up study of uncertainty and psychosocial adjustment among implantable cardioverter defibrillator recipients. Int J Nurs Stud 2010; 47:1080-8. [PMID: 20219197 DOI: 10.1016/j.ijnurstu.2010.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 01/08/2010] [Accepted: 02/07/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sudden cardiac death is an international health issue. Implantable defibrillators have been effective in the secondary prevention of sudden cardiac death and are increasingly being utilized for primary prevention in individuals without a prior history of cardiac arrest or sustained ventricular tachycardia. Although it has been well documented that some recipients experience psychological distress and have difficulty in adjusting to the device, long-term data on psychological outcomes are limited. OBJECTIVES The aims of this study were to determine: (a) if there is a long-term relationship between uncertainty and psychosocial adjustment among implantable cardioverter defibrillator (ICD) recipients; and (b) if changes in uncertainty and/or adjustment occur over time. DESIGN A longitudinal, descriptive, correlational design was used for this long-term follow-up study (M=9.4 years, SD=.23). SETTING AND PARTICIPANTS Ninety-four patients from 4 major teaching hospitals in New England who had participated in an investigation of uncertainty and adjustment at 1 and 8 weeks following an initial ICD implant between 1996 and 1997 were solicited. From the original sample, 41 patients had expired (44%) and 5 had heart transplants (5%). Two individuals chose not to participate. Twenty-five persons (27%) were not found despite numerous attempts to locate them. The final sample included 21 subjects (22%). METHODS Following university institutional review board approval, a mail survey was administered using the Dillman method. Instruments included a demographic data questionnaire, the Psychosocial Adjustment to Illness Scale-Self-Report and the 2-factor version of the Mishel Uncertainty in Illness Scale. RESULTS The final sample primarily included educated, married, white males. Uncertainty and adjustment levels did not change significantly over time. Early adjustment explained 40% of the variance in overall adjustment at long-term follow-up (P=.010). Men experienced significantly more uncertainty overall [t(19)=2.925, P=.009] and complexity related to living with the device [t(19)=3.62, P=.002]. CONCLUSIONS Patients should be screened for psychological distress prior to device implantation so early intervention can be provided. Qualitative research is recommended to determine whether gender specific needs related to living with an ICD exist. More quantitative, long-term longitudinal data are also needed.
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Affiliation(s)
- Ann Marie P Mauro
- College of Nursing, New York University, 726 Broadway, New York, NY 10003, USA.
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869
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Affiliation(s)
- Nanette K. Wenger
- From the Division of Cardiology, Emory University School of Medicine, and Emory Heart and Vascular Center, Atlanta, Ga
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870
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Role of psychological factors in the clinical course of heart transplant patients. J Heart Lung Transplant 2010; 29:257-60. [DOI: 10.1016/j.healun.2009.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 10/24/2009] [Accepted: 10/26/2009] [Indexed: 11/30/2022] Open
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871
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Cooper-DeHoff RM, Handberg EM, Mancia G, Zhou Q, Champion A, Legler UF, Pepine CJ. INVEST revisited: review of findings from the International Verapamil SR-Trandolapril Study. Expert Rev Cardiovasc Ther 2010; 7:1329-40. [PMID: 19900016 DOI: 10.1586/erc.09.102] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The International Verapamil SR-Trandolapril Study (INVEST), a randomized trial of 22,576 predominantly elderly patients with an average 2.7-year follow-up, compared a calcium antagonist-led strategy (verapamil SR plus trandolapril) with a beta-blocker-led strategy (atenolol plus hydrochlorothiazide) for hypertension treatment and prevention of cardiovascular outcomes in coronary artery disease patients. Patients received individualized dose and drug titration following a flexible, multi-drug, guideline-based treatment algorithm, with the objective of achieving optimal blood pressure (BP) control individualized for comorbidities (e.g., diabetes). The primary outcome (PO) was first occurrence of death (all-cause), nonfatal myocardial infarction or nonfatal stroke. The strategies resulted in significant and very similar BP reduction, with approximately 70% of patients in both strategies achieving BP control (<140/90 mmHg). Increasing number of office visits with BP in control was associated with reduced risk of the PO. Overall, there was no difference in the PO comparing the strategies; however, new-onset diabetes occurred more frequently in those assigned the atenolol strategy. This report summarizes findings from INVEST and puts them in perspective with our current state of knowledge derived from other large hypertension treatment trials. INVEST findings support that BP reduction is important for prevention of adverse cardiovascular morbidity and mortality, and selection of antihypertensive agents should be based on patient comorbidities and other risk factors (e.g., risk for diabetes) and not necessarily that any one drug be given to all.
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Affiliation(s)
- Rhonda M Cooper-DeHoff
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, 1600 SW Archer Road, Box 100486, Gainesville, FL 32610-0486, USA.
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872
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Leifheit-Limson EC, Reid KJ, Kasl SV, Lin H, Jones PG, Buchanan DM, Parashar S, Peterson PN, Spertus JA, Lichtman JH. The role of social support in health status and depressive symptoms after acute myocardial infarction: evidence for a stronger relationship among women. Circ Cardiovasc Qual Outcomes 2010; 3:143-50. [PMID: 20160162 DOI: 10.1161/circoutcomes.109.899815] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prior studies have associated low social support (SS) with increased rehospitalization and mortality after acute myocardial infarction. However, relatively little is known about whether similar patterns exist for other outcomes, such as health status and depressive symptoms, and whether these patterns vary by sex. METHODS AND RESULTS Using data from 2411 English- or Spanish-speaking patients with acute myocardial infarction enrolled in a 19-center prospective study, we examined the association of SS (low, moderate, high) with health status (angina, disease-specific quality of life, general physical and mental functioning) and depressive symptoms over the first year of recovery. Overall and sex-stratified associations were evaluated using mixed-effects Poisson and linear regression, adjusting for site, baseline health status, baseline depressive symptoms, and demographic and clinical factors. Patients with the lowest SS (relative to those with the highest) had increased risk of angina (relative risk, 1.27; 95% confidence interval [CI], 1.10, 1.48); lower disease-specific quality of life (mean difference [beta]=-3.33; 95% CI, -5.25, -1.41), lower mental functioning (beta=-1.72; 95% CI, -2.65, -0.79), and more depressive symptoms (beta=0.94; 95% CI, 0.51, 1.38). A nonsignificant trend toward lower physical functioning (beta=-0.87; 95% CI, -1.95, 0.20) was observed. In sex-stratified analyses, the relationship between SS and outcomes was stronger for women than for men, with a significant SS-by-sex interaction for disease-specific quality of life, physical functioning, and depressive symptoms (all P<0.02). CONCLUSIONS Lower SS is associated with worse health status and more depressive symptoms over the first year of acute myocardial infarction recovery, particularly for women.
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873
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Understanding and Promoting Effective Self-Care During Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2010; 12:1-9. [DOI: 10.1007/s11936-009-0053-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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874
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875
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Esler M. The 2009 Carl Ludwig Lecture: pathophysiology of the human sympathetic nervous system in cardiovascular diseases: the transition from mechanisms to medical management. J Appl Physiol (1985) 2010; 108:227-37. [DOI: 10.1152/japplphysiol.00832.2009] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sympathetic nervous system responses typically are regionally differentiated, with activation in one outflow sometimes accompanying no change or sympathetic inhibition in another. Regional sympathetic activity is best studied in humans by recording from postganglionic sympathetic efferents (multiunit or single fiber recording) and by isotope dilution-derived measurement of organ-specific norepinephrine release to plasma (regional “norepinephrine spillover”). Evidence assembled in this review indicates that sympathetic nervous system abnormalities are crucial in the development of cardiovascular disorders, notably heart failure, essential hypertension, disorders of postural circulatory control causing syncope, and “psychogenic heart disease,” heart disease attributable to mental stress and psychiatric illness. These abnormalities involve persistent, adverse activation of sympathetic outflows to the heart and kidneys in heart failure and hypertension, episodic or ongoing cardiac sympathetic activation in psychogenic heart disease, and defective sympathetic circulatory reflexes in disorders of postural circulatory control. An important goal for clinical scientists is translation of knowledge of pathophysiology, such as this, into better treatment for patients. The achievement of this “mechanisms-to-management” transition is at differing stages of development with the different conditions. Clinical translation is mature in cardiac failure, knowledge of cardiac neural pathophysiology having led to introduction of β-adrenergic blockers, an effective therapy. With essential hypertension, perhaps we are on the cusp of effective translation, with recent successful testing of selective catheter-based renal sympathetic nerve ablation in patients with resistant hypertension, an intervention firmly based on demonstration of activation of the renal sympathetic outflow. With psychogenic heart disease and postural syncope syndromes, knowledge of the neural pathophysiology is emerging, but clinical translation remains for the future.
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Affiliation(s)
- Murray Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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876
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Dowlati Y, Herrmann N, Swardfager WL, Reim EK, Lanctôt KL. Efficacy and tolerability of antidepressants for treatment of depression in coronary artery disease: a meta-analysis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:91-9. [PMID: 20181304 DOI: 10.1177/070674371005500205] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Depression occurs in 18% to 45% of patients with coronary artery disease (CAD) where it is associated with an increased risk of acute coronary events and mortality. Our objective was to quantitatively summarize the data on the efficacy and tolerability of antidepressant (AD) treatment for depression in CAD. METHODS We performed a meta-analysis of randomized, placebo-controlled, double-blind trials with a database search of the English literature (to March 2008) and manual search of references. RESULTS Four clinical trials with ADs (mirtazapine, citalopram, fluoxetine, and sertraline) of a 9- to 24-week duration involving 798 subjects (402 ADs, 396 placebo) with documented CAD and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for depression were included. ADs were superior to placebo for decreasing Hamilton Depression Rating Scale (HDRS) scores (402 ADs, 396 placebo; weighted mean difference 1.41, 95% CI 0.53 to 2.29, P = 0.002) and Beck Depression Inventory (BDI) scores (373 ADs, 369 placebo; weighted mean difference 2.27, 95% CI 0.60 to 3.94, P = 0.008). The proportion of patients (216 ADs, 213 placebo) who responded (a 50% or more reduction in HDRS scores, OR 1.72, 95% CI 1.17 to 2.54) and remitted (HDRS of 8 or less at final assessment, OR 1.80, 95% CI 1.18 to 2.74), were also significantly higher with AD, compared with placebo, with no significant differences between the 2 groups for overall dropouts (OR 0.84, 95% CI 0.42 to 1.68) or dropout owing to adverse events (OR 1.30, 95% CI 0.75 to 2.25). The combined studies were homogeneous except for overall dropout rate (P = 0.01). CONCLUSION Treatment with ADs for depression in CAD results in significant therapeutic effects without substantially increased rates of discontinuation.
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Affiliation(s)
- Yekta Dowlati
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario
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877
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Kapa S, Rotondi-Trevisan D, Mariano Z, Aves T, Irvine J, Dorian P, Hayes DL. Psychopathology in Patients with ICDs over Time: Results of a Prospective Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:198-208. [PMID: 19930108 DOI: 10.1111/j.1540-8159.2009.02599.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Suraj Kapa
- Division of Cardiology, Mayo Clinic-Rochester, 200 1st Street SW, Rochester, MN 55905, USA
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878
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Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients. J Cardiovasc Nurs 2010; 24:454-64. [PMID: 19858954 DOI: 10.1097/jcn.0b013e3181ac8a3c] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Recovery after open-heart surgery is a complex process that presents psychosocial and physical challenges that continue well after discharge. The purpose of this study was to examine the relationship among expectations, anxiety, depression, and physical health status (PHS) and to determine predictors of postoperative PHS in open-heart surgery patients. PARTICIPANTS AND METHODS A convenience sample (N = 54) was recruited from 2 hospitals in rural regions from 2 different mid-Atlantic states. The sample included participants who underwent coronary artery bypass graft or valve replacement surgery for the first time. The study used a longitudinal design, and data were collected preoperatively in the hospital or surgeons' offices and 4 weeks postoperatively by telephone interviews. Participants were interviewed using the following questionnaires: the Future Expectations Regarding Life with Heart Disease scale, the Hospital Anxiety and Depression scale, and the Medical Outcomes Study 36-Item Short Form Health Survey. Repeated-measures analysis of variance, Pearson product-moment correlations, and multiple regression were used for data analyses. RESULTS AND CONCLUSIONS Statistical analysis revealed that anxiety (P = .002) and depression (P = .026) scores decreased postoperatively. Significant relationships were found among the preoperative and postoperative variables: expectations, anxiety, depression, and PHS. Analyses also found that preoperative expectations, anxiety, depression, and PHS contributed 38% of the variance of postoperative PHS (P < .001). However, the postoperative variables were not significant predictors of postoperative PHS (P = .075). The findings support the need for interventions to assist patients in developing realistic expectations and for clinicians to screen patients for anxiety and depression before and after surgery. Future research needs to measure PHS at various times postoperatively to identify continued limitations after surgery.
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879
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Zafar MU, Paz-Yepes M, Shimbo D, Vilahur G, Burg MM, Chaplin W, Fuster V, Davidson KW, Badimon JJ. Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression. Eur Heart J 2010; 31:1573-82. [PMID: 20097703 DOI: 10.1093/eurheartj/ehp602] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
AIMS Depression and anxiety are linked to coronary events but the mechanism(s) remains unclear. We investigated the associations of depression and anxiety with serotonin-mediated platelet hyperactivity in coronary artery disease (CAD) patients in a cross-sectional study. METHODS AND RESULTS Three months after an acute coronary event, stable CAD patients (n = 83) on aspirin and clopidogrel were evaluated for depression (beck depression inventory) and anxiety (hospital anxiety and depression scale), and their platelet reactivity was measured (optical aggregometry and flow cytometric fibrinogen binding in response to adenosine diphosphate (ADP = 5 microM) and two serotonin + epinephrine doses [5HT:E (L) = 4 microM + 4 microM and 5HT:E (H) = 10 microM + 4 microM]. Platelet reactivity was significantly higher in depressed and anxious than in depressed only or non-depressed-and-non-anxious patients. Aggregation (mean +/- SE) was 41.9 +/- 2.6% vs. 32.2 +/- 2.6% vs. 30.4 +/- 3.7% with 5HT:E (L) and 46.9 +/- 2.7% vs. 35.6 +/- 2.7% vs. 31.7 +/- 3.8% with 5HT:E (H) (P < 0.05 for both). Differences in ADP aggregations were not significant, perhaps because of clopidogrel therapy. Flow cytometry findings were similar. In a multivariate linear regression model adjusted for age, body mass index, and each other, anxiety symptoms independently predicted all 5HT:E-mediated platelet reactivity measures, whereas depression predicted none. CONCLUSION Anxiety is associated with elevated serotonin-mediated platelet reactivity in stable CAD patients and symptoms of anxiety show strong, independent correlations with platelet function.
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Affiliation(s)
- M Urooj Zafar
- Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
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880
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Cudnoch-Jedrzejewska A, Szczepanska-Sadowska E, Dobruch J, Gomolka R, Puchalska L. Brain vasopressin V(1) receptors contribute to enhanced cardiovascular responses to acute stress in chronically stressed rats and rats with myocardial infarcton. Am J Physiol Regul Integr Comp Physiol 2009; 298:R672-80. [PMID: 20042688 DOI: 10.1152/ajpregu.00543.2009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study was designed to determine the role of central vasopressin 1 receptors (V(1)R) in the regulation of cardiovascular parameters in chronically stressed infarcted rats and sham-operated rats under resting conditions and during exposure to acute alarming stress. The experiments were performed on four groups of conscious sham-operated and four groups of infarcted rats subjected to intraventricular infusion of either vehicle or a V(1)R antagonist (V(1)RANT). Two groups of infarcted and two groups of sham-operated rats were subjected to mild chronic stressing. Mean arterial blood pressure (MABP) and heart rate (HR) were determined under resting conditions and after exposure to acute stress (air jet). During vehicle infusion, MABP and HR increases in response to acute stress in the infarcted rats not subjected to chronic stress, and in the infarcted and sham-operated chronically stressed rats, were significantly greater than in the sham-operated rats not exposed to chronic stress. However, MABP and HR responses to acute stress in the chronically stressed infarcted rats and chronically stressed sham-operated rats did not differ. V(1)RANT abolished differences in cardiovascular responses to acute stress between the experimental groups. Resting cardiovascular parameters were not affected by any of the experimental treatments. It is concluded that chronic stressing enhances the pressor and tachycardic responses to acute stress in the sham-operated rats but does not further intensify these responses in infarcted rats.The results provide evidence that central V(1)Rs are involved in potentiation of cardiovascular responses to acute stress in chronically stressed rats, infarcted rats, and chronically stressed infarcted rats.
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881
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Association of n-3 long-chain PUFA and fish intake with depressive symptoms and low dispositional optimism in older subjects with a history of myocardial infarction. Br J Nutr 2009; 103:1381-7. [DOI: 10.1017/s0007114509993308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Individuals with CHD are at increased risk of poor mental well-being. Dietary intake of EPA and DHA, the main n-3 fatty acids from fish, may be beneficial to mental well-being. We examined the association of EPA+DHA and fish intake with mental well-being in 644 participants, aged 60–80 years, with a history of myocardial infarction. Habitual food intake was assessed with a 203-item FFQ. Depressive symptoms were assessed with the self-report geriatric depression scale, and dispositional optimism was assessed with the revised life orientation test (LOT-R) and a four-item questionnaire (4Q). In Cox-regression models modified for cross-sectional analyses, we adjusted for sex, age, energy intake, BMI, family history of depression, education, marital status, smoking, physical activity and intake of saturated fat, alcohol and fibre. Compared with the lower tertile, subjects in the higher tertile of EPA+DHA intake had a lower prevalence of depressive symptoms, but this association was not statistically significant (prevalence ratio (PR) 0·78; 95 % CI 0·50, 1·22, P-trend 0·27). The higher tertile of EPA+DHA intake was positively associated with dispositional optimism measured with the 4Q (PR 0·69; 95 % CI 0·46, 1·03, P-trend 0·05), but not according to the LOT-R. Fish intake was not related to either depressive symptoms or dispositional optimism. In conclusion, intake of EPA+DHA was positively associated with dispositional optimism assessed with the 4Q, but not with optimism assessed with the LOT-R or with depressive symptoms.
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882
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Current world literature. Curr Opin Lipidol 2009; 20:512-9. [PMID: 19935200 DOI: 10.1097/mol.0b013e328334096a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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883
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Rollman BL, Belnap BH, LeMenager MS, Mazumdar S, Houck PR, Counihan PJ, Kapoor WN, Schulberg HC, Reynolds CF. Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial. JAMA 2009; 302:2095-103. [PMID: 19918088 PMCID: PMC3010227 DOI: 10.1001/jama.2009.1670] [Citation(s) in RCA: 284] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Depressive symptoms commonly follow coronary artery bypass graft (CABG) surgery and are associated with less positive clinical outcomes. OBJECTIVE To test the effectiveness of telephone-delivered collaborative care for post-CABG depression vs usual physician care. DESIGN, SETTING, AND PARTICIPANTS Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh, Pennsylvania. Participants were 302 post-CABG patients with depression (150, intervention; 152, usual care) and a comparison group of 151 randomly sampled post-CABG patients without depression recruited between March 2004 and September 2007 and observed as outpatients until June 2008. INTERVENTION Eight months of telephone-delivered collaborative care provided by nurses working with patients' primary care physicians and supervised by a psychiatrist and primary care physician from this study. MAIN OUTCOME MEASURES Mental health-related quality of life (HRQL) measured by the Short Form-36 Mental Component Summary (SF-36 MCS) at 8-month follow-up; secondary outcome measures included assessment of mood symptoms (Hamilton Rating Scale for Depression [HRS-D]), physical HRQL (SF-36 PCS), and functional status (Duke Activity Status Index [DASI]); and hospital readmissions. RESULTS The intervention patients reported greater improvements in mental HRQL (all P < or = .02) (SF-36 MCS: Delta, 3.2 points; 95% confidence interval [CI], 0.5-6.0), physical functioning (DASI: Delta, 4.6 points; 95% CI, 1.9-7.3), and mood symptoms (HRS-D: Delta, 3.1 points; 95% CI, 1.3-4.9); and were more likely to report a 50% or greater decline in HRS-D score from baseline (50.0% vs 29.6%; number needed to treat, 4.9 [95% CI, 3.2-10.4]) than usual care patients (P < .001). Men with depression were particularly likely to benefit from the intervention (SF-36 MCS: Delta, 5.7 points; 95% CI, 2.2-9.2; P = .001). However, the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group. CONCLUSION Compared with usual care, telephone-delivered collaborative care for treatment of post-CABG depression resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00091962.
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Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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884
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Shemesh E, Annunziato RA, Rubinstein D, Sultan S, Malhotra J, Santra M, Weatherley BD, Feaganes JR, Cotter G, Yehuda R. Screening for depression and suicidality in patients with cardiovascular illnesses. Am J Cardiol 2009; 104:1194-7. [PMID: 19840561 DOI: 10.1016/j.amjcard.2009.06.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 06/16/2009] [Accepted: 06/16/2009] [Indexed: 10/20/2022]
Abstract
The American Heart Association (AHA) and the American Psychiatric Association jointly recommend screening for depression in cardiology clinics. This includes screening for suicidality. It is not known how frequently patients disclose suicidal thinking (ideation) in this setting, and what proportion of those will turn out to have suicidal intent. Patients were screened for depression using a protocol identical to the one endorsed by the AHA in a cardiology community clinic in Elmhurst (Queens, New York). Depression was assessed using the Patient Health Questionnaire. Reports of suicidal ideation were immediately evaluated by a mental health professional. We determined the degree to which suicidal ideation was identified, the proportion of patients with suicidal intent of those reporting suicidal ideation, and the relation between depression and suicidal ideation in this setting. One thousand three patients were screened; 886 had complete Patient Health Questionnaire data. Of those, 12% (109 patients) expressed suicidal ideation. Four of those were hospitalized for suicidal intent (0.45% of all screened patients). Suicidal ideation and depression were correlated (point biserial correlation coefficient 0.478). In conclusion, suicidal ideation can and will be identified using the AHA depression screening recommendations, but only a very small fraction (0.45%) of screened patients will turn out to have suicidal intent. Discovery and stabilization of suicidal patients is an important benefit of the screening, but the fact that >12% of all screened patients will need to be immediately evaluated for suicidal intent has important implications for resource allocation to screening programs.
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885
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Hayes SN. Broken-Hearted Women: The Complex Relationship between Depression and Cardiovascular Disease. WOMENS HEALTH 2009; 5:709-25. [DOI: 10.2217/whe.09.56] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The importance of mind–body health relationships has been recognized for decades, but only recently has the wider medical and cardiovascular community become engaged in understanding and addressing the complex, bidirectional risk relationship between cardiovascular disease (CVD) and depression. Furthermore, it has become increasingly clear that there are incompletely understood sex differences in incidence and outcomes for both conditions that should guide treatment and future research efforts. This review will explore the role of depression in women as a risk factor for incident CVD, its impact on women already suffering from CVD, proposed psychobiologic mechanisms and links, and the implications of sex differences on diagnosis and treatment.
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Affiliation(s)
- Sharonne N Hayes
- Sharonne N Hayes, Cardiovascular Disease & Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA, Tel.: +1 507 284 3683, Fax: +1 507 266 9142,
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886
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Baumeister H, Hutter N, Bengel J. Psychological and pharmacological interventions for depression in patients with coronary artery disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd008012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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887
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Franklin BA. Impact of psychosocial risk factors on the heart: changing paradigms and perceptions. PHYSICIAN SPORTSMED 2009; 37:35-7. [PMID: 20048526 DOI: 10.3810/psm.2009.10.1727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To combat cardiovascular disease (CVD), physicians and allied health care professionals often focus on modifying conventional risk factors such as cigarette smoking, hypertension, hypercholesterolemia, and diabetes. However, a recent review of published research demonstrated that 75% to 90% of coronary artery disease (CAD) incidence is explained by these risk factors, either alone or in combination. This has stimulated a vigorous search for other correctable risk factors (ie, to explain the remaining incidence [10%-25%]), including genetic anomalies, markers of inflammation (C-reactive protein, lipoprotein-associated phospholipase A2), and specific lipid/lipoprotein particles to enhance risk stratification. Nevertheless, an escalating body of research provides strong evidence for the adverse effects of psychosocial factors in the development of CVD and in the prognosis of patients with CAD.
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888
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Patten SB, Kennedy SH, Lam RW, O'Donovan C, Filteau MJ, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. I. Classification, burden and principles of management. J Affect Disord 2009; 117 Suppl 1:S5-14. [PMID: 19674796 DOI: 10.1016/j.jad.2009.06.044] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 06/23/2009] [Indexed: 12/22/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is one of the most burdensome illnesses in Canada. The purpose of this introductory section of the 2009 revised CANMAT guidelines is to provide definitions of the depressive disorders (with an emphasis on MDD), summarize Canadian data concerning their epidemiology and describe overarching principles of managing these conditions. This section on "Classification, Burden and Principles of Management" is one of 5 guideline articles in the 2009 CANMAT guidelines. METHODS The CANMAT guidelines are based on a question-answer format to enhance accessibility to clinicians. An evidence-based format was used with updated systematic reviews of the literature and recommendations were graded according to the Level of Evidence using pre-defined criteria. Lines of Treatment were identified based on criteria that included evidence and expert clinical support. RESULTS Epidemiologic data indicate that MDD afflicts 11% of Canadians at some time in their lives, and approximately 4% during any given year. MDD has a detrimental impact on overall health, role functioning and quality of life. Detection of MDD, accurate diagnosis and provision of evidence-based treatment are challenging tasks for both clinicians and for the health systems in which they work. LIMITATIONS Epidemiologic and clinical data cannot be seamlessly linked due to heterogeneity of syndromes within the population. CONCLUSIONS In the eight years since the last CANMAT Guidelines for Treatment of Depressive Disorders were published, progress has been made in understanding the epidemiology and treatment of these disorders. Evidence supporting specific therapeutic interventions is summarized and evaluated in subsequent sections.
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889
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Thombs BD, Jewett LR, Knafo R, Coyne JC, Ziegelstein RC. Learning from history: a commentary on the American Heart Association Science Advisory on depression screening. Am Heart J 2009; 158:503-5. [PMID: 19781405 DOI: 10.1016/j.ahj.2009.07.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/24/2009] [Indexed: 11/25/2022]
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890
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Genest J, McPherson R, Frohlich J, Anderson T, Campbell N, Carpentier A, Couture P, Dufour R, Fodor G, Francis GA, Grover S, Gupta M, Hegele RA, Lau DC, Leiter L, Lewis GF, Lonn E, Mancini GBJ, Ng D, Pearson GJ, Sniderman A, Stone JA, Ur E. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult - 2009 recommendations. Can J Cardiol 2009; 25:567-79. [PMID: 19812802 PMCID: PMC2782500 DOI: 10.1016/s0828-282x(09)70715-9] [Citation(s) in RCA: 529] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Accepted: 08/12/2009] [Indexed: 12/19/2022] Open
Abstract
The present article represents the 2009 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult.
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891
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Whooley MA. To screen or not to screen? Depression in patients with cardiovascular disease. J Am Coll Cardiol 2009; 54:891-3. [PMID: 19712797 DOI: 10.1016/j.jacc.2009.05.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Accepted: 05/05/2009] [Indexed: 11/17/2022]
Abstract
There is considerable controversy about whether patients with cardiovascular disease should be screened for depression. Depression is known to be associated with increased morbidity and mortality, but screening by itself does not improve either depression or cardiovascular outcomes. Nonetheless, depression deserves treatment regardless of its cardiovascular effects, and screening plus collaborative care is cost effective in primary care settings. Thus, patients with cardiovascular disease should receive routine screening for depression by primary care providers in the context of a collaborative care treatment program.
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Affiliation(s)
- Mary A Whooley
- Veterans Affairs Medical Center and University of California, San Francisco, California, USA.
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892
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Ziegelstein RC, Thombs BD, Coyne JC, de Jonge P. Routine screening for depression in patients with coronary heart disease never mind. J Am Coll Cardiol 2009; 54:886-90. [PMID: 19712796 DOI: 10.1016/j.jacc.2009.01.082] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 01/20/2009] [Accepted: 01/25/2009] [Indexed: 01/01/2023]
Abstract
A recent Science Advisory from the American Heart Association (AHA) recommended routine screening of all patients with coronary heart disease (CHD) for depression. The authors of the advisory noted that the high prevalence of depression in patients with CHD supports this strategy. A systematic review of the evidence on depression screening and treatment in CHD patients published soon after the AHA advisory found that screening tools for major depression are reasonably accurate among patients with CHD, but that the majority of patients who screen positive will not have major depression; that depression treatment in CHD patients only accounts for a small amount of variance in depression symptom change scores; and that there is no evidence that screening for depression improves CHD outcomes. We call for the AHA to reassess their recommendations in light of this systematic review and considering the potential impact of their document on clinical practice.
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Affiliation(s)
- Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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893
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Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, Gurvitz MZ, Havranek EP, Lee CS, Lindenfeld J, Peterson PN, Pressler SJ, Schocken DD, Whellan DJ. State of the Science. Circulation 2009; 120:1141-63. [DOI: 10.1161/circulationaha.109.192628] [Citation(s) in RCA: 638] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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894
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895
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896
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Brief depression screening with the PHQ-2 associated with prognosis following percutaneous coronary intervention with paclitaxel-eluting stenting. J Gen Intern Med 2009; 24:1037-42. [PMID: 19579048 PMCID: PMC2726887 DOI: 10.1007/s11606-009-1054-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 04/22/2009] [Accepted: 06/09/2009] [Indexed: 12/02/2022]
Abstract
BACKGROUND Depression is associated with adverse prognosis in cardiac patients, warranting the availability of brief and valid instruments to identify depressed patients in clinical practice. OBJECTIVES We examined whether the two-item Patient Health Questionnaire (PHQ-2) was associated with adverse events in percutaneous coronary intervention (PCI) patients treated with paclitaxel-eluting stenting (using the continuous score and various cutoffs), overall and by gender. DESIGN Prospective follow-up study. PARTICIPANTS Consecutive PCI patients (n = 796) seen at a university medical centre. MEASUREMENTS PHQ-2 at baseline. The study endpoint was an adverse event, defined as a combination of death or non-fatal myocardial infarction (MI) at follow-up (mean of 1.4 years). RESULTS At follow-up, 47 patients had experienced an adverse event. Using the continuous score of the PHQ-2 and the recommended cutoff > or =3, depressive symptoms were not associated with adverse events (ps > 0.05). Using a cutoff > or =2, depressive symptoms were significantly associated with adverse events (HR: 1.89; 95% CI: 1.06-3.35) and remained significant in adjusted analysis (HR: 1.90; 95% CI: 1.05-3.44). Depressive symptoms were associated with an increased risk of adverse events in men (HR: 2.69; 95% CI: 1.36-5.32) but not in women (HR: 0.76; 95% CI: 0.24-2.43); these results remained in adjusted analysis. CONCLUSIONS Depression screening with a two-item scale and a cutoff score of > or =2 was independently associated with adverse events at follow-up. The PHQ-2 is a brief and valid measure that can easily be used post PCI to identify patients at risk for adverse health outcomes.
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897
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Kato N, Kinugawa K, Yao A, Hatano M, Shiga T, Kazuma K. Relationship of depressive symptoms with hospitalization and death in Japanese patients with heart failure. J Card Fail 2009; 15:912-9. [PMID: 19944369 DOI: 10.1016/j.cardfail.2009.06.442] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 06/28/2009] [Accepted: 06/30/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depressive symptoms are risk factors for poor outcomes and are positively associated with disease severity in patients with heart failure (HF). However, little is known about this association in the Japanese population. Therefore, we evaluated the prevalence of depressive symptoms and whether depressive symptoms predicted hospitalization for HF and death independent of disease severity and other factors in HF patients. METHODS AND RESULTS A 2-year prospective cohort study was conducted on 115 outpatients with HF (73.9% males; mean age 64.7 years) in Tokyo. Of these, 27 patients (23.5%) were classified as having depressive symptoms (Center for Epidemiologic Studies Depression Scale score >or=16). Patients with depressive symptoms had higher rates of 2-year cardiac death or HF hospitalization (34.0% vs. 10.3%; P < .01), HF hospitalization (27.4% vs. 9.2%; P = .01), and all-cause death (27.4% vs. 7.2%; P < .01). Multivariate Cox regression analyses indicated that depressive symptoms were predictors of cardiac death or HF hospitalization (hazard ratio [HR], 3.29; P = .02), HF hospitalization (HR, 3.36; P = .04), and all-cause death (HR, 5.52; P = .01), independent of age and brain natriuretic peptide. CONCLUSIONS Depressive symptoms were common and independent predictors of poor outcomes in Japanese patients with HF.
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Affiliation(s)
- Naoko Kato
- Department of Adult Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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898
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Versteeg H, Schiffer AA, Widdershoven JW, Meine MM, Doevendans PA, Pedersen SS. Response to cardiac resynchronization therapy: is it time to expand the criteria? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1247-56. [PMID: 19702599 DOI: 10.1111/j.1540-8159.2009.02505.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders. Given that there is a lack of consensus on how to define response to CRT, the purpose of this viewpoint is to discuss currently used definitions and their shortcomings, and to provide recommendations as to how an expansion of the criteria for CRT response may be useful to clinicians. METHODS AND RESULTS Analysis of the literature and case reports indicates that the majority of established measures of CRT response, including New York Heart Association functional class and echocardiographic, hemodynamic, and neurohormonal parameters, are poor associates of patient-reported symptoms and quality of life. Moreover, the potential moderating role of psychological factors in determining health outcomes after CRT has largely been neglected. CONCLUSIONS It is recommended to routinely assess health status after CRT with a disease-specific questionnaire in standard clinical practice and to examine its determinants, including psychological factors such as personality traits and depression. This may lead to improved (secondary) treatment and prognosis in CHF patients treated with CRT.
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Affiliation(s)
- Henneke Versteeg
- CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, The Netherlands
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899
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O'Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc 2009; 84:741-57. [PMID: 19648392 PMCID: PMC2719528 DOI: 10.1016/s0025-6196(11)60525-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite the fact that we possess highly effective tools for the primary and secondary prevention of myocardial infarction and other complications of atherosclerosis, coronary heart disease remains the most common cause of death in our society. Arterial inflammation and endothelial dysfunction play central roles in the pathogenesis of atherosclerosis and adverse cardiovascular (CV) events. Therapeutic lifestyle changes in conjunction with an aggressive multidrug regimen targeted toward the normalization of the major CV risk factors will neutralize the atherogenic milieu, reduce vascular inflammation, and markedly decrease the risk of adverse CV events and need for revascularization procedures. Specific CV risk factors and optimal therapies for primary and secondary prevention are discussed.
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Affiliation(s)
- James H O'Keefe
- Mid America Heart Institute and University of Missouri-Kansas City, Missouri, USA.
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900
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O'Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc 2009; 84:741-57. [PMID: 19648392 PMCID: PMC2719528 DOI: 10.4065/84.8.741] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Despite the fact that we possess highly effective tools for the primary and secondary prevention of myocardial infarction and other complications of atherosclerosis, coronary heart disease remains the most common cause of death in our society. Arterial inflammation and endothelial dysfunction play central roles in the pathogenesis of atherosclerosis and adverse cardiovascular (CV) events. Therapeutic lifestyle changes in conjunction with an aggressive multidrug regimen targeted toward the normalization of the major CV risk factors will neutralize the atherogenic milieu, reduce vascular inflammation, and markedly decrease the risk of adverse CV events and need for revascularization procedures. Specific CV risk factors and optimal therapies for primary and secondary prevention are discussed.
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Affiliation(s)
- James H O'Keefe
- Mid America Heart Institute and University of Missouri-Kansas City, Missouri, USA.
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