151
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Impact of history of depression on 1-year outcomes in patients with chronic coronary syndromes: An analysis of a contemporary, prospective, nationwide registry. Int J Cardiol 2021; 331:273-280. [PMID: 33422564 DOI: 10.1016/j.ijcard.2020.12.086] [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: 08/07/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Depression is common in patients with acute cardiovascular conditions and it is associated with adverse clinical events. METHODS Using the data from a nationwide, prospective registry on patients with chronic coronary syndromes (CCS), we assessed the impact of depression on major adverse cardiovascular events (MACE), a composite of all-cause death and hospitalization for myocardial infarction, revascularization, heart failure or stroke, and quality of life (QoL) at 1-year follow-up. RESULTS From the 5070 consecutive CCS patients enrolled in the registry, 531 (10.5%) presented a history of depression and the remaining 4539 (89.5%) did not. At 1 year (median 369; IQR 362-378 days) from enrolment, the incidence of the primary composite outcome was 9.8% for patients with a history of depression and 7.2% for non-depressed patients (p = 0.03). Patients with history of depression had a significantly higher rate of all-cause mortality (3.0% vs 1.4%; p = 0.004) and hospital admission for heart failure (3.4% vs 1.3%; p = 0.0002) compared to the group without depression. However, history of depression did not result as an independent predictor of MACE at multivariable analysis [hazard ratio 1.17, 95% confidence interval (0.87-1.58), p = 0.31]. Depressed patients had worse QoL according to all domains of the EQ. 5D-5L questionnaire as compared to non-depressed patients (all p < 0.001), at both enrolment and follow-up. CONCLUSIONS In this contemporary, large cohort of consecutive patients with CCS, patients with a history of depression experienced a two-fold rate of mortality, a higher incidence of MACE and a worse QoL at 1-year follow-up, compared to non-depressed patients.
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152
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Matsuda R, Kohno T, Kohsaka S, Shiraishi Y, Katsumata Y, Hayashida K, Yuasa S, Takatsuki S, Fukuda K. Psychological disturbances and their association with sleep disturbances in patients admitted for cardiovascular diseases. PLoS One 2021; 16:e0244484. [PMID: 33395422 PMCID: PMC7781384 DOI: 10.1371/journal.pone.0244484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/10/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Depression and anxiety are common mental health problems that are strongly associated with sleep disturbances, according to community-based researches. However, this association has not been investigated among patients admitted for cardiovascular diseases (CVDs). We examined the prevalence of depression and anxiety in inpatients with various CVDs and their association with sleep disturbances. MATERIALS AND METHODS This cross-sectional study included 1294 patients hospitalized for CVDs in a Japanese university hospital were evaluated for their mental status using the Hospital Anxiety and Depression Scale (HADS), for sleep-disordered breathing (SDB) using pulse oximetry, and for sleep quality using the Pittsburgh Sleep Quality Index (PSQI). RESULTS Patient characteristics were as below: mean age, 63.9±14.7 years; 25.7% female. Overall, 18.9% had depression (HADS-depression≥8) and 17.1% had anxiety (HADS-anxiety≥8). The presence of depression was associated with female sex, older age, higher plasma brain natriuretic peptide level, lower estimated glomerular filtration rate, and the prevalence of heart failure. Overall, 46.5% patients were categorized as having a poor sleep quality (PSQI>5), and 28.5% patients had SDB (3% oxygen desaturation index>15). Although depression and anxiety were not associated with SDB, they were independently associated with poor sleep quality (OR = 3.09, 95% CI 2.19-4.36; OR = 3.93, 95% CI 2.71-5.69, respectively). CONCLUSIONS Depression and anxiety were not uncommon in patients with CVDs. Poor sleep quality could be an important risk factor linked to psychological disturbances.
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Affiliation(s)
- Risa Matsuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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153
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Huang CY, Huang MC, Sun MF, Lin CL, Wu MY, Lin WC, Yen HR. Acupuncture Treatment Reduced the Risk of Coronary Heart Disease in Patients with Depression: A Propensity-Score Matched Cohort Study. Neuropsychiatr Dis Treat 2021; 17:2315-2325. [PMID: 34285491 PMCID: PMC8286083 DOI: 10.2147/ndt.s315572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/17/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Major depressive disorder is a significant public health concern, which often leads to loss of productivity, functional decline, and various complications. The aim of this study was to investigate the effectiveness of acupuncture in the risk reduction of coronary heart disease (CHD) in patients with depression. METHODS We enrolled patients diagnosed with depression between January 1, 1997, and December 31, 2010, through the Taiwanese National Health Insurance Research Database (NHIRD). Propensity score was used to match equal numbers (n=14,647) of acupuncture cohort and no-acupuncture cohort based on characteristics including sex, age, baseline comorbidity and medication. Patients were followed up until December 31, 2013, or withdrawn from the NHIRD. The Cox regression model was used to compare the hazard ratios (HRs) of CHD in the two cohorts. RESULTS The basic characteristics of the two groups were similar. A lower cumulative incidence of CHD was noted in the acupuncture cohort (Log rank test, p < 0.001). Over time, 1626 patients in the acupuncture cohort (21.05 per 1000 person-years) and 2412 patients in the no-acupuncture cohort (39.84 per 1000 person-years) developed CHD (adjusted HR=0.50, 95% CI 0.47-0.53). The decreased CHD incidence was independent of age, sex, comorbidities, and medications used. The cumulative incidence of CHD was significantly lower in the acupuncture cohort than in the no-acupuncture cohort (Log rank test, p<0.001). CONCLUSION The results provided a real-world evidence that acupuncture may have beneficial effect on CHD risk reduction in patients with depression.
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Affiliation(s)
- Chia-Yu Huang
- Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 427, Taiwan.,School of Medicine, Tzu Chi University, Hualien, 970, Taiwan.,Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan
| | - Ming-Cheng Huang
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Mao-Feng Sun
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan.,College of Medicine, China Medical University, Taichung, 404, Taiwan
| | - Mei-Yao Wu
- Department of Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan.,School of Post-baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan
| | - Wu-Chou Lin
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, 404, Taiwan
| | - Hung-Rong Yen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, 404, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taichung, 404, Taiwan.,Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, 404, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, 404, Taiwan
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154
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Miranda AM, Goulart AC, Benseñor IM, Lotufo PA, Marchioni DM. Moderate coffee consumption is associated with lower risk of mortality in prior Acute Coronary Syndrome patients: a prospective analysis in the ERICO cohort. Int J Food Sci Nutr 2020; 72:794-804. [PMID: 33349068 DOI: 10.1080/09637486.2020.1862069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined the association between coffee consumption and all-cause mortality in patients with a prior acute myocardial infarction or unstable angina. Data were from the prospective study ERICO, totalising 928 patients with Acute Coronary Syndrome (ACS). During 4 years' follow-up, a total of 111 deaths occurred. Moderate coffee consumption (1-2 and 2-3 cups/day) was inversely associated with total mortality (HR 0.13, 95% CI: 0.06-0.29 and 0.22, 95% CI: 0.13-0.39, respectively). For patients with higher coffee consumption (>3 cups/day), there was a positive association with mortality (HR 2.12, 95% CI: 1.06-4.24). After stratification by smoking status, the analysis revealed lower risk of mortality in never and former smokers, drinking 1-2 and 2-3 cups/day. Among current smokers there was a positive association between >3 cups/day and mortality. The moderate consumption of coffee was associated with lower risk of all-cause mortality in patients with a prior ACS, particularly in non-smokers.
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Affiliation(s)
| | | | - Isabela Martins Benseñor
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, SP, Brazil.,School of Medicine, University of São Paulo, SP, Brazil
| | - Paulo Andrade Lotufo
- Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, SP, Brazil.,School of Medicine, University of São Paulo, SP, Brazil
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, SP, Brazil
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155
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Lee C, Lee SC, Shin YS, Park S, Won KB, Ann SH, Ko EJ. Severity, Progress, and Related Factors of Mood Disorders in Patients with Coronary Artery Disease: A Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8040568. [PMID: 33339355 PMCID: PMC7766069 DOI: 10.3390/healthcare8040568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Patients with coronary artery disease (CAD) are more likely to experience depression and anxiety, which, in turn, are risk factors for CAD. The Beck depression inventory (BDI) and Beck anxiety inventory (BAI) were applied for mood evaluation during hospitalization and again 3 months after discharge in 118 patients with CAD, and cardiopulmonary exercise tests were conducted in the outpatient department. Of the patients diagnosed with CAD, 40 (33.9%) had depressive moods, and 51 (43.2%) had anxious moods. A family history of CAD, low Korean activity scale index (KASI), and use of beta-blockers were independent factors causing depressive mood, while lower left ventricular ejection fraction (LVEF) and low KASI score were independent factors causing anxious mood. A considerable number of patients (35.7% with depressive mood and 25.0% with anxious mood) still had emotional problems after 3 months of discharge. The change values of BDI were associated with lower LVEF and longer hospital stay, while those of BAI was associated with a longer hospital stay. Since some patients had depressive and anxious moods after three months of discharge, evaluating and treating them are essential.
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Affiliation(s)
- Changbae Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Sang Cheol Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Yeon Seob Shin
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Ki Bum Won
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Korea
- Correspondence:
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156
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Edwards KS, Chow EKH, Dao C, Hossepian D, Johnson AG, Desai M, Shah S, Lee A, Yeung AC, Fischbein M, Fearon WF. Impact of cognitive behavioral therapy on depression symptoms after transcatheter aortic valve replacement: A randomized controlled trial. Int J Cardiol 2020; 321:61-68. [PMID: 32800909 DOI: 10.1016/j.ijcard.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/04/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression is a significant concern after cardiac surgery and has not been studied in patients undergoing transcatheter aortic valve replacement (TAVR). We sought to examine the prevalence of pre-procedure depression and anxiety symptoms and explore whether brief bedside cognitive behavioral therapy (CBT) could prevent post-TAVR psychological distress. METHODS We prospectively recruited consecutive TAVR patients and randomized them to receive brief CBT or treatment as usual (TAU) during their hospitalization. Multi-level regression techniques were used to evaluate changes by treatment arm in depression, anxiety, and quality of life from baseline to 1 month post-TAVR adjusted for sex, race, DM, CHF, MMSE, and STS score. RESULTS One hundred and forty six participants were randomized. The mean age was 82 years, and 43% were female. Self-reported depression and anxiety scores meeting cutoffs for clinical level distress were 24.6% and 23.2% respectively. Both TAU and CBT groups had comparable improvements in depressive symptoms at 1-month (31% reduction for TAU and 35% reduction for CBT, p = .83). Similarly, both TAU and CBT groups had comparable improvements in anxiety symptoms at 1-month (8% reduction for TAU and 11% reduction for CBT, p = .1). Quality of life scores also improved and were not significantly different between the two groups. CONCLUSIONS Pre-procedure depression and anxiety may be common among patients undergoing TAVR. However, TAVR patients show spontaneous improvement in depression and anxiety scores at 1-month follow up, regardless of brief CBT. Further research is needed to determine whether more tailored CBT interventions may improve psychological and medical outcomes.
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Affiliation(s)
| | - Eric K H Chow
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Catherine Dao
- Department of Medicine, Stanford University, United States of America
| | - Derik Hossepian
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Audrey G Johnson
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Sonia Shah
- Department of Medicine, Stanford University, United States of America
| | - Anson Lee
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - Alan C Yeung
- Department of Medicine, Stanford University, United States of America
| | - Michael Fischbein
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - William F Fearon
- Department of Medicine, Stanford University, United States of America
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157
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Affiliation(s)
- Esther S H Kim
- From the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville
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158
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Keogh TM, Howard S, O'Riordan A, Gallagher S. Motivational orientation mediates the association between depression and cardiovascular reactivity to acute psychological stress. Psychophysiology 2020; 58:e13732. [PMID: 33252783 DOI: 10.1111/psyp.13732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/22/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022]
Abstract
Recent theoretical developments in cardiovascular reactivity research suggest the association between depression and blunted reactions to stress is linked to motivational factors. Thus, the present study aimed to test whether the association between depressive symptoms and cardiovascular reactivity to acute stress was mediated by motivation; be it intrinsic or extrinsic motivation. One hundred and eighty-two healthy young adults completed measures of motivation (Global Motivation Scale; GMS), and depression (Hospital Anxiety and Depression Scale; HADS) and had their blood pressure and heart rate monitored throughout a standardised stress testing protocol. Results indicated that depression was negatively associated with both systolic blood pressure (SBP) and heart rate (HR) reactions to the stress task (all ps < .05), such that those who reported higher depressive symptomology displayed a blunted response. Furthermore this relationship was mediated by intrinsic, but not extrinsic motivation; the blunted responses were less pronounced through intrinsic motivation. The present findings add extensively to existing research and confirm that motivation is an underlying mechanism linking depression and cardiovascular reactivity.
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Affiliation(s)
- Tracey M Keogh
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Howard
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Adam O'Riordan
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Stephen Gallagher
- Department of Psychology, Centre for Social Issues Research, Study of Anxiety, Stress and Health Laboratory, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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159
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Tully PJ, Higgins R. Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide,
- Department of Medicine, Flinders Medical Centre and Flinders University of South Australia,
| | - Rosemary Higgins
- Heart Research Centre,
- Department of Physiotherapy, The University of Melbourne,
- Cabrini Health,
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160
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The relationship between coronary artery disease and depression and anxiety scores. North Clin Istanb 2020; 7:523-526. [PMID: 33163893 PMCID: PMC7603855 DOI: 10.14744/nci.2020.72602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023] Open
Abstract
Coronary artery disease (CAD) is one of the severe diseases that may cause significant moral and financial burden on society today. There are many studies in the literature on whether psychiatric disorders may cause CAD or an increase in prevalence after CAD. Although many studies have emphasized the importance of early diagnosis and treatment of depression in CAD patients, clinicians do not attach much attention to depression in daily practice. Several scales have been developed that are comfortable to use to describe anxiety and depression in CAD patients. High depression and anxiety scores predicted by psychological symptom scales following CAD treatment are closely related to treatment success and prognosis of the CAD. We believe that patients with CAD should be followed carefully for the diagnosis of depression and anxiety disorders; since the treatment of them may improve the prognosis of CAD.
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161
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Alsumih N, Alqahtani R, Almutairi F, Faraj R, Alsubeai T, Alghanim A, Alharbi S, Almodaimegh H. The Use of Antidepressants in Patients with Heart Failure. J Saudi Heart Assoc 2020; 32:46-51. [PMID: 33154891 PMCID: PMC7640597 DOI: 10.37616/2212-5043.1008] [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: 08/31/2019] [Revised: 09/23/2019] [Accepted: 09/29/2019] [Indexed: 11/20/2022] Open
Abstract
Background Heart failure (HF) is a chronic disease affecting patients' quality of life (QoL) and may cause depression. Recent studies reported that the prevalence of depression in patients with HF is 21.5%. Antidepressants, mainly selective serotonin reuptake inhibitors, are usually prescribed for HF patients diagnosed with depression. Some evidence supports antidepressant's role in improving symptoms by enhancing the psychological aspect of their QoL. Depression screening and treatment are important in the multidisciplinary management; however, their survival benefits are inconsistent. In our study, we aim to investigate the prevalence of depression and the use of antidepressants in patients with HF as well as to determine the acceptance of using antidepressants in such patients. Methods This is a cross-sectional study conducted by interviewing HF outpatients at National Guard Hospital in Riyadh. Patients were assessed using Hamilton depression rating scale. Results A total of 306 patients were included, with the majority (69%) being male and aged >61 years (60%). Patients' medical history was classified into different groups, with the largest proportion (39.9%) in the diabetic-hypertensive group, followed by a diabetic group (21.2%) and a hypertensive group (10.8%). Patients were classified according to the New York Heart Association Functional Classification, and most patients were in Class I (61.8%). Some of the patients (8.5%) had been diagnosed with depression. There was no statistically significant association between HF and depression (p > 0.05). However, 5.6% of patients had been prescribed antidepressants and 17.1% of patients believed that they required antidepressants. Moreover, there was a statically significant association between medical history and development of depression (p = 0.014). Conclusions The prevalence of depression in HF patients in our population was lower than reported. There was no association between HF stage, depression, and antidepressant use.
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Affiliation(s)
- Norah Alsumih
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rahaf Alqahtani
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Pharmaceutical Care Department, Ministry of the National Guard -Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faisal Almutairi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rakan Faraj
- College of Pharmacy, UMM AlQura University, Makkah, Saudi Arabia
| | - Turki Alsubeai
- College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Ahmed Alghanim
- College of Medicine, Arabian Gulf University, Manama, Bahrain
| | - Shmylan Alharbi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Pharmaceutical Care Department, Ministry of the National Guard -Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hind Almodaimegh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Pharmaceutical Care Department, Ministry of the National Guard -Health Affairs, Riyadh, Saudi Arabia
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162
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Macchi C, Favero C, Ceresa A, Vigna L, Conti DM, Pesatori AC, Racagni G, Corsini A, Ferri N, Sirtori CR, Buoli M, Bollati V, Ruscica M. Depression and cardiovascular risk-association among Beck Depression Inventory, PCSK9 levels and insulin resistance. Cardiovasc Diabetol 2020; 19:187. [PMID: 33143700 PMCID: PMC7641831 DOI: 10.1186/s12933-020-01158-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Depression and cardiovascular disease (CVD) are among the most common causes of disability in high-income countries, depression being associated with a 30% increased risk of future CV events. Depression is twice as common in people with diabetes and is associated with a 60% rise in the incidence of type 2 diabetes, an independent CVD risk factor. Proprotein convertase subtilisin/kexin type 9 (PCSK9), a key regulator of low-density lipoprotein cholesterol, has been related to a large number of CV risk factors, including insulin resistance. Aim of this study was to investigate whether the presence of depression could affect PCSK9 levels in a population of obese subjects susceptible to depressive symptoms and how these changes may mediate a pre-diabetic risk. RESULTS In 389 obese individuals, the Beck Depression Inventory (BDI-II) was significantly associated with PCSK9 levels. For every one-unit increment in BDI-II score, PCSK9 rose by 1.85 ng/mL. Depression was associated also with the HOMA-IR (homeostatic model assessment index of insulin resistance), 11% of this effect operating indirectly via PCSK9. CONCLUSIONS This study indicates a possible mechanism linking depression and insulin resistance, a well-known CV risk factor, providing evidence for a significant role of PCSK9.
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Affiliation(s)
- C Macchi
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - C Favero
- EPIGET Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - A Ceresa
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - L Vigna
- Occupational Medicine Unit, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - D M Conti
- Occupational Medicine Unit, Fondazione Cà Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - A C Pesatori
- EPIGET Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - G Racagni
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - A Corsini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
- IRCCS, Multimedica, Sesto San Giovanni (Milan), Italy
| | - N Ferri
- Dipartimento di Scienze del Farmaco, Università degli Studi di Padova, Padua, Italy
| | - C R Sirtori
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - M Buoli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Neurosciences and Mental Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Bollati
- EPIGET Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - M Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
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Quittner AL, Abbott J, Hussain S, Ong T, Uluer A, Hempstead S, Lomas P, Smith B. Integration of mental health screening and treatment into cystic fibrosis clinics: Evaluation of initial implementation in 84 programs across the United States. Pediatr Pulmonol 2020; 55:2995-3004. [PMID: 32649006 DOI: 10.1002/ppul.24949] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND A large-scale epidemiological study of 6088 individuals with cystic fibrosis (CF) and 4102 caregivers in nine countries documented elevated symptoms of depression and anxiety, leading to international guidelines for annual screening and follow-up. To facilitate national implementation, 84 CF programs funded a mental health coordinators (MHC). Implementation was evaluated after 1 year using the consolidated framework for implementation research (CFIR) to identify facilitators and barriers. METHODS A 45-item internet survey was developed to assess relevant CFIR implementation steps. Surveys were completed in 2016. It assessed five domains tailored to study aims: (a) Intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of individuals, and (e) process of implementation. RESULTS Response rate was 88%, with pediatric and adult programs equally represented. A majority of MHCs were social workers (54.1%) and psychologists (41.9%); 41% had joined the team in the past year. Facilitators across the five domains included universal uptake of screening tools, greater awareness and detection of psychological symptoms, reduced stigma, and positive feedback from patients and families. Barriers included limited staff time, space, and logistics. DISCUSSION This is the largest systematic effort to integrate mental health screening and treatment into the care of individuals with a serious, chronic illness and their caregivers. MHCs implementing screening, interpretation and follow-up reported positive results, and significant barriers. This national implementation effort demonstrated that depression and anxiety can be efficiently evaluated and treated in a complex, chronic disease. Future efforts include recommending the addition of screening scores to national CF Registries and examining their effects on health outcomes.
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Affiliation(s)
| | - Janice Abbott
- School Psychology, University of Lancashire, Preston, UK
| | - Saida Hussain
- Research Institute, Nicklaus Children's Research Institute, Miami, Florida
| | - Thida Ong
- Pediatric Pulmonology, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Ahmet Uluer
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Sarah Hempstead
- Clinical Affairs, Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Paula Lomas
- Clinical Affairs, Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Beth Smith
- Department of Psychiatry, State University of New York, Buffalo, New York
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164
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Excess mortality associated with mental illness in people living with HIV in Cape Town, South Africa: a cohort study using linked electronic health records. LANCET GLOBAL HEALTH 2020; 8:e1326-e1334. [PMID: 32971055 PMCID: PMC7582785 DOI: 10.1016/s2214-109x(20)30279-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 06/03/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mental disorders can adversely affect HIV treatment outcomes and survival. Data are scarce on premature deaths in people with mental disorders in HIV-positive populations, particularly in low-income and middle-income countries. In this study, we quantified excess mortality associated with mental disorders in HIV-positive people in South Africa, adjusting for HIV treatment outcomes. METHODS For this cohort study, we analysed routinely collected data on HIV-positive adults receiving antiretroviral therapy (ART) in Cape Town, South Africa between Jan 1, 2004, to Dec 31, 2017. Data from three ART programmes were linked with routine medical records on mental health treatment from Jan 1, 2010, to Dec 31, 2017, and mortality surveillance data from the South African National Population Register up to Dec 31, 2017. People living with HIV aged 15 years or older who initiated ART at a programme site were eligible for analysis. We followed up patients from ART initiation or Jan 1, 2010, whichever occurred later, to transfer, death, or Dec 31, 2017. Patients were considered as having a history of mental illness if they had ever received psychiatric medication or been hospitalised for a mental disorder. We calculated adjusted hazard ratios (aHRs) with 95% CIs for associations between history of mental illness, mortality, and HIV treatment outcomes (retention in care with viral load suppression [VLS; viral load <1000 copies per mL], retention in care with non-suppressed viral load [NVL; viral load ≥1000 copies per mL], and loss to follow-up [LTFU; >180 days late for a clinic visit at closure of the database]) using Cox proportional hazard regression and multistate models. RESULTS 58 664 patients were followed up for a median of 4·3 years (IQR 2·1-6·4), 2927 (5·0%) of whom had a history of mental illness. After adjustment for age, sex, treatment programme, and year of ART initiation, history of mental illness was associated with increased risk of mortality from all causes (aHR 2·98 [95% CI 2·69-3·30]), natural causes (3·00 [2·69-3·36]), and unnatural causes (2·10 [1·27-3·49]), compared with no history of mental illness. Risk of all-cause mortality in people with a history of mental illness remained increased in multivariable analysis adjusted for age, sex, treatment programme, year of ART initiation, CD4 count and WHO clinical stage at ART initiation, retention in HIV care with or without VLS, and LTFU (2·73 [2·46-3·02]). In our multistate model, adjusted for age, sex, year of ART initiation, cumulative time with NVL, and WHO clinical stage and CD4 cell count at ART initiation, rates of excess all-cause mortality in people with history of mental illness were greatest in patients retained in care with VLS (aHR 3·43 [95% CI 2·83-4·15]), followed by patients retained in care with NVL (2·74 [2·32-3·24]), and smallest in those LTFU (2·12 [1·78-2·53]). History of mental illness was also associated with increased risk of HIV viral rebound (transitioning from VLS to NVL; 1·50 [1·32-1·69]) and LTFU in people with VLS (1·19 [1·06-1·34]). INTERPRETATION Mental illness was associated with substantial excess mortality in HIV-positive adults in Cape Town. Excess mortality among people with a history of mental illness occurred independently of HIV treatment success. Interventions to reduce excess mortality should address the complex physical and mental health-care needs of people living with HIV and mental illness. FUNDING National Institutes of Health, Swiss National Science Foundation, South African Medical Research Council.
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165
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Giuliani M, Gorini A, Barbieri S, Veglia F, Tremoli E. Examination of the best cut-off points of PHQ-2 and GAD-2 for detecting depression and anxiety in Italian cardiovascular inpatients. Psychol Health 2020; 36:1088-1101. [PMID: 33026888 DOI: 10.1080/08870446.2020.1830093] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Despite the frequent association between anxiety, depression and cardiovascular diseases (CVD), cardiovascular inpatients are not usually screened for these psychopathological conditions. To fill this gap, especially in hospital environments, there is the need of brief screening instruments that provide reliable information in a very short time. According to this need, the aim of this study was to examine the best cut-off points of two brief and easy-to-use questionnaires in a sample of Italian cardiovascular inpatients: the 2-item Patient Health Questionnaire (PHQ-2) and the 2-item Generalized Anxiety Disorder (GAD-2). DESIGN 3500 cardiovascular inpatients were recruited and completed both the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7). PHQ-2 and GAD-2 were then obtained extracting the first two item from PHQ-9 and GAD-7. MAIN OUTCOME MEASURES The PHQ-2 and GAD-2 psychometric properties were calculated comparing them with PHQ-9 and GAD-7, respectively. RESULTS The PHQ-2 threshold of ≥ 2 and the GAD-2 threshold of ≥ 3 are the best solutions in balancing between sensitivity and specificity, also providing acceptable rates of false positives and false negatives. CONCLUSIONS the PHQ-2 and GAD-2 Italian versions showed good diagnostic features for measuring depression and anxiety in CVD patients.
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Affiliation(s)
| | - Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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World Trade Center Health Program: First Decade of Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197290. [PMID: 33036199 PMCID: PMC7579473 DOI: 10.3390/ijerph17197290] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/19/2022]
Abstract
The terrorist attacks on 11 September 2001 placed nearly a half million people at increased risk of adverse health. Health effects research began shortly after and continues today, now mostly as a coordinated effort under the federally mandated World Trade Center (WTC) Health Program (WTCHP). Established in 2011, the WTCHP provides medical monitoring and treatment of covered health conditions for responders and survivors and maintains a research program aimed to improve the care and well-being of the affected population. By 2020, funds in excess of USD 127 M had been awarded for health effects research. This review describes research findings and provides an overview of the WTCHP and its future directions. The literature was systematically searched for relevant articles published from 11 September 2001 through 30 June 2020. Synthesis was limited to broad categories of mental health, cancer, respiratory disease, vulnerable populations, and emerging conditions. In total, 944 WTC articles were published, including peer-reviewed articles funded by the WTCHP (n = 291) and other sources. Research has focused on characterizing the burden and etiology of WTC-related health conditions. As the program moves forward, translational research that directly enhances the care of individuals with chronic mental and physical health conditions is needed.
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167
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Kewcharoen J, Tachorueangwiwat C, Kanitsoraphan C, Saowapa S, Nitinai N, Vutthikraivit W, Rattanawong P, Banerjee D. Association between depression and increased risk of readmission in patients with heart failure: a systematic review and meta-analysis. Minerva Cardiol Angiol 2020; 69:389-397. [PMID: 32996309 DOI: 10.23736/s2724-5683.20.05346-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Heart failure (HF) is one of the world leading causes of admission and readmission. Recent studies have shown that the presence of depression is associated with hospital readmission in patients after an index admission for heart failure (HF). However, there is disagreement between published studies regarding this finding. We performed a systematic review and meta-analysis to evaluate the effect of depression on readmission rates in HF patients. EVIDENCE ACQUISITION We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were published study evaluating readmission rate of HF patients, with and without depression. Data from each study were combined using a random-effects model, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals. EVIDENCE SYNTHESIS Ten studies were included in the meta-analysis with a total of 53,165 patients (6194 patients with depression). The presence of depression was associated with an increased risk of readmission in patients with HF (pooled HR=1.54, 95% CI: 1.22-1.94, P<0.001, I2=55.4%). In a subgroup analysis, depression was associated with an increased risk of readmission in patients with HF in both short-term (≤90 days) follow-up (pooled HR=1.75, 95% CI: 1.07-2.85, P=0.025, I2=76.0%) and long-term (>90 days) follow-up (pooled HR=1.58, 95% CI: 1.32-1.90, P<0.001, I2=0.0%). CONCLUSIONS Our meta-analysis demonstrated that depression is associated with an increased risk of hospital readmission in patients with HF.
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Affiliation(s)
- Jakrin Kewcharoen
- Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA -
| | | | | | - Sakditad Saowapa
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nattapat Nitinai
- Faculty of Medicine, Chulalongkorn University Hospital, Bangkok, Thailand
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Pattara Rattanawong
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Dipanjan Banerjee
- Queens Heart Physician Practice, Queen's Medical Center, Honolulu, HI, USA.,John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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168
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Chindhy S, Taub PR, Lavie CJ, Shen J. Current challenges in cardiac rehabilitation: strategies to overcome social factors and attendance barriers. Expert Rev Cardiovasc Ther 2020; 18:777-789. [PMID: 32885702 DOI: 10.1080/14779072.2020.1816464] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cardiac rehabilitation (CR) significantly reduces secondary cardiovascular events and mortality and is a class 1A recommendation by the American Heart Association (AHA) and American College of Cardiology (ACC). However, it remains an underutilized intervention and many eligible patients fail to enroll or complete CR programs. The aim of this review is to identify barriers to CR attendance and discuss strategies to overcome them. AREAS COVERED Specific barriers to CR attendance and participation will be reviewed. This will be followed by a discussion of solutions/strategies to help overcome these barriers with a particular focus on home-based CR (HBCR). EXPERT OPINION HBCR alone or in combination with center-based CR (CBCR) can help overcome many barriers to traditional CBCR participation, such as schedule flexibility, time commitment, travel distance, cost, and patient preference. Using remote coaching with indirect exercise supervision, HBCR has been shown to have comparable benefits to CBCR. At this time, however, funding remains the main barrier to universal incorporation of HBCR into health systems, necessitating the need for additional cost benefit analysis and outcome studies. Ultimately, the choice for HBCR should be based on patient preference and availability of resources.
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Affiliation(s)
- Shahzad Chindhy
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , CA, USA
| | - Pam R Taub
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , CA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, -the University of Queensland School of Medicine , New Orleans, LA, USA
| | - Jia Shen
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , CA, USA
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169
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Krishnamurthi N, Schopfer DW, Shen H, Whooley MA. Association of Mental Health Conditions With Participation in Cardiac Rehabilitation. J Am Heart Assoc 2020; 8:e011639. [PMID: 31115253 PMCID: PMC6585364 DOI: 10.1161/jaha.118.011639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Mental health conditions are associated with adverse cardiovascular outcomes in patients with ischemic heart disease, and much of this risk can be attributed to poor health behaviors. Although all patients with ischemic heart disease should be referred for cardiac rehabilitation (CR), whether patients with mental health conditions are willing to participate in CR programs is unknown. We sought to compare CR participation rates among patients with ischemic heart disease with versus without comorbid depression and/or posttraumatic stress disorder (PTSD). Methods and Results We used national electronic health records to identify all patients hospitalized for acute myocardial infarction or coronary revascularization at Veterans Health Administration hospitals between 2010 and 2014. Multivariable logistic regression models were used to determine whether comorbid depression/PTSD was associated with CR participation during the 12 months after hospital discharge. Of the 86 537 patients hospitalized for ischemic heart disease between 2010 and 2014, 24% experienced PTSD and/or depression. Patients with PTSD and/or depression had higher CR participation rates than those without PTSD or depression (11% versus 8%; P<0.001). In comparison to patients without PTSD or depression, the odds of participation was 24% greater in patients with depression alone (odds ratio, 1.24; 95% CI, 1.15–1.34), 38% greater in patients with PTSD alone (odds ratio, 1.38; 95% CI, 1.24–1.54), and 57% greater in patients with both PTSD and depression (odds ratio, 1.57; 95% CI, 1.43–1.74). Conclusions Among patients with ischemic heart disease, the presence of comorbid depression and/or PTSD is associated with greater participation in CR, providing an important opportunity to promote healthy lifestyle behaviors and reduce adverse cardiovascular outcomes among these patients.
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Affiliation(s)
- Nirupama Krishnamurthi
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - David W Schopfer
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Hui Shen
- 3 San Francisco Veterans Affairs Medical Center San Francisco CA
| | - Mary A Whooley
- 1 Department of Medicine University of California, San Francisco San Francisco CA.,2 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco CA.,3 San Francisco Veterans Affairs Medical Center San Francisco CA
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170
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Wang Y, Liu W, Xiao Y, Yuan H, Wang F, Jiang P, Luo Z. Association of Apelin and Apelin Receptor Polymorphisms With the Risk of Comorbid Depression and Anxiety in Coronary Heart Disease Patients. Front Genet 2020; 11:893. [PMID: 32849850 PMCID: PMC7432257 DOI: 10.3389/fgene.2020.00893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022] Open
Abstract
The Apelin (APLN)/apelin receptor (APLNR) signaling pathway is a newly identified regulator in various cardiovascular diseases, which is considered as a candidate pathway for the occurrence of coronary heart disease (CHD), depression, and anxiety. The goal of this study was to investigate the association between APLN/APLNR gene polymorphisms and the risk of depression and anxiety in CHD patients. To this end, a case-control study involving 269 CHD patients and 184 healthy control individuals was conducted. The 269 patients with CHD including 122 patients with and 147 patients without depression, and 56 patients with and 213 patients without anxiety Four single nucleotide polymorphisms were selected and successfully genotyped using Sanger sequencing. The APLN rs2235310T allele and APLNR rs9943582C allele were found to be associated with an increased risk of CHD after multiple test correction (P-adjust < 0.05). The patients with CHD who carried the rs9943582C allele had a higher risk of depression, after adjusting for alcohol drinking habits, insomnia, hypertension, and stroke history, with the Bonferroni correction (P-adjust = 0.018). The APLNR rs2282623 T allele was associated with an increased risk of anxiety in CHD patients after adjusting for related disease complications, with the Bonferroni correction (P-adjust = 0.022). We reported for the first time that the APLN rs2235310 and APLNR rs2282623 polymorphisms are associated with the risks of psychiatric disorders in CHD patients and may serve as novel biomarkers for therapy.
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Affiliation(s)
- Ying Wang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Wenhui Liu
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Yiwen Xiao
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Haiyan Yuan
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Feng Wang
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Pei Jiang
- Institute of Clinical Pharmacy & Pharmacology, Jining First People's Hospital, Jining Medical University, Jining, China
| | - Zhiying Luo
- Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China.,Institute of Clinical Pharmacy, Central South University, Changsha, China
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171
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Nollett C, Bartlett R, Man R, Pickles T, Ryan B, Acton JH. Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study. BMC Psychiatry 2020; 20:419. [PMID: 32842989 PMCID: PMC7448511 DOI: 10.1186/s12888-020-02805-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Undetected depression is common in people with low vision and depression screening has been recommended. However, depression screening is a complex procedure for which low vision practitioners need training. This study examined the integration of routine depression screening, using two questions, and referral pathways into a national low vision service in Wales at 6 months following practitioner training, and identified key barriers to implementation. METHODS This pre-post single group study employed a convergent mixed methods design to collect quantitative questionnaire and qualitative interview data on low vision practitioners' clinical practice and perceived barriers to implementing depression screening. Forty practitioners completed questionnaires pre-, immediately post- and 6 months post-training and nine engaged in interviews 6 months post-training. Ordinal questionnaire scores were Rasch-transformed into interval-level data before linear regression analyses were performed to determine the change in scores over time and the association between perceived barriers and clinical practice. Thematic Analysis was applied to the interviews and the narrative results merged with the questionnaire findings. RESULTS Before training, only one third of practitioners (n = 15) identified depression in low vision patients, increasing to over 90% (n = 37) at 6 months post-training, with a corresponding increase in those using validated depression screening questions from 10% (n = 4) to 80% (n = 32). Six months post-training, practitioners reported taking significantly more action in response to suspected depression (difference in means = 2.77, 95% CI 1.93 to 3.61, p < 0.001) and perceived less barriers to addressing depression (difference in means = - 0.95, 95% CI - 1.32 to - 0.59, p < 0.001). However, the screening questions were not used consistently. Some barriers to implementation remained, including perceived patient reluctance to discuss depression, time constraints and lack of confidence in addressing depression. CONCLUSIONS The introduction of depression screening service guidelines and training successfully increased the number of low vision practitioners identifying and addressing depression. However, standardized screening of all low vision attendees has not yet been achieved and several barriers remain. Healthcare services need to address these barriers when considering mental health screening, and further research could focus on the process from the patients' perspective, to determine the desire for and acceptability of screening.
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Affiliation(s)
- Claire Nollett
- Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Rebecca Bartlett
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Ryan Man
- Singapore Eye Research Institute, 20 College Road, Ngee Ann KongSi The Academia, Discovery Tower Level 6, Singapore, 169856 Singapore
| | - Timothy Pickles
- Centre for Trials Research, Cardiff University, 5th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Barbara Ryan
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
| | - Jennifer H. Acton
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ UK
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Vyas CM, Ogata S, Reynolds CF, Mischoulon D, Chang G, Cook NR, Manson JE, Crous-Bou M, De Vivo I, Okereke OI. Lifestyle and behavioral factors and mitochondrial DNA copy number in a diverse cohort of mid-life and older adults. PLoS One 2020; 15:e0237235. [PMID: 32785256 PMCID: PMC7423118 DOI: 10.1371/journal.pone.0237235] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/02/2020] [Indexed: 01/15/2023] Open
Abstract
Mitochondrial DNA copy number (mtDNAcn) is a putative biomarker of oxidative stress and biological aging. Modifiable factors, including physical activity (PA), avoidance of heavy alcohol use and smoking, and maintaining good mental health, may reduce oxidative stress and promote healthy aging. Yet, limited data exist regarding how these factors are associated with mtDNAcn or whether age, sex or race/ethnicity moderate associations. In this cross-sectional study, we selected 391 adults (183 non-Hispanic White, 110 Black and 98 Hispanic; mean = 67 years) from the VITAL-DEP (VITamin D and OmegA-3 TriaL-Depression Endpoint Prevention) ancillary to the VITAL trial. We estimated associations between lifestyle and behavioral factors (PA, alcohol consumption, cigarette smoking and depression) and log-transformed mtDNAcn using multivariable linear regression models. MtDNAcn was not correlated with chronological age; women had ~17% higher mtDNAcn compared to men. There were no significant associations between PA measures (frequency, amount or intensity) or alcohol consumption with mtDNAcn. Cigarette smoking (per 5 pack-years) was significantly associated with mtDNAcn (percent difference = -2.9% (95% confidence interval (CI) = -5.4%, -0.4%)); a large contrast was observed among heavy vs. non-smokers (≥30 vs. 0 pack-years): percent difference = -28.5% (95% CI = -44.2%, -8.3%). The estimate of mtDNAcn was suggestively different for past vs. no depression history (percent difference = -15.1% 95% CI = -30.8%, 4.1%), but this difference was not statistically significant. The association between smoking and log-mtDNAcn varied by sex and race/ethnicity; it was stronger in men and Black participants. While chance findings cannot be excluded, results from this study support associations of smoking, but not chronological age, with mtDNAcn and suggest nuanced considerations of mtDNAcn as indicative of varying oxidative stress states vs. biological aging itself.
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Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Soshiro Ogata
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, Massachusetts, United States of America
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - JoAnn E. Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Marta Crous-Bou
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
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Granata N, Nissanova E, Torlaschi V, Ferrari M, Vigorè M, Sommaruga M, Angelino E, Rizza C, Caprino A, Pierobon A. Psychosocial Cardiological Schedule-Revised (PCS-R) in a Cardiac Rehabilitation Unit: Reflections Upon Data Collection (2010-2017) and New Challenges. Front Psychol 2020; 11:1720. [PMID: 32765382 PMCID: PMC7381208 DOI: 10.3389/fpsyg.2020.01720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction The Psychosocial Cardiological Schedule (PCS) was developed as a screening tool for patients undergoing cardiac rehabilitation (CR) to detect clinically relevant psychosocial/cognitive problems requiring psychological assessment/intervention. Filled out by a trained nurse, it classifies patients according to their need or not for a psychological interview and intervention provided by the psychologist (PCS-Yes vs. PCS-No). Aims The main aim was to compare PCS data collected, respectively, in 2010 and 2017, regarding patients’ socio-demographic characteristics, clinical variables, and the inclusion criteria for psychological counseling. Subsequently, the original Italian PCS was revised and an English version of the schedule was provided [PCS-Revised (PCS-R)]. Results 28 patients (aged 53.5 + 12.6 years, M = 20) of the 87 recruited in 2010 vs. 35 (aged 64.9 + 12.7 years, M = 28) of the 83 recruited in 2017 met the criteria for PCS-Yes: age < 55 years, social problems (living alone, no social support), manifest psychological/behavioral problems, suspected neuropsychological disorders, low prescription adherence, inadequate disease awareness. Comparing the two samples (2010 vs. 2017), clinical variables were similar, and the need for a psychological interview did not differ substantially (32.2 vs. 42.2%), but age increased significantly (PCS-Yes: 53.5 ± 12.6 vs. 64.9 ± 12.7 years, p = 0.001; PCS-No: 68.3 ± 8.0 vs. 75.0 ± 7.7 years, p = 0.0001). A significant increase was observed in the recommendation for neuropsychological assessment (3.6 vs. 25.7%, p = 0.02) to confirm eventual cognitive deficits. These results, the clinical experience, and the recent evidences from literature led to the PCS-R, incorporating a psychosocial screening, a psychological/neuropsychological deeper assessment, and a recommendation for a specific intervention to be carried out either during rehabilitation or in outpatient services. Conclusion The data comparison highlight changes in the cardiac population, which is aging and more frequently requires neuropsychological assessment. The PCS-R could be considered in clinical practice as a useful screening tool to implement a timely coordinated interdisciplinary intervention, comprehensive of specific and tailored psychotherapeutic techniques.
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Affiliation(s)
- Nicolò Granata
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Ekaterina Nissanova
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Valeria Torlaschi
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marina Ferrari
- Department of Cardiac Rehabilitation, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Martina Vigorè
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Marinella Sommaruga
- Psychology Unit, Istituto di Camaldoli, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Elisabetta Angelino
- Psychology Unit, Istituto di Torino, Istituti Clinici Scientifici Maugeri IRCCS, Turin, Italy
| | | | - Alessandra Caprino
- Department of Cardiac Rehabilitation, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonia Pierobon
- Psychology Unit, Istituto di Montescano, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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174
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Pimple P, Lima BB, Hammadah M, Wilmot K, Ramadan R, Levantsevych O, Sullivan S, Kim JH, Kaseer B, Shah AJ, Ward L, Raggi P, Bremner JD, Hanfelt J, Lewis T, Quyyumi AA, Vaccarino V. Psychological Distress and Subsequent Cardiovascular Events in Individuals With Coronary Artery Disease. J Am Heart Assoc 2020; 8:e011866. [PMID: 31055991 PMCID: PMC6512132 DOI: 10.1161/jaha.118.011866] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Higher symptom levels of a variety of measures of emotional distress have been associated with cardiovascular disease ( CVD ), especially among women. Here, our goal was to investigate the association between a composite measure of psychological distress and incident cardiovascular events. Methods and Results In a prospective cohort study, we assessed 662 individuals (28% women; 30% blacks) with stable coronary artery disease. We used a composite score of psychological distress derived through summation of Z-transformed psychological distress symptom scales (depression, posttraumatic stress, anxiety, anger, hostility, and perceived stress) as a predictor of an adjudicated composite end point of adverse events (cardiovascular death, myocardial infarction, stroke, heart failure, or unstable angina). During a mean follow-up of 2.8 years, 120 (18%) subjects developed CVD events. In the overall population, there was no association between the psychological distress measure and CVD events, but there was a sex-based interaction ( P=0.004). In women, higher psychological distress was associated with a higher incidence of CVD events; each SD increase in the composite score of psychological distress was associated with 1.44 times adjusted hazard of CVD events (95% CI, 1.09-1.92). No such association was found in men. Conclusions Among patients with coronary artery disease, higher psychological distress is associated with future cardiovascular events in women only.
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Affiliation(s)
- Pratik Pimple
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Bruno B Lima
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Muhammad Hammadah
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Kobina Wilmot
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Ronnie Ramadan
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | | | - Samaah Sullivan
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Jeong Hwan Kim
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Belal Kaseer
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Amit J Shah
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Laura Ward
- 3 Department of Biostatistics & Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Paolo Raggi
- 4 Mazankowski Alberta Heart Institute University of Alberta Edmonton Alberta Canada
| | - J Douglas Bremner
- 5 Department of Psychiatry and Behavioral Sciences Emory University School of Medicine Atlanta GA
| | - John Hanfelt
- 3 Department of Biostatistics & Bioinformatics Rollins School of Public Health Emory University Atlanta GA
| | - Tene Lewis
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
| | - Arshed A Quyyumi
- 2 Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Viola Vaccarino
- 1 Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA.,2 Division of Cardiology Department of Medicine Emory University Atlanta GA
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175
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Peter RS, Meyer ML, Mons U, Schöttker B, Keller F, Schmucker R, Koenig W, Brenner H, Rothenbacher D. Long-term trajectories of anxiety and depression in patients with stable coronary heart disease and risk of subsequent cardiovascular events. Depress Anxiety 2020; 37:784-792. [PMID: 32237189 DOI: 10.1002/da.23011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/14/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anxiety and depression seem to be under-recognized in their importance and are often not incorporated in subsequent prevention strategies in routine clinical care of coronary heart disease. METHODS The KAROLA cohort included coronary heart disease patients participating in an in-patient rehabilitation program (years 1999/2000) and followed after 1, 3, 6, 8, 10, 13, and 15 years. We identified anxiety and depression trajectories based on the hospital anxiety and depression scale subdomains using joint latent class mixture time-to-event models. We included cardiovascular (CV) events and non-CV mortality as competing endpoints. RESULTS We included 1,109 patients (15.4% female; mean age, 59.4 (standard deviation [SD] = 8.0) years) with baseline covariate data. Over a median follow-up of 14.8 years, participants experienced 324 subsequent CV events. We identified four anxiety and depression trajectory classes, a low-stable class (52.2% and 69.6% of patients for anxiety and depression, respectively), moderate-stable class (37.6% and 23.8%), increasing class (2.3% and 3.3%), and high-stable/high-decreasing class (7.9% and 3.3%). The hazard ratio (HR) for subsequent CV events for the increasing anxiety class was 2.13 (95% confidence interval [CI], 0.61; 7.45) compared with the low-stable class after covariate adjustment. Patients following the high-decreasing anxiety trajectory showed an HR of 1.72 (95% CI, 1.11; 2.68) and patients following the high-stable depression trajectory an HR of 2.47 (95% CI, 1.35; 4.54). CONCLUSIONS Chronic high anxiety and depression trajectory classes were associated with increased risk of subsequent CV events. Assessments of both symptoms of anxiety and depression during long-term routine medical care are recommended to identify patients who would benefit from appropriate interventions.
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Affiliation(s)
- Raphael S Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ute Mons
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Network Ageing Research, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | | | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance (partner site), Munich, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Division of Clinical Epidemiology and Ageing Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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176
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Caspi-Avissar N, Grosman-Rimon L, Gohari J, Arazi M, Granot D, Ghanim D, Carasso S, Shalabi A, Sudarsky D, Eilat-Adar S, Kinany W, Amir O, Kachel E. Clinical, Surgical, and Sociopsychological Factors and Depression After Cardiothoracic Surgery. Ann Thorac Surg 2020; 111:1064-1070. [PMID: 32707196 DOI: 10.1016/j.athoracsur.2020.05.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression is highly prevalent in cardiac surgical patients and is associated with mortality. The objectives of the study were to evaluate depression scores longitudinally pre- and postoperatively and to examine the association between postoperative depression scores and clinical, surgical, and sociopsychological factors. METHODS Depression scores were assessed using the Center for Epidemiological Study of Depression (CES-D) in 100 cardiac surgical patients who underwent cardiac surgery preoperatively, during hospitalization, and at 2 and 6 week after discharge. Clinical, surgical, and sociopsychological predictors of depression scores were recorded. RESULTS The average depression scores significantly increased from preoperative levels (14.9 ± 1.07) to during hospitalization (21.5 ± 1.05) and decreased at both 2 weeks (15.8 ± 1.07) and 6 weeks after discharge (14.0 ± 1.06), as compared with scores during hospitalization (P < .001). The percentage of patients who scored CES-D > 16 increased significantly from preoperative (39%) to hospitalization (71%) and decreased gradually at 2 weeks (45%) and 6 weeks (37%) after discharge (P < .001). Significant predictors of high postoperative CES-D scores were female gender, ejection fraction < 50%, and high preoperative CES-D scores. CONCLUSIONS High depression scores after cardiac surgery suggest that perioperative screening and management of depression after surgery are necessary and may improve outcomes of these patients who are at high risk for depression. Further understanding of the factors that contribute to high depression scores is required to facilitate clinical intervention.
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Affiliation(s)
- Noa Caspi-Avissar
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel
| | - Liza Grosman-Rimon
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel; The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | - Jacob Gohari
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mattan Arazi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel
| | - Dina Granot
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel
| | - Diab Ghanim
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Shemy Carasso
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel
| | - Amjad Shalabi
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel
| | - Doron Sudarsky
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel
| | - Sigal Eilat-Adar
- The Academic College at Wingate, Wingate Institute, Netanya, Israel
| | - Wadi Kinany
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel
| | - Offer Amir
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel; Department of Cardiology, The Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Erez Kachel
- Department of Cardiology and Cardiac Surgery, Poriya Medical Center, Tiberias, Israel; Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat, Israel.
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177
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Nicholson B, Morse S, Lundgren T, Vadiei N, Bhattacharjee S. Effect of depression on health behavior among myocardial infarction survivors in the United States. Ment Health Clin 2020; 10:222-231. [PMID: 32685333 PMCID: PMC7337999 DOI: 10.9740/mhc.2020.07.222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction The purpose of this study was to evaluate the effect of depression on health behavior among myocardial infarction (MI) survivors. Methods This retrospective, cross-sectional study used publicly available 2015 Behavioral Risk Factor Surveillance System (BRFSS) data. Our study sample includes adults aged 50 years or older who completed the 2015 BRFSS survey and reported having MI. The BRFSS participants with a yes response to the question, Has a doctor, nurse, or other health care professional ever told you that you had a heart attack, also called a myocardial infarction? were identified as MI survivors. The presence or absence of depression among MI survivors was identified using a similar question. Health behaviors, the dependent variable of this study, included physical activity, smoking status, alcohol use, body mass index, last flu immunization, last physical checkup, last blood cholesterol check, heavy drinking, and vegetable and fruit consumption. Univariate (χ2 tests) and multivariable (binomial logistic regression) analyses were used to assess the differences in health behaviors between MI survivors with or without depression. Results Our final study sample consists of 20 483 older adults with MI among whom 5343 (26.19%) reported having depression. Multivariable analyses reveal MI survivors with depression are more overweight, have less physical activity, and have higher likelihood of smoking but less odds of consuming alcohol compared to MI survivors without depression. Discussion In this nationally representative sample of adults aged over 50 years in the United States, MI survivors with depression exhibited poorer health behaviors compared to those without depression.
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Affiliation(s)
- Brooke Nicholson
- Pharmacist, Banner University Medical Center South, Tucson, Arizona
| | | | | | - Nina Vadiei
- Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona
| | - Sandipan Bhattacharjee
- Pharmacist, Banner University Medical Center South, Tucson, Arizona.,Pharmacist, Walmart, Sierra Vista, Arizona.,Pharmacist, Genoa Healthcare, Tucson, Arizona.,Assistant Professor, Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, Arizona
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178
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Gorini A, Giuliani M, Raggio L, Barbieri S, Tremoli E. Depressive and Anxiety Symptoms Screening in Cardiac Inpatients: A Virtuous Italian Approach to Psychocardiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145007. [PMID: 32664632 PMCID: PMC7399851 DOI: 10.3390/ijerph17145007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/18/2022]
Abstract
Despite the fact that American Heart Association (AHA) recommended a systematic screening for depression in cardiovascular inpatients, poor attention has been given to this issue. Furthermore, no specific guidelines exist for anxiety screening in cardiovascular inpatients. Thus, the aims of this study were to verify the feasibility of a depressive and anxiety symptoms screening protocol in an Italian hospital specializing in cardiovascular diseases and to evaluate both anxiety and depressive symptoms prevalence. A group of 2009 consecutive inpatients completed the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Disorder (GAD-7). The rates of depressive and anxiety symptoms were almost 9% and 16% respectively. Men were less likely than women to experience both depressive and anxiety symptoms. Patients who were admitted to the heart failure unit reported higher risk of experiencing both symptoms compared to patients in other wards. Similarly, patients admitted to the cardiac surgery unit showed a higher risk of experiencing anxiety symptoms compared to other patients. The proposed screening procedure showed a good feasibility and acceptance. This study highlighted the importance of implementing a short screening procedure in hospitals dealing with cardiovascular inpatients to identify those individuals who require specific attention and interventions.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
- IRCCS Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy; (M.G.); (S.B.); (E.T.)
- Correspondence: ; Tel.: +39-025-800-246
| | - Mattia Giuliani
- IRCCS Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy; (M.G.); (S.B.); (E.T.)
| | - Luca Raggio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Simone Barbieri
- IRCCS Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy; (M.G.); (S.B.); (E.T.)
| | - Elena Tremoli
- IRCCS Centro Cardiologico Monzino, Via Carlo Parea, 4, 20138 Milan, Italy; (M.G.); (S.B.); (E.T.)
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179
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Ai AL, Carretta H. Depression in Patients with Heart Diseases: Gender Differences and Association of Comorbidities, Optimism, and Spiritual Struggle. Int J Behav Med 2020; 28:382-392. [PMID: 32617901 DOI: 10.1007/s12529-020-09915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression is a well-established comorbidity of heart disease (HD) and is more prevalent in women than in men. Few studies have examined the gender effect on depression in patients with advanced heart disease prior to open heart surgery (OHS), controlling for cardiac indices. Previous studies indicated the health benefit of optimism but often lacked adjustment for medical confounders. This interdisciplinary study investigated gender differences in pre-OHS depression and the role of medical comorbidities and strength factors. METHOD Two waves of survey data were collected from 481 patients (mean age = 62, female 42%) along with medical indices in the Society of Thoracic Surgeon's (STS) national database used by all US cardiac surgeons. RESULTS A t test showed significantly higher levels of pre-OHS depressive symptoms in women than in men. In multivariate analyses, the gender effect on depression vanished after entry of other socio-demographics, medical comorbidities, objectively assessed cardiac indices in the STS database, and psychosocial strength factors. Depressive symptoms linked inversely with dispositional optimism and positively with medical comorbidities and religious/spiritual struggle, but not with any cardiac indices. A mediation analysis supported the role of comorbidities in the gender difference. CONCLUSION Women with heart disease were more depressed, but the gender difference may be partly explained by multiple comorbid conditions that could complicate disease burden. Reinforcing the literature, optimism, but not other strength factors, appeared to counteract depression after adjusting for health and cardiac conditions. The finding suggests that health providers should be more attentive to overall health of women with heart disease and to the positive expectations of OHS patients.
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Affiliation(s)
- Amy L Ai
- Institute of Longevity, Department of Behavioral Sciences and Social Medicine, College of Medicine, College of Social Work, and College of Nursing, Florida State University, 2570 University Center Building C, Tallahassee, FL, 32306, USA. .,Department of Behavioral Sciences and Social Medicine, College of Medicine, College of Social Work, Florida State University, Box 3064300, Tallahassee, FL, 32306, USA.
| | - Henry Carretta
- Institute of Longevity, Department of Behavioral Sciences and Social Medicine, College of Medicine, College of Social Work, and College of Nursing, Florida State University, 2570 University Center Building C, Tallahassee, FL, 32306, USA.,Department of Behavioral Sciences and Social Medicine, College of Medicine, College of Social Work, Florida State University, Box 3064300, Tallahassee, FL, 32306, USA
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180
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Kuhlmann SL, Arolt V, Haverkamp W, Martus P, Ströhle A, Waltenberger J, Rieckmann N, Müller-Nordhorn J. Prevalence, 12-Month Prognosis, and Clinical Management Need of Depression in Coronary Heart Disease Patients: A Prospective Cohort Study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:300-311. [PMID: 31450228 DOI: 10.1159/000501502] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Screening for depression in patients with coronary heart disease (CHD) remains controversial. There is limited data on the actual depression management need in routine care. The aim of this study was to examine the prevalence, treatment rates, prognosis, and management need of clinical and subclinical depression in CHD patients according to the American Heart Association recommendations and the National Institute for Health and Care Excellence (NICE) guideline "Depression in Adults with a Chronic Physical Health Problem". METHODS Patients were recruited at 2 German university clinics between 2012 and 2014. Depressive disorders were assessed according to the DSM-IV and depressive symptom severity at baseline and during follow-up was evaluated with the Patient Health Questionnaire (PHQ-9). Depression management need was determined by the severity and longitudinal course of depression symptoms. RESULTS Of 1,024 patients (19% women), 12% had clinical depression (depressive disorder) and 45% had subclinical depression (PHQ-9 score ≥5) at baseline. Among those with clinical depression, 46% were in treatment at least once during 12 months; 26% were continuously in treatment during follow-up. Depressive disorder and depressive symptoms were significant risk factor-adjusted predictors of the 12-months mortality (adjusted HR = 3.19; 95% CI 1.32-7.69, and adjusted HR = 1.09; 95% CI 1.02-1.16, respectively). Depressive symptoms persisted in 85% of the clinically depressed and in 47% of the subclinically depressed patients. According to current recommendations, 29% of all CHD patients would require depression management within 1 year. CONCLUSIONS There is a need for enhanced recognition, referral, and continuous and improved clinical management of depression in CHD patients.
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Affiliation(s)
- Stella L Kuhlmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany, .,Division of Emergency and Acute Medicine (CVK, CCM), Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany,
| | - Volker Arolt
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Wilhelm Haverkamp
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Jacqueline Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
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181
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Fernandes N, Prada L, Rosa MM, Ferreira JJ, Costa J, Pinto FJ, Caldeira D. The impact of SSRIs on mortality and cardiovascular events in patients with coronary artery disease and depression: systematic review and meta-analysis. Clin Res Cardiol 2020; 110:183-193. [PMID: 32617669 DOI: 10.1007/s00392-020-01697-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/23/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Depression is common in patients after acute coronary syndromes (ACS) and with stable coronary artery disease (CAD) and has been associated with increased mortality and morbidity. However, it is unclear whether selective serotonin receptor inhibitors (SSRIs) reduce mortality or cardiac events in patients with CAD and depression. OBJECTIVE We conducted a systematic review and meta-analysis to assess the effects of SSRIs on cardiovascular events in depressed CAD patients. METHODS The CENTRAL, MEDLINE, and PsycINFO databases were searched (April 2020) for randomized controlled trials (RCTs) and extended follow-up analyses of RCTs that compared SSRIs with placebo or no intervention in patients with CAD and depression. The primary outcomes were all-cause mortality, cardiovascular mortality, and myocardial infarction incidence. The results were calculated through random-effect meta-analyses and reported in terms of risk ratio (RR) with 95% confidence intervals (CI). RESULTS We retrieved 8 RCTs (2 of which with extended follow-up analyses), comprising a total of 1148 patients. 7 studies only included post-ACS patients. SSRIs were associated with a significantly lower risk of myocardial infarction in patients with CAD and depression (RR 0.54, 95% CI 0.34-0.86), and in post-ACS patients with depression (RR 0.56, 95% CI 0.35-0.90). We found no statistically significant difference in all-cause mortality, cardiovascular mortality, hospitalizations, angina, congestive heart failure, or stroke incidence. CONCLUSION The use of SSRIs in post-ACS patients with depression was associated with a 44% relative risk reduction of myocardial infarction. No difference in mortality was found. Given that the quality of the evidence was low, further research is warranted.
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Affiliation(s)
- Nuno Fernandes
- Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Luísa Prada
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Mário Miguel Rosa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,CNS-Campus Neurológico Sénior, Torres Vedras, Portugal
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Fausto J Pinto
- Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Daniel Caldeira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal. .,Centro Cardiovascular da Universidade de Lisboa-CCUL, CAML, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal. .,Serviço de Cardiologia, Departamento do Coração e Vasos, Hospital Universitário de Santa Maria-CHULN, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.
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182
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Heterogeneous association patterns of depressive subfactors in suicidality: The 2014 and 2016 Korea National Health and Nutrition Examination Surveys. J Affect Disord 2020; 272:183-190. [PMID: 32379614 DOI: 10.1016/j.jad.2020.04.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The heterogeneity of depressive symptoms in suicidality is poorly understood. This study examines the heterogeneous association between subfactors of depressive symptoms in suicidality. METHODS The data of 5742 participants aged 19 and older were taken from the 2014 and 2016 Korean National Health and Nutrition Examination Surveys and analyzed. Subfactors of depressive symptoms were identified utilizing factor analyses that yielded two groups (typical- and other-depressive factors). Multivariable logistic regression models were used to estimate the association between each factor and suicidality after adjusting for covariates. RESULTS Typical depressive factors included cardinal and somatic symptoms, whereas other depressive factors contained cognitive and other symptoms. The typical factors were associated with each suicidality in succession, however, others depressive factors were not. The heterogeneity of subfactors made the greatest impact on suicide attempts, controlling for all covariates, followed by suicide plans, with a robust coefficient of typical depressive factors. These differential patterns of subfactors existed especially in females and younger people, suggesting the importance of concerning typical depressive factors for those groups. LIMITATIONS Although a confirmatory factor analysis was performed, depressive subfactors need validation and reliability tests. CONCLUSIONS Our study findings may help to explain why an improved understanding of the typical depressive factors including cardinal and somatic symptoms is important to prevent suicidality, especially in females and younger people.
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183
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Singh M, Spertus JA, Gharacholou SM, Arora RC, Widmer RJ, Kanwar A, Sanjanwala RM, Welle GA, Al-Hijji MA. Comprehensive Geriatric Assessment in the Management of Older Patients With Cardiovascular Disease. Mayo Clin Proc 2020; 95:1231-1252. [PMID: 32498778 DOI: 10.1016/j.mayocp.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/30/2022]
Abstract
Cardiovascular disease (CVD) disproportionately affects older adults. It is expected that by 2030, one in five people in the United States will be older than 65 years. Individuals with CVD now live longer due, in part, to current prevention and treatment approaches. Addressing the needs of older individuals requires inclusion and assessment of frailty, multimorbidity, depression, quality of life, and cognition. Despite the conceptual relevance and prognostic importance of these factors, they are seldom formally evaluated in clinical practice. Further, although these constructs coexist with traditional cardiovascular risk factors, their exact prevalence and prognostic impact remain largely unknown. Development of the right decision tools, which include these variables, can facilitate patient-centered care for older adults. These gaps in knowledge hinder optimal care use and underscore the need to rigorously evaluate the optimal constructs for providing care to older adults. In this review, we describe available tools to examine the prognostic role of age-related factors in patients with CVD.
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Affiliation(s)
- Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO
| | | | - Rakesh C Arora
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Amrit Kanwar
- University of Iowa Carver College of Medicine, Iowa City, IA
| | - Rohan M Sanjanwala
- Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada
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184
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Basiri A, Taheri M, Khoshdel A, Golshan S, Mohseni-rad H, Borumandnia N, Simforoosh N, Nafar M, Aliasgari M, Nourbala MH, Pourmand G, Farhangi S, Khalili N. Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant. Int J Equity Health 2020; 19:79. [PMID: 32487079 PMCID: PMC7268666 DOI: 10.1186/s12939-020-01200-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Kidney transplant improves patients' survival and quality of life. Worldwide, concern about the equality of access to the renal transplant wait-list is increasing. In Iran, patients have the choice to be placed on either the living or deceased-donor transplant wait-list. METHODS This was a prospective study performed on 416 kidney transplant recipients (n = 217 (52.2%) from living donors and n = 199 (47.8%) from deceased donors). Subjects were recruited from four referral kidney transplant centers across Tehran, Iran, during 2016-2017. The primary outcome was to identify the psycho-socioeconomic factors influencing the selection of type of donor (living versus deceased). Secondary objective was to compare the outcomes associated with each type of transplant. The impact of psycho-socioeconomic variables on selecting type of donor was evaluated by using multiple logistic regression and the effect of surgical and non-surgical variables on the early post-transplant creatinine trend was assessed by univariate repeated measure ANOVA. RESULTS Based on standardized coefficients, the main predictors for selecting living donor were academic educational level (adjusted OR = 3.25, 95% CI: 1.176-9.005, p = 0.023), psychological status based on general health questionnaire (GHQ) (adjusted OR = 2.46, 95% CI: 1.105-5.489, p = 0.028), and lower monthly income (adjusted OR = 2.20, 95% CI: 1.242-3.916, p = 0.007). The waiting time was substantially shorter in patients who received kidneys from living donors (p < 0.001). The early post-transplant creatinine trend was more desirable in recipients of living donors (β = 0.80, 95% CI: 0.16-1.44, p-value = 0.014), patients with an ICU stay of fewer than five days (β = - 0.583, 95% CI: - 0.643- -0.522, p-value = < 0.001), and those with less dialysis duration time (β = 0.016, 95% CI: 0.004-0.028, p-value = 0.012). Post-operative surgical outcomes were not different across the two groups of recipients (p = 0.08), however, medical complications occurred considerably less in the living-donor group (p = 0.04). CONCLUSION Kidney transplant from living donors was associated with shorter transplant wait-list period and better early outcome, however, inequality of access to living donors was observed. Patients with higher socioeconomic status and higher level of education and those suffering from anxiety and sleep disorders were significantly more likely to select living donors.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Taheri
- Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshdel
- Modern Epidemiology Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Shabnam Golshan
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mohseni-rad
- Department of Urology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Nafar
- Chronic Kidney Disease Research Center, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Aliasgari
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gholamreza Pourmand
- Urology Research Center, Ibin Sina Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nastaran Khalili
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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185
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Belnap BH, Anderson A, Abebe KZ, Ramani R, Muldoon MF, Karp JF, Rollman BL. Blended Collaborative Care to Treat Heart Failure and Comorbid Depression: Rationale and Study Design of the Hopeful Heart Trial. Psychosom Med 2020; 81:495-505. [PMID: 31083056 PMCID: PMC6602832 DOI: 10.1097/psy.0000000000000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Despite numerous improvements in care, morbidity from heart failure (HF) has remained essentially unchanged in recent years. One potential reason is that depression, which is comorbid in approximately 40% of hospitalized HF patients and associated with adverse HF outcomes, often goes unrecognized and untreated. The Hopeful Heart Trial is the first study to evaluate whether a widely generalizable telephone-delivered collaborative care program for treating depression in HF patients improves clinical outcomes. METHODS The Hopeful Heart Trial aimed to enroll 750 patients with reduced ejection fraction (HFrEF) (ejection fraction ≤ 45%) including the following: (A) 625 patients who screened positive for depression both during their hospitalization (Patient Health Questionnaire [PHQ-2]) and two weeks following discharge (PHQ-9 ≥ 10); and (B) 125 non-depressed control patients (PHQ-2(-)/PHQ-9 < 5). We randomized depressed patients to either their primary care physician's "usual care" (UC) or to one of two nurse-delivered 12-month collaborative care programs for (a) depression and HFrEF ("blended") or (b) HrEFF alone (enhanced UC). Our co-primary hypotheses will test whether "blended" care can improve mental health-related quality of life versus UC and versus enhanced UC, respectively, on the Mental Component Summary of the Short-Form 12 Health Survey. Secondary hypotheses will evaluate the effectiveness of our interventions on mood, functional status, hospital readmissions, deaths, provision of evidence-based care for HFrEF, and treatment costs. RESULTS Not applicable. CONCLUSIONS The Hopeful Heart Trial will determine whether "blended" collaborative care for depression and HFrEF is more effective at improving patient-relevant outcomes than collaborative care for HFrEF alone or doctors' UC for HFrEF. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02044211.
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Affiliation(s)
- Bea Herbeck Belnap
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Amy Anderson
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kaleab Z. Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Clinical Trials & Data Coordination, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ravi Ramani
- Cardiovascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mathew F. Muldoon
- Cardiovascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jordan F. Karp
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bruce L. Rollman
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Center for Behavioral Health and Smart Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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186
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Yousuf T, Nakhle A, Rawal H, Harrison D, Maini R, Irimpen A. Natural disasters and acute myocardial infarction. Prog Cardiovasc Dis 2020; 63:510-517. [PMID: 32417189 DOI: 10.1016/j.pcad.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Natural disasters are devastating to not only our physical property but also to our health. There have been several studies over the last few decades that have correlated different types of natural disasters with acute myocardial infarctions (AMIs). Since the early 1930's singular meteorological events have been reported to have some association and effect on cardiovascular (CV) mortality and morbidity. Multiple natural disasters regardless of location have repeatedly reported a significant increase in the incidence of acute coronary syndromes (ACS). Each event was associated with similar mechanisms, which increase the overall CV mortality. The most prominent of those being neurohormonal activation, total scarcity of supplies and access to health care, poverty, stress, increased incidence of smoking and drug abuse. Increased incidence of associated infections added to the burden of ACS. We know natural disasters are inevitable; however, disaster preparedness is surely a reliable way to help curb their devastating effects on human life. In this manuscript, the authors present many forms of natural disasters and their association with acute myocardial infarction (AMI).
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Affiliation(s)
- Tariq Yousuf
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112, USA.
| | - Asaad Nakhle
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112, USA
| | - Harsh Rawal
- Medstar Heart and Vascular Institute, Medstar Washington Hospital Center, 110 Irving St. NW, Washington, DC 20010, USA
| | - Daniel Harrison
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112, USA
| | - Rohit Maini
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112, USA
| | - Anand Irimpen
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, Tulane University Heart and Vascular Institute, 1430 Tulane Avenue, SL-48, New Orleans, LA 70112, USA; Department of Cardiology, Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70112, USA
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187
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Hansen VB, Aagaard S, Hygum A, Johansen JB, Pedersen SS, Nielsen VL, Neergaard MA, Salomonsen GR, Guldin MB, Gustafsson I, Eiskjær H, Gustafsson F, Roikjær SG, Nørager B, Larsen H, Zwisler AD. The First Steps Taken to Implement Palliative Care in Advanced Heart Disease: A Position Statement from Denmark. J Palliat Med 2020; 23:1159-1166. [PMID: 32380928 DOI: 10.1089/jpm.2019.0566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
According to the World Health Organization, palliative care must be available for everyone with life-threatening diseases. However, in daily practice the primary focus worldwide is on cancer patients. The aim of the article was to generate a national position statement as the first step in implementing palliative care in severe heart disease with focus on advanced heart failure, including tools to identify the need for and timing of palliative care and how palliative care could be organized in Denmark. A task force was formed in the Danish Society of Cardiology Heart Failure Working Group, and the position statement was prepared in collaboration with members from a broad group of specialties, including palliative medicine. Because of major gaps in evidence, the position statement was based on small and low-quality studies and clinical practice statements. This position statement was aligned with the European Society of Cardiology recommendation, focusing on relieving suffering from the early disease stages parallel to standard care and supplementing life-prolonging treatment. The statement delivers practical guidance on clinical aspects and managing symptoms during the three stages of advanced heart disease. Furthermore, the statement describes the importance of communication and topics to be broached, including deactivating implantable cardioverter defibrillators. The statement recommends a targeted effort on organizational strategies using high-quality assessment tools and emphasizes multidisciplinary and intersectoral collaboration. Danish cardiologists supported by allied professionals acknowledge the importance of palliative care in advanced heart disease. This national position statement intended to inform and influence policy and practice and can hopefully inspire other countries to take action toward implementing palliative care in advanced heart disease.
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Affiliation(s)
- Vibeke Brogaard Hansen
- Heart Failure, Department of Cardiology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Danish Society of Cardiology, Copenhagen, Denmark
| | - Susanne Aagaard
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Hygum
- Palliative Care Team, Department of Oncology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Danish Society of Palliative Medicine, Copenhagen, Denmark
| | - Jens Brock Johansen
- Danish Society of Cardiology, Copenhagen, Denmark.,Arrhythmias, Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Susanne S Pedersen
- Danish Society of Cardiology, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Vivi Lindeborg Nielsen
- Danish Society of Cardiovascular and Thoracic Surgery Nursing, Copenhagen, Denmark.,Heart Failure, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Asbjørn Neergaard
- Danish Society of Palliative Medicine, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Ryom Salomonsen
- Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark.,Danish Society of Cardiovascular and Thoracic Surgery Nursing, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Institute of Public Health-Research Unit for General Practice, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Gustafsson
- Danish Society of Cardiology, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Gustafsson
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Stine Gundtoft Roikjær
- Danish Society of Cardiology, Copenhagen, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Betina Nørager
- Danish Society of Cardiology, Copenhagen, Denmark.,Congenital Heart Diseases, Department of Cardiology, Herlev & Gentofte Hospital, Herlev, Denmark
| | - Henrik Larsen
- Danish Society of Palliative Medicine, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Rigshospitalet, Copenhagen, Denmark.,Danish Multidisciplinary Group for Cancer and Palliative Care, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- Danish Society of Cardiology, Copenhagen, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,Rehabilitation, Department of Cardiology, Odense University Hospital, Odense, Denmark
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188
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Petersen BD, Stenager E, Mogensen CB, Erlangsen A. The association between heart diseases and suicide: a nationwide cohort study. J Intern Med 2020; 287:558-568. [PMID: 31960499 DOI: 10.1111/joim.13025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the association between specific heart diseases and suicide. DESIGN Nationwide retrospective cohort study. PARTICIPANTS A total of 7 298 002 individuals (3 640 632 males and 3 657 370 females) aged ≥15 years and living in Denmark during 1980-2016. MAIN OUTCOME MEASURES Incidence rate ratios (IRR) with 95% confidence intervals. In multivariate analysis, we adjust for sex, period, age group, living status, income level, Charlson Comorbidity Index, psychiatric disorders prior to heart disease and self-harm prior to heart disease. RESULTS Excess suicide rate ratios were found for following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was noted during the first 6 months after the diagnosis of heart failure (IRR: 2.38; 95% CI: 2.04-2.79); acute myocardial infarction (IRR: 2.24; 95% CI: 1.89-2.66); atrial fibrillation and flutter (IRR: 2.70; 95% CI: 2.30-3.18); and angina pectoris (IRR: 1.83; 95% CI: 1.53-2.19) when compared to later. CONCLUSION Several specific disorders were found to be associated with elevated rates of suicide. Additionally, we found temporal associations with higher suicide rates in the first time after diagnosis. Our results underscore the importance of being attentive towards psychological distress in individuals with heart disease.
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Affiliation(s)
- B D Petersen
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - E Stenager
- From the, Psychiatric Research Unit, Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - C B Mogensen
- Acute Medicine Research Unit, Department of Regional Health Research, University of Southern Denmark, University Hospital of Southern Denmark, Abenraa, Denmark
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center of Mental Health Research, Australian National University, Canberra, ACT, Australia
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189
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Willingness to Engage in Traditional and Novel Depression Treatment Modalities Among Myocardial Infarction Survivors. J Gen Intern Med 2020; 35:1620-1622. [PMID: 31659671 PMCID: PMC7210362 DOI: 10.1007/s11606-019-05406-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
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190
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Heenan A, Pipe A, Lemay K, Davidson JR, Tulloch H. Cognitive-Behavioral Therapy for Insomnia Tailored to Patients With Cardiovascular Disease: A Pre-Post Study. Behav Sleep Med 2020; 18:372-385. [PMID: 31007057 DOI: 10.1080/15402002.2019.1594815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: There is little research assessing the use of cognitive-behavioral therapy for insomnia (CBT-I) among patients with cardiovascular disease (CVD), even less on the effects of CBT-I on CVD risk factors such as anxiety and depression, and to our knowledge, only limited studies of the efficacy of CBT-I protocols with cardiac disease-specific modifications. The objective of this study is to evaluate a group-based CBT-I intervention tailored to patients with CVD on sleep quality, duration, and mental health. Participants: A sample of 47 participants (25 men) diagnosed with primary insomnia were included in this study. Methods: This study used a pre-post design comparing outcomes before and after a group intervention. Clinicians in a cardiac center referred CVD patients with self-reported sleep disturbance to the intervention group. Following screening and confirmation of insomnia disorder, participants completed a six-week CBT-I group-based intervention tailored for patients with CVD. Participants completed sleep diaries and questionnaires, including the Insomnia Severity Index, Beck Depression Inventory-II, and Beck Anxiety Inventory, pre- and postintervention. Results: Participants' sleep outcomes (sleep duration, maintenance, efficiency, latency, and quality) were significantly improved and patients reported significantly fewer symptoms of anxiety, depression, and insomnia following the CBT-I intervention (p values < .05). Conclusions: After participating in a CBT-I group intervention tailored for cardiac patients, patients reported improved sleep and significantly lower levels of anxiety and depression. Randomized trials of this intervention are warranted.
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Affiliation(s)
- Adam Heenan
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Andrew Pipe
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Kyle Lemay
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Heather Tulloch
- Division of cardiac prevention and rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
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191
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Black RM, Williams AK, Ratner L, Crona DJ, Wiltshire T, Weck KE, Stouffer GA, Lee CR. Projected impact of pharmacogenomic testing on medications beyond antiplatelet therapy in percutaneous coronary intervention patients. Pharmacogenomics 2020; 21:431-441. [PMID: 32343201 DOI: 10.2217/pgs-2019-0185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Aim: CYP2C19 genotyping is used to guide antiplatelet therapy after percutaneous coronary intervention (PCI). This study evaluated the potential impact of CYP2C19 and multigene pharmacogenomics (PGx) testing on medications beyond antiplatelet therapy in a real-world cohort of PCI patients that underwent CYP2C19 testing. Methodology & results: Multiple medications with actionable PGx recommendations, including proton pump inhibitors, antidepressants and opioids, were commonly prescribed. Approximately 50% received a CYP2C19 metabolized medication beyond clopidogrel and 7% met criteria for a CYP2C19 genotype-guided intervention. A simulation analysis projected that 17.5 PGx-guided medication interventions per 100 PCI patients could have been made if multigene PGx results were available. Conclusion: This suggests that CYP2C19 and multigene PGx results could be used to optimize medication prescribing beyond antiplatelet therapy in PCI patients.
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Affiliation(s)
- Rachel M Black
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Alexis K Williams
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lindsay Ratner
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Daniel J Crona
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Tim Wiltshire
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen E Weck
- Department of Pathology & Laboratory Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - George A Stouffer
- Division of Cardiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Craig R Lee
- Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.,UNC McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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192
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Sun ZQ, Yu TT, Ma Y, Ma QM, Jiao YD, He DX, Jia-KeWu, Wen ZY, Wang XN, Hou Y, Sun ZJ. Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study. World J Clin Cases 2020; 8:1232-1240. [PMID: 32337197 PMCID: PMC7176617 DOI: 10.12998/wjcc.v8.i7.1232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes. However, the association between depression and myocardial injury on cardiac magnetic resonance (CMR) in patients with ST-segment elevation myocardial infarction (STEMI) has still not been assessed.
AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.
METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention (P-PCI) were analyzed in this prospectivecohort study. Each subject completed the Patient Health Questionnaire-9 (PHQ-9) to assess the presence and severity of depressive symptoms. CMR was performed at a median of 3 d after P-PCI for quantifying post-MI myocardial injury. Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.
RESULTS In this study, 19 patients (17.8%) were diagnosed with major depression identified by the PHQ-9 ≥ 10. PHQ-9 was analyzed both as a continuous variable and dichotomous variable. After multivariable adjustment, the proportion of patients with large infarction size was significantly higher in the major depression group (PHQ-9 ≥ 10) (OR: 4.840, 95%CI: 1.122–20.868, P =0.034). When the PHQ-9 was evaluated as a continuous variable, after multivariable adjustment, an increased PHQ-9 score was associated with an increased risk of large infarction size (OR: 1.226, 95%CI: 1.073–1.401, P =0.003).
CONCLUSION In patients with STEMI undergoing PCI, depression was independently associated with a large infarction size.
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Affiliation(s)
- Zhao-Qing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Tong-Tong Yu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yue Ma
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Quan-Mei Ma
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Yun-Di Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Dong-Xu He
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jia-KeWu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zong-Yu Wen
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiao-Nan Wang
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Yang Hou
- Department of Radiology, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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193
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Eisenberg MJ, Habib B, Alcaraz M, Thombs BD, Filion KB. Bright light therapy for depressive symptoms in hospitalized cardiac patients: A randomized controlled pilot trial. PLoS One 2020; 15:e0230839. [PMID: 32226019 PMCID: PMC7105123 DOI: 10.1371/journal.pone.0230839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
Depression is common among cardiac patients and associated with adverse cardiovascular outcomes. Bright light therapy has emerged as a promising treatment for depressive symptoms, however it has not yet been investigated in this population. We conducted a double-blind, randomized, placebo-controlled pilot trial to assess the feasibility of a larger-scale trial testing bright light therapy for depressive symptoms in cardiac patients. Patients hospitalized for an acute coronary syndrome or undergoing cardiac surgery were randomized to either bright light (10,000 lux) or dim light placebo (500 lux) lamps for 30 minutes each day over 4 weeks, beginning in-hospital. Depression was quantified using the Patient Health Questionnaire 9 (PHQ-9) and Depression Anxiety and Stress Scales (DASS-21). The Short-Form Health Survey 36 (SF-36) was used to measure quality of life. A total of 175 patients were screened and 15 were randomized (8 treatment, 7 placebo) (8.6%) over 10 months. Despite protocol amendments which broadened the inclusion criteria, the trial was terminated early for infeasibility based on the rate of enrollment (1–2 participants/month), with 39.5% of the target sample (38 participants) enrolled. Future trials should take into account the timing of the onset of depressive symptoms in these patients, and consider a less conservative approach to eligibility as well as ways to increase the acceptability of bright light therapy in hospitalized cardiac patients. Once enrolled, our findings suggest that most participants will adhere to the assigned treatment and complete follow-up.
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Affiliation(s)
- Mark J. Eisenberg
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, QC, Canada
- * E-mail:
| | - Bettina Habib
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
| | - Maria Alcaraz
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
| | - Brett D. Thombs
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Departments of Psychiatry, of Psychology, and of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Kristian B. Filion
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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194
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Li X, Yang S, Wang Y, Yang B, Zhang J. Effects of a transtheoretical model - based intervention and motivational interviewing on the management of depression in hospitalized patients with coronary heart disease: a randomized controlled trial. BMC Public Health 2020; 20:420. [PMID: 32228532 PMCID: PMC7106625 DOI: 10.1186/s12889-020-08568-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Depression is a major risk factor for the morbidity and mortality of cardiovascular disease. A transtheoretical model-based intervention and motivational interviewing have been used to change health risk behaviors and have demonstrated positive effects. To our knowledge, no studies of patients with coronary heart disease (CHD) have used a transtheoretical model-based intervention and motivational interviewing as an intervention to provide dynamic education. Therefore, this study aimed to determine the effects of the transtheoretical model-based intervention and motivational interviewing on the management of depression in hospitalized patients with CHD. Method A randomized controlled trial was designed. A total of 110 participants were randomly divided into an intervention group (n = 55) and a control group (n = 55). The Hamilton Rating Scale for Depression and the Depression Prevention & Management Survey items (stages of change, perceived benefits, perceived barriers, process of change and self-efficacy) were used to collect data at all time points. Analysis of covariance, chi-square test and repeated measures analysis of variance were used to analyze the data. Results After the intervention, there were more positive changes in stages of change, higher scores for the cognitive and behavioral levels, the perceived benefits, and self-efficacy, and lower perceived barriers and depression in the intervention group than in the control group. Finally, there were statistically significant differences in the depression scores at different time points in the intervention group (F = 17.814, p = 0.000 < 0.01). Conclusions The study showed that a transtheoretical model-based intervention and motivational interviewing exert positive effects on the management of depression in hospitalized patients with CHD. Trial registration Clinicaltrials.gov, NCT03953924 (Date assigned: 16/5/2019). Retrospectively registered.
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Affiliation(s)
- Xiaoyun Li
- Xiangya Nursing School of Central South University, 172 Tong Zi Po Road, Changsha, 410000, Hunan, China.,Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Silan Yang
- Xiangya Nursing School of Central South University, 172 Tong Zi Po Road, Changsha, 410000, Hunan, China
| | - Yishu Wang
- The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Bingxiang Yang
- Health Sciences of Wuhan University, Wuhan, Hubei, China
| | - Jingping Zhang
- Xiangya Nursing School of Central South University, 172 Tong Zi Po Road, Changsha, 410000, Hunan, China.
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195
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Patel N, Chakraborty S, Bandyopadhyay D, Amgai B, Hajra A, Atti V, Das A, Ghosh RK, Deedwania PC, Aronow WS, Lavie CJ, Di Tullio MR, Vaduganathan M, Fonarow GC. Association between depression and readmission of heart failure: A national representative database study. Prog Cardiovasc Dis 2020; 63:585-590. [PMID: 32224112 DOI: 10.1016/j.pcad.2020.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Depression is a recognized predictor of adverse outcomes in patients with heart failure (HF) and is associated with poor quality of life, functional limitation, increased morbidity and mortality, decreased adherence to treatment, and increased rehospitalization. To understand the impact of depression on HF readmission, we conducted a retrospective cohort study using the Nationwide Readmission Database (NRD) 2010-2014. METHODS We identified all patients with the primary discharge diagnosis of HF by ICD-9-CM codes. The primary outcome of the study was to identify 30-day all-cause readmission and causes of readmission in patients with and without depression. Multivariate Cox regression analysis was used to estimate the adjusted hazard ratio for the primary and secondary outcomes. RESULTS Among, 3,500,570 patients admitted with HF, 9.7% had concomitant depression. Patients with depression were more likely to be readmitted within 30 days (19.7% vs. 18.5%; P < 0.001). Concomitant depression was associated with higher risk of all-cause readmissions within 30 days and 90 days [P < 0.001] but was not associated with increased readmissions due to cardiovascular (CV) cause at 30 days and 90 days. The hazard of psychiatric causes of readmission was higher in patients with depression, both at 30 days [P < 0.001], and 90 days [P < 0.001]. Most of the readmissions were due to CV causes, with HF being the most common cause. CONCLUSION Among patients hospitalized with HF, the presence of depression is associated with increased all-cause readmission driven mainly by psychiatric causes but not CV-related readmission. Standard interventions targeted toward HF are unlikely to modify this portion of all-cause readmission.
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Affiliation(s)
| | | | | | | | - Adrija Hajra
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Avash Das
- University of Texas Southwestern Medical Center, TX, USA
| | - Raktim K Ghosh
- Case Western Reserve University, Heart and Vascular Institute, MetroHealth Medical Center, Cleveland, OH, USA
| | | | - Wilbert S Aronow
- Westchester Medical Center and New York Medical College, New York, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA
| | | | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA
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196
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Falk A, Eriksson M, Stenman M. Depressive and/or anxiety scoring instruments used as screening tools for predicting postoperative delirium after cardiac surgery: A pilot study. Intensive Crit Care Nurs 2020; 59:102851. [PMID: 32223922 DOI: 10.1016/j.iccn.2020.102851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Depression is common in patients with cardiac disease. Depression is a risk factor for developing postoperative delirium, a common and serious complication to cardiac surgery. OBJECTIVES The aim was to evaluate if screening tools for depression can be used to predict postoperative delirium after cardiac surgery. METHODS This was a prospective population-based pilot study including 26 patients between 23 and 80 years of age undergoing cardiac surgery in Sweden during 2018. The day before surgery the participants filled out the depression screening instruments Hospital Anxiety and Depression Scale and Patient Health Questionnaire. After discharge the patient charts were examined for documentation of symptoms of delirium. RESULTS Five (20%) patients screened positive regarding depression using the Hospital Anxiety and Depression Scale and 7 patients (27%) screened positive using The Patient Health Questionnaire. Four (22%) patients showed symptoms of postoperative delirium, none of them screened positive for depression prior to surgery. CONCLUSION We found no difference between the questionnaires PHQ-9 and HADS regarding identifying depressive symptoms. Moreover, we found that post-operative delirium, to a certain extent, can be detected by reading the patient́s charts postoperatively. However, this pilot study showed that screening tools for delirium need to be better implemented.
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Affiliation(s)
- Anna Falk
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Malin Stenman
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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197
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Association of Depression with Subclinical Coronary Atherosclerosis: a Systematic Review. J Cardiovasc Transl Res 2020; 14:685-705. [PMID: 32198701 DOI: 10.1007/s12265-020-09985-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/02/2020] [Indexed: 01/26/2023]
Abstract
To assess causal association of depression with subclinical coronary atherosclerosis, we performed computer-based and manual search of literature for studies which had assessed relationship of depression disorder with coronary atherosclerosis. All studies had diagnosed depression with validated tools in patients without diagnosed coronary artery disease. The Bradford Hill criteria of cause-effect association was consistently fulfilled by those studies which achieved statistical significance and further showed incremental strength of association with one or more of the following attributes: (1) prospective cohort study, met cause-effect criteria of "temporality"; (2) relatively severe and/or longer period of depression, met cause-effect criteria of "dose-response"; (3) depression with predominantly somatic symptoms cluster, met cause-effect criteria of "scientific plausibility"; (4) multiethnic larger sample, met cause-effect criteria of "population equivalence"; and (5) multicenter study, met criteria of "environmental equivalence." Our results show that there is a significant association of depression with coronary atherosclerosis at its subclinical stages.
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198
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Vyas CM, Donneyong M, Mischoulon D, Chang G, Gibson H, Cook NR, Manson JE, Reynolds CF, Okereke OI. Association of Race and Ethnicity With Late-Life Depression Severity, Symptom Burden, and Care. JAMA Netw Open 2020; 3:e201606. [PMID: 32215634 PMCID: PMC7325738 DOI: 10.1001/jamanetworkopen.2020.1606] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Importance Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care. Objective To examine racial/ethnic differences in depression severity, symptom burden, and care. Design, Setting, and Participants This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018. Exposure Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race). Main Outcomes and Measures Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression. Results There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56). Conclusions and Relevance In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.
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Affiliation(s)
- Chirag M. Vyas
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace Chang
- Department of Psychiatry, VA Boston Healthcare System, Brockton, MA, USA
| | - Heike Gibson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy R. Cook
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Charles F. Reynolds
- Department of Psychiatry, UPMC and University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Olivia I. Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
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199
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Burell G. Dangerous depression in cardiac patients: What can we do about it? Eur J Prev Cardiol 2020; 27:473-477. [DOI: 10.1177/2047487319879787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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200
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Bangalore S, Shah R, Gao X, Pappadopulos E, Deshpande CG, Shelbaya A, Prieto R, Stephens J, Chambers R, Schepman P, McIntyre RS. Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States-based retrospective claims database analysis. J Med Econ 2020; 23:262-270. [PMID: 31665949 DOI: 10.1080/13696998.2019.1686311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010-2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20 mg/day for nonelderly and ≥10 mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.
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Affiliation(s)
- Sripal Bangalore
- Cardiovascular Outcomes Group, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | | | - Xin Gao
- Pharmerit International, LP, Bethesda, MD, USA
| | | | | | - Ahmed Shelbaya
- Pfizer Inc., New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | | | | | - Roger S McIntyre
- Mood Disorders PsychoPharmacology Unit University Health Network, University of Toronto, Toronto, Canada
- Brain and Cognition Discovery Foundation, Toronto, Canada
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