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Ciotola F, Pyxaras S, Rittger H, Buia V. MEMS Technology in Cardiology: Advancements and Applications in Heart Failure Management Focusing on the CardioMEMS Device. SENSORS (BASEL, SWITZERLAND) 2024; 24:2922. [PMID: 38733027 PMCID: PMC11086351 DOI: 10.3390/s24092922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024]
Abstract
Heart failure (HF) is a complex clinical syndrome associated with significant morbidity, mortality, and healthcare costs. It is characterized by various structural and/or functional abnormalities of the heart, resulting in elevated intracardiac pressure and/or inadequate cardiac output at rest and/or during exercise. These dysfunctions can originate from a variety of conditions, including coronary artery disease, hypertension, cardiomyopathies, heart valve disorders, arrhythmias, and other lifestyle or systemic factors. Identifying the underlying cause is crucial for detecting reversible or treatable forms of HF. Recent epidemiological studies indicate that there has not been an increase in the incidence of the disease. Instead, patients seem to experience a chronic trajectory marked by frequent hospitalizations and stagnant mortality rates. Managing these patients requires a multidisciplinary approach that focuses on preventing disease progression, controlling symptoms, and preventing acute decompensations. In the outpatient setting, patient self-care plays a vital role in achieving these goals. This involves implementing necessary lifestyle changes and promptly recognizing symptoms/signs such as dyspnea, lower limb edema, or unexpected weight gain over a few days, to alert the healthcare team for evaluation of medication adjustments. Traditional methods of HF monitoring, such as symptom assessment and periodic clinic visits, may not capture subtle changes in hemodynamics. Sensor-based technologies offer a promising solution for remote monitoring of HF patients, enabling early detection of fluid overload and optimization of medical therapy. In this review, we provide an overview of the CardioMEMS device, a novel sensor-based system for pulmonary artery pressure monitoring in HF patients. We discuss the technical aspects, clinical evidence, and future directions of CardioMEMS in HF management.
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Affiliation(s)
| | | | | | - Veronica Buia
- Medizinische Klinik I, Klinikum Fürth, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nürnberg, Jakob-Henle Str. 1, 90766 Fürth, Germany; (F.C.); (S.P.); (H.R.)
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Nahlén Bose C. A meta-review of systematic reviews and meta-analyses on outcomes of psychosocial interventions in heart failure. Front Psychiatry 2023; 14:1095665. [PMID: 36970265 PMCID: PMC10036787 DOI: 10.3389/fpsyt.2023.1095665] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/15/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionChronic heart failure is a severe condition that influences not just the physical dimension but also the mental dimension in patients. Comorbidity of depression and anxiety are prevalent and the quality of life is reduced. Despite the psychological impact there are no recommendations in the guidelines for psychosocial interventions for people with heart failure. The aim of this meta-review is to synthesize results of systematic reviews and meta-analyses on the outcomes of psychosocial interventions in heart failure.MethodsSearches were conducted in PubMed, PsychInfo, Cinahl and the Cochrane Library. In total, seven articles were included after screening 259 studies for eligibility.ResultsThe included reviews had, in total, 67 original studies included. The measured outcomes in the systematic reviews and meta-analyses were; depression, anxiety, quality of life, hospitalization, mortality, self-care and physical capacity. The results are inconsistent but show some short-term benefit of psychosocial interventions for reduced depression and anxiety and improved quality of life. However, the long-term effects were sparsely followed up.DiscussionThis meta-review appears to be the first in the field of the efficacy of psychosocial interventions in chronic heart failure. This meta-review identifies gaps in the current available evidence that need to be further explored, such as booster sessions, longer follow-up time for evaluation and incorporating clinical outcomes and measures of stress processes.
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Longer-Term Effects of Remote Patient Management Following Hospital Discharge After Acute Systolic Heart Failure: The Randomized E-INH Trial. JACC. HEART FAILURE 2023; 11:191-206. [PMID: 36718715 DOI: 10.1016/j.jchf.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The randomized INH (Interdisciplinary Network Heart Failure) trial (N = 715) reported that 6 months' remote patient management (RPM) (HeartNetCare-HF) did not reduce the primary outcome (time to all-cause death/rehospitalization) vs usual care (UC) in patients discharged after admission for acute heart failure, but suggested lower mortality and better quality of life in the RPM group. OBJECTIVES The Extended (E)-INH trial investigated the effects of 18 months' HeartNetCare-HF on the same primary outcome in an expanded population (N = 1,022) and followed survivors up to 60 months (primary outcome events) or up to 120 months (mortality) after RPM termination. METHODS Eligible patients aged ≥18 years, hospitalized for acute heart failure, and with predischarge ejection fraction ≤40% were randomized to RPM (RPM+UC; n = 509) or control (UC; n = 513). Follow-up visits were every 6 months during RPM, and then at 36, 60, and 120 months. RESULTS The primary outcome did not differ between groups at 18 months (60.7% [95% CI: 56.5%-65.0%] vs 61.2% [95% CI: 57.0%-65.4%]) or 60 months (78.1% [95% CI: 74.4%-81.6%] vs 82.8% [95% CI: 79.5%-86.0%]). At 60 and 120 months, all-cause mortality was lower in patients previously undergoing RPM (41.1% [95% CI: 37.0%-45.5%] vs 47.4% [95% CI: 43.2%-51.8%]; P = 0.040 and 64.0% [95% CI: 59.8%-68.2%] vs 69.6% [95% CI: 65.6%-73.5%]; P = 0.019). At all visits, health-related quality of life was better in patients exposed to HeartNetCare-HF vs UC. CONCLUSIONS Although 18 months' HeartNetCare-HF did not significantly reduce the primary outcome of death or rehospitalization at 60 months, lower 120-month mortality in patients previously undergoing HeartNetCare-HF suggested beneficial longer-term effects, although the possibility of a chance finding remains.
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Cao G, Fan C, Liu Y, Huang H, Li J, Liang J, Tao B, Yuan J. A telehealth program benefits discharged patients with heart failure. Acta Cardiol 2022; 78:195-202. [PMID: 34979861 DOI: 10.1080/00015385.2021.1999571] [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: 11/01/2022]
Abstract
BACKGROUND Heart failure (HF) remains a major cause of mortality, hospitalisations, and poor quality of life. The mortality and readmission rate of HF patients after discharge are still high due to poor self-care and adherence, or inability to detect signs of deterioration. Telehealth programs may benefit a broad range of patients and reduce the suffering from HF. We aimed to investigate the impact of a 12-week telehealth program on outcomes among discharged patients with HF. METHODS Study population was consisted of 425 patients discharged between Jan 2020 to Aug 2020. All enrolled participants were diagnosed as HF and underwent standard treatments. At discharge, they were randomised into the telehealth or control group. The intervention was based on telephone support biweekly. After 12-week follow-up, patients' outcomes including mortality, readmission, disease condition, adherence, self-care behaviours, and mental health were compared between the groups. RESULTS The telehealth program significantly improved the HF symptoms in patients (p < 0.001). Patients in telehealth group showed better adherence compared to control (p = 0.002). Moreover, the intervention enhanced patients' self-care skills, indicated by the increased ratio of individuals knowing how to evaluate the cardiac function (p = 0.009) and purchasing medicines (p = 0.03). In addition, the telehealth program significantly improved the mental health status of patients (p = 0.03). CONCLUSION The telehealth program is beneficial for improving HF symptoms, adherence, self-care skills and mental health status of discharged patients and support the future use of this program to manage patients and reduce the burden attributed to the condition.
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Affiliation(s)
- Guilan Cao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Fan
- Department of Geriatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Liu
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haixia Huang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Li
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liang
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baoming Tao
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yuan
- Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Heart Failure Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Depressive symptoms and their associated factors in heart failure patients. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objectives
Depressive symptoms are common in heart failure (HF) patients and they may exacerbate the progression of HF. Thus, identifying associations with depressive symptoms is essential to develop effective interventions to alleviate patients’ depressive symptoms. Therefore, this study aimed to explore the factors related to HF patients’ depressive symptoms.
Methods
Potential hospitalized patients were recruited from a university-affiliated hospital by convenience sampling. This study included 321 HF patients who had completed information about depressive symptoms, functional capacity, social support, dispositional optimism, self-care confidence, and health literacy. Descriptive statistics were used to characterize the sample. Independent group t-tests and one-way analysis of variance were used to assess the difference in depressive symptoms score in demographic and clinical characteristics, while Pearson's correlation was used to assess the associations among continuous variables.
Results
The scores for functional capacity, social support, dispositional optimism, self-care confidence, and health literacy were negatively associated with the score for depressive symptoms. The interaction effect between the functional capacity and the dispositional optimism on depressive symptoms was significant.
Conclusions
Interventions targeted improving the above-mentioned factors may be beneficial to reduce depressive symptoms in HF patients.
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Cowie MR, Flett A, Cowburn P, Foley P, Chandrasekaran B, Loke I, Critoph C, Gardner RS, Guha K, Betts TR, Carr-White G, Zaidi A, Lim HS, Hayward C, Patwala A, Rogers D, Pettit S, Gazzola C, Henderson J, Adamson PB. Real-world evidence in a national health service: results of the UK CardioMEMS HF System Post-Market Study. ESC Heart Fail 2021; 9:48-56. [PMID: 34882989 PMCID: PMC8787982 DOI: 10.1002/ehf2.13748] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/02/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Aims The CardioMEMS HF System Post‐Market Study (COAST) was designed to evaluate the safety, effectiveness, and feasibility of haemodynamic‐guided heart failure (HF) management using a small sensor implanted in the pulmonary artery of New York Heart Association (NYHA) Class III HF patients in the UK, Europe, and Australia. Methods and results COAST is a prospective, international, multicentre, open‐label clinical study (NCT02954341). The primary clinical endpoint compares annualized HF hospitalization rates after 1 year of haemodynamic‐guided management vs. the year prior to sensor implantation in patients with NYHA Class III symptoms and a previous HF hospitalization. The primary safety endpoints assess freedom from device/system‐related complications and pressure sensor failure after 2 years. Results from the first 100 patients implanted at 14 out of the 15 participating centres in the UK are reported here. At baseline, all patients were in NYHA Class III, 70% were male, mean age was 69 ± 12 years, and 39% had an aetiology of ischaemic cardiomyopathy. The annualized HF hospitalization rate after 12 months was 82% lower [95% confidence interval 72–88%] than the previous 12 months (0.27 vs. 1.52 events/patient‐year, respectively, P < 0.0001). Freedom from device/system‐related complications and pressure sensor failure at 2 years was 100% and 99%, respectively. Conclusions Remote haemodynamic‐guided HF management, using frequent assessment of pulmonary artery pressures, was successfully implemented at 14 specialist centres in the UK. Haemodynamic‐guided HF management was safe and significantly reduced hospitalization in a group of high‐risk patients. These results support implementation of this innovative remote management strategy to improve outcome for patients with symptomatic HF. Clinical registration number: ClinicalTrials.gov identifier: NCT02954341.
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Affiliation(s)
- Martin R Cowie
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Sydney Street, London, SW3 6NP, UK
| | - Andrew Flett
- University Hospital Southampton, Southampton, UK
| | | | | | | | - Ian Loke
- Glenfield Hospital, Leicester, UK
| | | | | | | | - Tim R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Amir Zaidi
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
| | | | | | - Ashish Patwala
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | | | - Stephen Pettit
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Radhoe SP, Brugts JJ. CardioMEMS™: a tool for remote hemodynamic monitoring of chronic heart failure patients. Future Cardiol 2021; 18:173-183. [PMID: 34697954 DOI: 10.2217/fca-2021-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Remote monitoring is becoming increasingly important for management of chronic heart failure patients. Recently, hemodynamic monitoring by measuring intracardiac filling pressures has been gaining attention. It is believed that hemodynamic congestion precedes clinical congestion by several weeks and that remote hemodynamic monitoring therefore enables clinicians to intervene in an early stage and prevent heart failure hospitalizations. The CardioMEMS HF system (Abbott, CA, USA) is a sensor capable of measuring pulmonary artery pressures as a surrogate of left ventricular filling pressures. Clinical evidence for CardioMEMS has been convincing in terms of efficacy and safety. This article provides detailed information on the CardioMEMS HF system and summarizes all available evidence of this promising technique.
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Affiliation(s)
- Sumant P Radhoe
- Erasmus MC, University Medical Center Rotterdam, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Erasmus MC, University Medical Center Rotterdam, Thorax Center, Department of Cardiology, Rotterdam, The Netherlands
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Radhoe SP, Veenis JF, Brugts JJ. Invasive Devices and Sensors for Remote Care of Heart Failure Patients. SENSORS 2021; 21:s21062014. [PMID: 33809205 PMCID: PMC7999467 DOI: 10.3390/s21062014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
The large and growing burden of chronic heart failure (CHF) on healthcare systems and economies is mainly caused by a high hospital admission rate for acute decompensated heart failure (HF). Several remote monitoring techniques have been developed for early detection of worsening disease, potentially limiting the number of hospitalizations. Over the last years, the scope has been shifting towards the relatively novel invasive sensors capable of measuring intracardiac filling pressures, because it is believed that hemodynamic congestion precedes clinical congestion. Monitoring intracardiac pressures may therefore enable clinicians to intervene and avert hospitalizations in a pre-symptomatic phase. Several techniques have been discussed in this review, and thus far, remote monitoring of pulmonary artery pressures (PAP) by the CardioMEMS (CardioMicroelectromechanical system) HF System is the only technique with proven safety as well as efficacy with regard to the prevention of HF-related hospital admissions. Efforts are currently aimed to further develop existing techniques and new sensors capable of measuring left atrial pressures (LAP). With the growing body of evidence and need for remote care, it is expected that remote monitoring by invasive sensors will play a larger role in HF care in the near future.
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Störk S, Angermann C, Bauersachs J, Frantz S. [Care of patients with chronic heart failure: an interdisciplinary challenge]. Dtsch Med Wochenschr 2021; 146:309-316. [PMID: 33647999 DOI: 10.1055/a-1235-0422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The diverse manifestations of heart failure led to complex treatment guidelines and care scenarios and therefore always require an integrated, multidisciplinary care approach. Patients with chronic heart failure suffer from a large number of cardiac and noncardiac comorbidities. For example, iron deficiency leads to decreased performance and exertional dyspnea and should be diagnosed. Psychological screening questionnaires should be used for the early detection of psychological comorbidities.ARNI and SGLT-inhibitors expand the pharmacotherapeutic possibilities and gain in importance. The constant development of diagnostic possibilities and therapeutic options must be implemented consistently into the care continuum in order to have a lasting effect. The challenge of interdisciplinary coordination can be significantly reduced through jointly agreed process logs (e. g. within the framework of integrated supply contracts or a Heart Failure Unit Network).
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Rebora P, Spedale V, Occhino G, Luciani M, Alvaro R, Vellone E, Riegel B, Ausili D. Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial. Qual Life Res 2021; 30:1939-1949. [PMID: 33616815 PMCID: PMC8233269 DOI: 10.1007/s11136-021-02788-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
Purpose Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention. Methods This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year. Results We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2. Conclusion Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502). Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02788-3).
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Affiliation(s)
- Paola Rebora
- Department of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Valentina Spedale
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Giuseppe Occhino
- Biostatistics and Bioimaging Centre, University of Milano - Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900 Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104-4217 USA
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano - Bicocca, Via Cadore 48, 20900 Monza, Italy
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Heart and brain interactions : Pathophysiology and management of cardio-psycho-neurological disorders. Herz 2021; 46:138-149. [PMID: 33544152 PMCID: PMC7966144 DOI: 10.1007/s00059-021-05022-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/22/2022]
Abstract
Cardiovascular diseases (CVD) and mental health disorders (MHD; e.g. depression, anxiety and cognitive dysfunction) are highly prevalent and are associated with significant morbidity and mortality and impaired quality of life. Currently, possible interactions between pathophysiological mechanisms in MHD and CVD are rarely considered during the diagnostic work-up, prognostic assessment and treatment planning in patients with CVD, and research addressing bidirectional disease mechanisms in a systematic fashion is scarce. Besides some overarching pathogenetic principles shared by CVD and MHD, there are specific syndromes in which pre-existing neurological or psychiatric illness predisposes and contributes to CVD development (as in Takotsubo syndrome), or in which the distorted interplay between innate immune and central nervous systems and/or pre-existing CVD leads to secondary MHD and brain damage (as in peripartum cardiomyopathy or atrial fibrillation). Clinical manifestations and phenotypes of cardio-psycho-neurological diseases depend on the individual somatic, psychosocial, and genetic risk profile as well as on personal resilience, and differ in many respects between men and women. In this article, we provide arguments on why, in such conditions, multidisciplinary collaborations should be established to allow for more comprehensive understanding of the pathophysiology as well as appropriate and targeted diagnosis and treatment. In addition, we summarize current knowledge on the complex interactions between the cardiovascular and central nervous systems in Takotsubo syndrome and peripartum cardiomyopathy, and on the neurological and psychiatric complications of atrial fibrillation.
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Bansal A, Padappayil RP, Gopal S, Garg M, Joshi R. Practice patterns in the management of congestive heart failure and post-discharge quality of life: A hospital-based cross-sectional study. J Family Med Prim Care 2021; 9:5592-5596. [PMID: 33532400 PMCID: PMC7842451 DOI: 10.4103/jfmpc.jfmpc_218_20] [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: 02/05/2020] [Revised: 03/13/2020] [Accepted: 09/06/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of the study is to identify the etiology, risk factors, frequency of major and minor components of the Framingham criteria for heart failure, discharge medications, mortality, and quality of life after discharge from the hospital, for patients who were admitted to the in-patient unit of a tertiary care hospital in central India, with a diagnosis of congestive heart failure (CHF). Methods: This hospital-based cross-sectional study involved retrospective chart review of patients who were admitted to the in-patient unit with a diagnosis of CHF. These patients were then attempted to reach via their telephone numbers listed in the medical records and their current quality of life was assessed using Euro-QoL 5D questionnaire. Results: In the 69 patients who were admitted to the hospital with congestive cardiac failure during the pre-defined period, ischemic heart disease was the most common etiology and smoking was the most common risk factor for the development of CHF. The most common findings based on Framingham criteria were dyspnea on mild exertion, rales and bilateral ankle edema. It was determined that one-fourth of the individuals were non-compliant to the medical treatment and more than half of the patients had a poor health score. Conclusion: Smoking remains to be a major risk factor for patients to develop ischemic heart disease and subsequent CHF. Patients with congestive cardiac failure also had severe deterioration in their quality of life after discharge from the hospital, implying the need for improving efforts toward prevention and better management.
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Affiliation(s)
- Agam Bansal
- Department of Internal Medicine, Cleveland Clinic Foundation, Ohio, USA
| | - Rana P Padappayil
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shwetha Gopal
- Department of Internal Medicine, Affiliation, St Barnabas Medical Centre, Livingston, New Jersey, USA
| | - Mohil Garg
- All India Institute of Medical Sciences, India
| | - Rajnish Joshi
- Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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Guenther SPW, Hornung R, Joskowiak D, Vlachea P, Feil K, Orban M, Peterss S, Born F, Hausleiter J, Massberg S, Hagl C. Extracorporeal life support in therapy-refractory cardiocirculatory failure: looking beyond 30 days. Interact Cardiovasc Thorac Surg 2020; 32:607-615. [PMID: 33347585 DOI: 10.1093/icvts/ivaa312] [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] [Received: 09/11/2020] [Revised: 10/22/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Venoarterial extracorporeal life support (ECLS) has emerged as a potentially life-saving treatment option in therapy-refractory cardiocirculatory failure, but longer-term outcome is poorly defined. Here, we present a comprehensive follow-up analysis covering all major organ systems. METHODS From February 2012 to December 2016, 180 patients were treated with ECLS for therapy-refractory cardiogenic shock or cardiac arrest. The 30-day survival was 43.9%, and 30-day survivors (n = 79) underwent follow-up analysis with the assessment of medium-term survival, quality of life, neuropsychological, cardiopulmonary and end-organ status. RESULTS After a median of 1.9 (1.1-3.6) years (182.4 patient years), 45 of the 79 patients (57.0%) were alive, 35.4% had died and 7.6% were lost to follow-up. Follow-up survival estimates were 78.0% at 1, 61.2% at 3 and 55.1% at 5 years. NYHA class at follow-up was ≤II for 83.3%. The median creatinine was 1.1 (1.0-1.4) mg/dl, and the median bilirubin was 0.8 (0.5-1.0) mg/dl. No patient required dialysis. Overall, 94.4% were free from moderate or severe disability, although 11.1% needed care. Full re-integration into social life was reported by 58.3%, and 39.4% were working. Quality of life was favourable for mental components, but a subset showed deficits in physical aspects. While age was the only peri-implantation parameter significantly predicting medium-term survival, adverse events and functional status at discharge or 30 days were strong predictors. CONCLUSIONS This study demonstrates positive medium-term outcome with high rates of independence in daily life and self-care but a subset of 10-20% suffered from sustained impairments. Our results indicate that peri-implantation parameters lack predictive power but downstream morbidity and functional status at discharge or 30 days can help identify patients at risk for poor recovery.
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Affiliation(s)
- Sabina P W Guenther
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Roman Hornung
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian-University, Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Polyxeni Vlachea
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Katharina Feil
- Department of Neurology, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Martin Orban
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Jörg Hausleiter
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany
| | - Steffen Massberg
- Medical Department I, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilian-University, Munich, Germany.,Munich Heart Alliance, German Center for Cardiovascular Research, Munich, Germany
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14
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Sepehrvand N, Savu A, Spertus JA, Dyck JRB, Anderson T, Howlett J, Paterson I, Oudit GY, Kaul P, McAlister FA, Ezekowitz JA. Change of Health-Related Quality of Life Over Time and Its Association With Patient Outcomes in Patients With Heart Failure. J Am Heart Assoc 2020; 9:e017278. [PMID: 32812460 PMCID: PMC7660771 DOI: 10.1161/jaha.120.017278] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Improving health-related quality of life is an important goal in the management of patients with heart failure (HF). Defining health-related quality of life changes over time in patients with HF with preserved (HFpEF) or reduced ejection fraction and showing their association with other important clinical events could support the use of health-related quality of life as a measure of quantifying HF care. Methods and Results In the Alberta HEART (Heart Failure Aetiology and Analysis Team) cohort (n=621), patients were categorized into 4 subgroups: healthy controls (n=98), at risk (n=163), HFpEF (n=191), and HF with reduced ejection fraction (n=169). The change of the Kansas City Cardiomyopathy Questionnaire (KCCQ), EuroQOL 5 dimensions, and Functional Assessment of Cancer Therapy-Anemia over 12 months, and its association with a composite of death or rehospitalization within 3 years were assessed. At baseline, the KCCQ overall summary score was 73 (interquartile range, 53-86) in HFpEF and 78 (interquartile range, 56-90) in HF with reduced ejection fraction (P=0.22). Overall, 30.5% of patients with HF experienced ≥5-point improvements and 32.4% had ≥5-point worsening in KCCQ overall summary score at 12 months, which did not differ between HFpEF and HF with reduced ejection fraction (P=0.23). Clinical events were higher in patients with HF who had a decline in KCCQ over 12 months as compared with those with stable KCCQ scores (70.2% versus 52.0%, P=0.012). The results were similar for the Functional Assessment of Cancer Therapy-Anemia and EuroQOL 5 dimensions. Conclusions In patients with HF, the KCCQ quantified clinically meaningful changes over time, which were associated with important clinical outcomes in patients with HFpEF. Given the observed variability and prognostication in different patient trajectories, health-related quality of life measures could be valuable for quantifying the quality of care in healthcare systems.
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Affiliation(s)
- Nariman Sepehrvand
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Anamaria Savu
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
| | - John A. Spertus
- University of Missouri–Kansas CityKansas CityMO
- Saint Luke’s Mid America Heart InstituteKansas CityMO
| | - Jason R. B. Dyck
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Todd Anderson
- Libin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada
- Department of Cardiac SciencesUniversity of CalgaryAlbertaCanada
| | - Jonathan Howlett
- Libin Cardiovascular Institute of AlbertaCalgaryAlbertaCanada
- Department of Cardiac SciencesUniversity of CalgaryAlbertaCanada
| | - Ian Paterson
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Gavin Y Oudit
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
| | - Padma Kaul
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Finlay A. McAlister
- Patient Health Outcomes Research and Clinical Effectiveness UnitUniversity of AlbertaEdmontonAlbertaCanada
- Division of General Internal MedicineDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Justin A. Ezekowitz
- Canadian VIGOUR CentreUniversity of AlbertaEdmontonAlbertaCanada
- Mazankowski Alberta Heart InstituteEdmontonAlbertaCanada
- Division of CardiologyDepartment of MedicineUniversity of AlbertaEdmontonAlbertaCanada
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15
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Giles L, Freeman C, Field P, Sörstadius E, Kartman B. Humanistic burden and economic impact of heart failure – a systematic review of the literature. F1000Res 2020. [DOI: 10.12688/f1000research.19365.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Heart failure (HF) is increasing in prevalence worldwide. This systematic review was conducted to inform understanding of its humanistic and economic burden. Methods: Electronic databases (Embase, MEDLINE®, and Cochrane Library) were searched in May 2017. Data were extracted from studies reporting health-related quality of life (HRQoL) in 200 patients or more (published 2007–2017), or costs and resource use in 100 patients or more (published 2012–2017). Relevant HRQoL studies were those that used the 12- or 36-item Short-Form Health Surveys, EuroQol Group 5-dimensions measure of health status, Minnesota Living with Heart Failure Questionnaire or Kansas City Cardiomyopathy Questionnaire. Results: In total, 124 studies were identified: 54 for HRQoL and 71 for costs and resource use (Europe: 25/15; North America: 24/50; rest of world/multinational: 5/6). Overall, individuals with HF reported worse HRQoL than the general population and patients with other chronic diseases. Some evidence identified supports a correlation between increasing disease severity and worse HRQoL. Patients with HF incurred higher costs and resource use than the general population and patients with other chronic conditions. Inpatient care and hospitalizations were identified as major cost drivers in HF. Conclusions: Our findings indicate that patients with HF experience worse HRQoL and incur higher costs than individuals without HF or patients with other chronic diseases. Early treatment of HF and careful disease management to slow progression and to limit the requirement for hospital admission are likely to reduce both the humanistic burden and economic impact of HF.
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16
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Angermann CE, Assmus B, Anker SD, Asselbergs FW, Brachmann J, Brett M, Brugts JJ, Ertl G, Ginn G, Hilker L, Koehler F, Rosenkranz S, Zhou Q, Adamson PB, Böhm M. Pulmonary artery pressure‐guided therapy in ambulatory patients with symptomatic heart failure: the
CardioMEMS E
uropean
M
onitoring
S
tudy for
H
eart
F
ailure (
MEMS‐HF
). Eur J Heart Fail 2020; 22:1891-1901. [DOI: 10.1002/ejhf.1943] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/27/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Christiane E. Angermann
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | - Birgit Assmus
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany
- Department of Medicine I, Cardiology/Angiology University Hospital Giessen Germany
| | - Stefan D. Anker
- Division of Cardiology & Metabolism and Department of Cardiology & Berlin‐Brandenburg Center for Regenerative Therapies, and German Center for Cardiovascular Research, partner site Berlin Charité Universitätsmedizin Berlin Berlin Germany
| | - Folkert W. Asselbergs
- Division Heart & Lungs, Department of Cardiology University Medical Centre Utrecht Utrecht The Netherlands
| | - Johannes Brachmann
- Medical Centre Coburg GmbH II, Medical Clinic Cardiology, Angiology, Pulmonology Coburg Germany
| | | | - Jasper J. Brugts
- Erasmus MC University Medical Centre, Thoraxcenter Rotterdam The Netherlands
| | - Georg Ertl
- Comprehensive Heart Failure Center, University and University Hospital, Würzburg University Hospital Würzburg Würzburg Germany
| | | | - Lutz Hilker
- Klinikum Karlsburg, Heart and Diabetes Center Mecklenburg‐Western Pommerania Karlsburg Germany
| | - Friedrich Koehler
- Division of Cardiology and Angiology, Medical Department, Campus Charité Mitte, Centre for Cardiovascular Telemedicine Charité Universitätsmedizin Berlin Berlin Germany
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine University of Cologne Heart Center, and Cologne Cardiovascular Research Center (CCRC) Cologne Germany
| | - Qian Zhou
- Department of Cardiology and Angiology I University Heart Center Freiburg – Bad Krozingen, University of Freiburg Freiburg Germany
- Department of Cardiology University Hospital Basel Basel Switzerland
| | | | - Michael Böhm
- Internal Medicine III Cardiology, Angiology, Intensive Care Saarland University Medical Centre Homburg Germany
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17
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Jahanfar A, Fereidouni Z, Behnammoghadam M, Dehghan A, Bashti S. Efficacy of Eye Movement Desensitization and Reprocessing on the Quality of Life in Patients with Major Depressive Disorder: A Randomized Clinical Trial. Psychol Res Behav Manag 2020; 13:11-17. [PMID: 32021505 PMCID: PMC6955614 DOI: 10.2147/prbm.s232589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction The present study was conducted with the aim of investigating the efficacy of eye movement desensitization and reprocessing (EMDR) on the quality of life (QOL) in patients with major depressive disorder (MDD). Methods This is a randomized clinical trial study that investigated the efficacy of EMDR on the QOL in patients with MDD. In this study, all patients suffered from psychological trauma were currently in a major depressive episode and had a history of depression. 70 patients with MDD were selected through convenience sampling. Patients were then assigned to two groups of intervention and control (35 patients in each group). The assignment was performed randomly. For the intervention group, EMDR were performed in eight 90 mins sessions over 3 weeks. For the control group, no intervention was considered. Data on the QOL were collected using the WHO Quality of Life-BREF instrument before and after the treatment, and analysed using descriptive tests, paired t-test, independent t-test, and chi-square with SPSS v19. Results This study showed that the QOL in all its domains (physical health, psychological health, social relationships and environments) was significantly improved in patients with MDD in the intervention group after 8 sessions of EMDR. The post-treatment effect for the EMDR condition was 2.11, with a confidence interval of 1.3 to 2.7. Another finding of this study was that there was a statistically significant difference in the QOL scores in patients in the control group before and after the treatment; however, the mean difference in the intervention group was more than the control. Conclusion The results of this study showed that EMDR were effective on the QOL in patients with major depressive disorder, and improved individuals' QOL and all its domains. Treatment team members may use this technique as an effective and supportive one to improve the QOL in patients.
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Affiliation(s)
- Abdolhadi Jahanfar
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zhila Fereidouni
- Department of Medical Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Fasa, Fars, Iran
| | - Mohammad Behnammoghadam
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Somayeh Bashti
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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18
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Abstract
Cognitive behavioral therapy has emerged as an important approach to alleviate the depression of patients with heart failure. However, the use of cognitive behavioral therapy for heart failure has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of cognitive behavioral therapy for alleviating depression for heart failure.PubMed, Embase, and the Cochrane Central Register of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of cognitive behavioral therapy on heart failure are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. Meta-analysis is performed using the random-effect model.Eight RCTs involving 480 patients are included in the meta-analysis. Compared with control intervention for heart failure, cognitive behavioral therapy can substantially decrease depression scale (Std. MD = -0.27; 95% CI = -0.47 to -0.06; P = 0.01), but has no substantial influence on the quality of life (Std. MD = 0.21; 95% CI = -0.01 to 0.42; P = 0.06), self-care scores (Std. MD = 0.12; 95% CI = -0.18 to 0.42; P = 0.44), and 6-minute walk test distance (Std. MD = 0; 95% CI = -0.28 to 0.28; P = 0.99).Cognitive behavioral therapy is associated with significantly decreased depression scale, but with no substantial impact on the quality of life, self-care scores, and 6-minute walk test distance for heart failure.
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Affiliation(s)
- Yan Peng
- Department of Cardiology, The University-Town Hospital of Chongqing Medical University
| | - Junjie Fang
- Department of Cardiology, The University-Town Hospital of Chongqing Medical University
| | - Wei Huang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University
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19
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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21
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Symptom patterns and clinical outcomes in women versus men with systolic heart failure and depression. Clin Res Cardiol 2018; 108:244-253. [PMID: 30097684 DOI: 10.1007/s00392-018-1348-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Depression is more common in females than in males and is 3-5 times more prevalent in patients with heart failure (HF) than in the general population. The 9-item Patient Health Questionnaire (PHQ-9) is a validated depression screening instrument; higher sum-scores predict adverse clinical outcomes. Sex- and gender differences in PHQ-9 symptom profile, diagnostic and prognostic properties, and impact on health-related quality of life (HRQOL) have not been comprehensively studied in HF patients. METHODS AND RESULTS This post hoc analysis from the Interdisciplinary Network Heart Failure program enrolled 852/1022 participants (67 ± 13 years, 28% female) who completed the PHQ-9 at hospital discharge after cardiac decompensation. All had a left ventricular ejection fraction ≤ 40%. Women had a higher mean PHQ-9 sum-score than men (8.4 ± 5.6 vs. 7.4 ± 5.5; p = 0.027), and higher proportions rated the following items ≥ 2 (i.e., present on ≥ 50% of days): 'feeling down, hopeless' (25.8 vs. 18.0%; p = 0.011); 'fatigue' (51.9 vs. 37.2%; p < 0.001); and 'trouble concentrating' (21.6 vs. 15.4%; p = 0.032). A PHQ-9 sum-score ≥ 10 predicted increased mortality in women [hazard ratio 1.91 (95% confidence interval 1.06-3.43); p = 0.030] and men [2.10 (1.43-3.09); p < 0.001] and was associated with worse HRQOL (p < 0.001 for all comparisons). Sum-scores ≥ 10 predicted higher re-hospitalization rates in men only [1.35 (1.08-1.69); p = 0.008]. CONCLUSIONS Differences in several PHQ-9 items indicated sex- or gender-specific depression symptomatology in HF. For both sexes, HRQOL and survival were worse when PHQ-9 sum-score was ≥ 10, but higher sum-scores predicted higher re-hospitalization rates in men only. Considering these specific aspects might help optimize care strategies in HF.
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Tian J, Xue J, Hu X, Han Q, Zhang Y. CHF-PROM: validation of a patient-reported outcome measure for patients with chronic heart failure. Health Qual Life Outcomes 2018; 16:51. [PMID: 29554963 PMCID: PMC5859646 DOI: 10.1186/s12955-018-0874-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/27/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Due to a lack of an appropriate disease-specific patient-reported outcome (PRO) instrument for chronic heart failure including its social support and treatment aspects in China, this study was performed to develop a patient-reported outcome measure (PROM) for patients with chronic heart failure and evaluate its reliability, validity, and feasibility. METHODS According to the standard PROM guidelines established by the Food and Drug Administration, an item pool was formed by reviewing a large amount of relevant literature and interviewing patients with chronic heart failure about their main symptoms. Thus, the primary scale was created after adjusting the items and language with the help of patients and experts in the field. Next, 155 patients from 8 hospitals in different districts were recruited for a pilot survey using questionnaires containing these items. The patients' responses were analyzed using the classical test theory and item response theory to select high-quality items and determine the subdomains of the scale. This was followed by a formal investigation in the same eight hospitals. In total, 360 patients and 100 healthy subjects were included to evaluate the reliability, validity, and feasibility of the items. Through this process, the final scale was established. RESULTS The final scale comprised 12 subdomains with 57 items related to physical, psychological, social, and therapeutic areas. The data analysis results of the formal investigation showed that the PROM for chronic heart failure had good reliability, validity, and feasibility. Reliability was verified by Cronbach's alpha coefficient, which was 0.913 for the total scale, 0.903 for the physical domain, 0.941 for the psychological domain, 0.827 for the social domain, and 0.839 for the therapeutic domain. The construct validity results met the relative criteria of confirmatory factor analysis. Discriminant validity was represented by score comparisons of nine subdomains. The response rate and the effective rate of return of the CHF-PROM were 98.94% and 98.92%, respectively. CONCLUSIONS The final scale coincides with the theoretical framework and better reflects the overall quality of life of patients with chronic heart failure. This scale can be used as a valid instrument to evaluate clinical treatment and clinical trials of chronic heart failure.
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Affiliation(s)
- Jing Tian
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001 China
| | - Jiangping Xue
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001 China
| | - Xiaojuan Hu
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001 China
| | - Qinghua Han
- Department of Cardiology, The 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001 China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001 China
- Shanxi Medical University molecular imaging precision medicine Collaborative Innovation Center, Taiyuan, Shanxi Province 030001 China
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23
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Dorow M, Stein J, Pabst A, Weyerer S, Werle J, Maier W, Miebach L, Scherer M, Stark A, Wiese B, Moor L, Bock JO, König HH, Riedel-Heller SG. Categorical and dimensional perspectives on depression in elderly primary care patients - Results of the AgeMooDe study. Int J Methods Psychiatr Res 2018; 27:e1577. [PMID: 28948667 PMCID: PMC6877261 DOI: 10.1002/mpr.1577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/29/2017] [Accepted: 07/03/2017] [Indexed: 02/04/2023] Open
Abstract
An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)" a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.
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Affiliation(s)
- Marie Dorow
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Siegfried Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jochen Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Lisa Miebach
- Department of Psychiatry, University of Bonn and German Center for Neurodegenerative Diseases within the Helmholtz Association, Bonn, Germany
| | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgitt Wiese
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Lilia Moor
- Institute for General Practice, Working Group Medical Statistics and IT-Infrastructure, Hannover Medical School, Hannover, Germany
| | - Jens-Oliver Bock
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
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24
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Eisele M, Boczor S, Rakebrandt A, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. General practitioners' awareness of depressive symptomatology is not associated with quality of life in heart failure patients - cross-sectional results of the observational RECODE-HF Study. BMC FAMILY PRACTICE 2017; 18:100. [PMID: 29221442 PMCID: PMC5723041 DOI: 10.1186/s12875-017-0670-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs' awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients. METHODS For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients' comorbidities and potential depression treatment. Descriptive and regression analysis were performed. RESULTS GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient's HRQOL was not significantly associated with the GPs' awareness of depression. CONCLUSION GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs' awareness of depressive symptomatology is not linked to patients' HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099 Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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25
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Abstract
OBJECTIVES Health-related quality of life (HR-QoL) of patients with heart failure (HF) is low despite the aim of HF treatment to improve HR-QoL. To date, most studies have focused on medical and physical factors in relation to HR-QoL, few data are available on the role of emotional factors such as dispositional optimism. This study examines the prevalence of optimism and pessimism in HF patients and investigates how optimism and pessimism are associated with different patient characteristics and HR-QoL. METHODS Dispositional optimism was assessed in 86 HF patients (mean age 70 ± 9 years, 28% female, mean left ventricular ejection fraction 33%) with the Revised Life Orientation Test (LOT-R). HR-QoL was assessed with the Minnesota Living with Heart Failure Questionnaire and the EuroQol. RESULTS The (mean ± SD) total score on the LOT-R was 14.6 ± 2.9 (theoretical range 0-24) and the scores on the subscales optimism and pessimism were 8.1 ± 1.9 and 5.5 ± 2.5, respectively. Higher age was related to more optimism (r = 0.22, p < 0.05), and optimism was associated with higher generic HR-QoL (B = 0.04, p < 0.05).Significance of resultsThe association found between optimism and generic HR-QoL of HF patients can lead to promising strategies to improve HF patients' HR-QoL, particularly because the literature has indicated that optimism is a modifiable condition.
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Chen Y, Funk M, Wen J, Tang X, He G, Liu H. Effectiveness of a multidisciplinary disease management program on outcomes in patients with heart failure in China: A randomized controlled single center study. Heart Lung 2017; 47:24-31. [PMID: 29103661 DOI: 10.1016/j.hrtlng.2017.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Multidisciplinary disease management programs (MDMP) for patients with heart failure (HF) have been delivered, but evidence of their effectiveness in China is limited. OBJECTIVE To determine if a MDMP improves quality of life (QoL), physical performance, depressive symptoms, self-care behaviors and mortality or rehospitalization in patients with HF in China. METHODS This is a randomized controlled single center trial in which patients with HF received either MDMP with discharge education, physical training, follow-up visits and telephone calls for 180 days (n = 31) or standard care (SC, n = 31). RESULTS Compared with SC, QoL, depressive symptoms, and self-care behaviors were significantly improved by MDMP from baseline to 180 days (37% vs 66%, 20% vs 61%, and 8% vs 33%, respectively, all p < 0.001). There were no differences in physical performance and mortality or rehospitalization during follow-up. CONCLUSIONS A HF MDMP can improve QoL, depressive symptoms and self-care behaviors in China.
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Affiliation(s)
- Yiyin Chen
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Middle Renmin Rd., Furong District, Changsha, Hunan, 410011, China.
| | - Marjorie Funk
- Yale School of Nursing, Yale University West Campus, Building 400, 300 Heffernan Drive, West Haven, CT 06516, USA.
| | - Jia Wen
- Cardiology Department, The Third Xiangya Hospital of Central South University, Western Tongzipo Rd, Yuelu District, Changsha, Hunan, 410013, China.
| | - Xianghua Tang
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Middle Renmin Rd., Furong District, Changsha, Hunan, 410011, China.
| | - Guixiang He
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Middle Renmin Rd., Furong District, Changsha, Hunan, 410011, China.
| | - Hong Liu
- Department of Geriatrics, The Second Xiangya Hospital of Central South University, Middle Renmin Rd., Furong District, Changsha, Hunan, 410011, China.
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Kawauchi TS, Umeda IIK, Braga LM, Mansur ADP, Rossi-Neto JM, Guerra de Moraes Rego Sousa A, Hirata MH, Cahalin LP, Nakagawa NK. Is there any benefit using low-intensity inspiratory and peripheral muscle training in heart failure? A randomized clinical trial. Clin Res Cardiol 2017; 106:676-685. [PMID: 28255812 DOI: 10.1007/s00392-017-1089-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/08/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inspiratory and peripheral muscle training improves muscle strength, exercise tolerance, and quality of life in patients with chronic heart failure (HF). However, studies investigating different workloads for these exercise modalities are still lacking. OBJECTIVE To examine the effects of low and moderate intensities on muscle strength, functional capacity, and quality of life. DESIGN A randomized controlled trial. METHODS Thirty-five patients with stable HF (aged >18 years, NYHA II/III, LVEF <40%) were randomized to: non-exercise control group (n = 9), low-intensity training group (LIPRT, n = 13, 15% maximal inspiratory workload, and 0.5 kg of peripheral muscle workload) or moderate-intensity training group (MIPRT, n = 13, 30% maximal inspiratory workload and 50% of one maximum repetition of peripheral muscle workload). The outcomes were: respiratory and peripheral muscle strength, pulmonary function, exercise tolerance by the 6-minute walk test, symptoms based on the NYHA functional class, and quality of life using the Minnesota Living with Heart Failure Questionnaire. RESULTS All groups showed similar quality-of-life improvements. Low and moderate intensities training programs improved inspiratory muscle strength, peripheral muscle strength, and walking distance. However, only moderate intensity improved expiratory muscle strength and NYHA functional class in HF patients. CONCLUSIONS The low-intensity inspiratory and peripheral resistance muscle training improved inspiratory and peripheral muscle strength and walking distance, demonstrating that LIPRT is an efficient rehabilitation method for debilitated HF patients. In addition, the moderate-intensity resistance training also improved expiratory muscle strength and NYHA functional class in HF patients.
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Affiliation(s)
- Tatiana Satie Kawauchi
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil
| | - Iracema Ioco Kikuchi Umeda
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Lays Magalhães Braga
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil
| | - Antonio de Pádua Mansur
- Heart Institute - HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar, 44, São Paulo, SP, Brazil
| | - João Manoel Rossi-Neto
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | | | - Mário Hiroyuki Hirata
- Dante Pazzanese Institute of Cardiology São Paulo State, Av. Dr. Dante Pazzanese, 500, São Paulo, SP, Brazil
| | - Lawrence P Cahalin
- Department of Physical Therapy, University of Miami, Coral Gables, FL, USA
| | - Naomi Kondo Nakagawa
- Department of Physiotherapy, LIM-34, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 Room 1150, São Paulo, SP, 01246-930, Brazil.
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Lam RW, McIntosh D, Wang J, Enns MW, Kolivakis T, Michalak EE, Sareen J, Song WY, Kennedy SH, MacQueen GM, Milev RV, Parikh SV, Ravindran AV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 1. Disease Burden and Principles of Care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:510-23. [PMID: 27486151 PMCID: PMC4994789 DOI: 10.1177/0706743716659416] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) conducted a revision of the 2009 guidelines by updating the evidence and recommendations. The scope of the 2016 guidelines remains the management of major depressive disorder (MDD) in adults, with a target audience of psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. This section is the first of six guidelines articles. RESULTS In Canada, the annual and lifetime prevalence of MDD was 4.7% and 11.3%, respectively. MDD represents the second leading cause of global disability, with high occupational and economic impact mainly attributable to indirect costs. DSM-5 criteria for depressive disorders remain relatively unchanged, but other clinical dimensions (sleep, cognition, physical symptoms) may have implications for depression management. e-Mental health is increasingly used to support clinical and self-management of MDD. In the 2-phase (acute and maintenance) treatment model, specific goals address symptom remission, functional recovery, improved quality of life, and prevention of recurrence. CONCLUSIONS The burden attributed to MDD remains high, whether from individual distress, functional and relationship impairment, reduced quality of life, or societal economic cost. Applying core principles of care, including comprehensive assessment, therapeutic alliance, support of self-management, evidence-informed treatment, and measurement-based care, will optimize clinical, quality of life, and functional outcomes in MDD.
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Affiliation(s)
- Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Diane McIntosh
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - JianLi Wang
- Department of Psychiatry, University of Calgary, Calgary, Alberta
| | - Murray W Enns
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Theo Kolivakis
- Department of Psychiatry, McGill University, Montréal, Quebec
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba
| | - Wei-Yi Song
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Toronto, Ontario Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Impaired quality of life in systemic sclerosis and patient perception of the disease: A large international survey. Semin Arthritis Rheum 2016; 46:115-23. [PMID: 27132536 DOI: 10.1016/j.semarthrit.2016.02.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/22/2015] [Accepted: 02/20/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The purpose of this study was to assess health-related quality of life (HRQoL) and disease perception in a large, international group of patients with systemic sclerosis (SSc). METHODS We placed a standardized questionnaire on a website for patient access. Socio-demographic information, disease characteristics, and self-assessment questionnaires-the Short Form 36 (SF-36) and the Revised Illness Perception Questionnaire (IPQ-R)-were collected. RESULTS A total of 1902 patients from 60 countries were included. HRQoL appeared to be impaired in SSc, particularly for physical health (PCS, mean ± SD = 43.4 ± 23.4). SSc patients also had strong perceptions about the chronic nature and negative consequence of the disease, and experienced negative emotions due to SSc. Patients with diffuse cutaneous SSc had a poorer HRQoL than those with limited cutaneous SSc, for both physical (PCS, mean ± SD = 46.6 ± 23.7 vs. 39.8 ± 22.3; p < 0.0001) and mental components (MCS, mean ± SD = 53.8 ± 23.0 vs. 50.3 ± 23.2; p = 0.003). Late-stage SSc patients were more likely to perceive their disease chronic (p < 0.0001), less controllable (p = 0.03) and with more consequences (p = 0.008), but they had a better understanding of their disease and experienced fewer negative emotions. Raynaud's phenomenon and gastrointestinal complications were the organ involvements with the greatest impact on QoL, they were the two variables associated with the most negative perception of illness severity. CONCLUSION This study, performed on the largest group ever set up for this purpose, confirms the major impact on QoL and the negative perceptions of their disease expressed by SSc patients. However, the perception of this illness tended to improve with disease duration, suggesting that patients find effective coping strategies.
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Freedland KE, Carney RM, Rich MW, Steinmeyer BC, Rubin EH. Cognitive Behavior Therapy for Depression and Self-Care in Heart Failure Patients: A Randomized Clinical Trial. JAMA Intern Med 2015; 175:1773-82. [PMID: 26414759 PMCID: PMC4712737 DOI: 10.1001/jamainternmed.2015.5220] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Depression and inadequate self-care are common and interrelated problems that increase the risks of hospitalization and mortality in patients with heart failure (HF). OBJECTIVE To determine the efficacy of an integrative cognitive behavior therapy (CBT) intervention for depression and HF self-care. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial with single-blind outcome assessments. Eligible patients were enrolled at Washington University Medical Center in St Louis between January 4, 2010, and June 28, 2013. The primary data analyses were conducted in February 2015. The participants were 158 outpatients in New York Heart Association Class I, II, and III heart failure with comorbid major depression. INTERVENTIONS Cognitive behavior therapy delivered by experienced therapists plus usual care (UC), or UC alone. Usual care was enhanced in both groups with a structured HF education program delivered by a cardiac nurse. MAIN OUTCOMES AND MEASURES The primary outcome was severity of depression at 6 months as measured by the Beck Depression Inventory. The Self-Care of Heart Failure Index Confidence and Maintenance subscales were coprimary outcomes. Secondary outcomes included measures of anxiety, depression, physical functioning, fatigue, social roles and activities, and quality of life. Hospitalizations and deaths were exploratory outcomes. RESULTS One hundred fifty-eight patients were randomized to UC (n = 79) or CBT (n = 79). Within each arm, 26 (33%) of the patients were taking an antidepressant at baseline. One hundred thirty-two (84%) of the participants completed the 6-month posttreatment assessments; 60 (76%) of the UC and 58 (73%) of the CBT participants completed every follow-up assessment (P = .88). Six-month depression scores were lower in the CBT than the UC arm on the Beck Depression Inventory (BDI-II) (12.8 [10.6] vs 17.3 [10.7]; P = .008). Remission rates differed on the BDI-II (46% vs 19%; number needed to treat [NNT] = 3.76; 95% CI, 3.62-3.90; P < .001) and the Hamilton Depression Scale (51% vs 20%; NNT = 3.29; 95% CI, 3.15-3.43; P < .001). The groups did not differ on the Self-Care Maintenance or Confidence subscales. The mean (SD) Beck Depression Inventory scores 6 months after randomization were lower in the CBT (12.8 [10.6]) than the UC arm (17.3 [10.7]), P = .008. There were no statistically significant differences between the groups on the Self-Care Maintenance or Confidence subscale scores or on physical functioning measures. Anxiety and fatigue scores were lower and mental- and HF-related quality of life and social functioning scores were higher at 6 months in the CBT than the UC arm, and there were fewer hospitalizations in the intervention than the UC arm. CONCLUSIONS AND RELEVANCE A CBT intervention that targets both depression and heart failure self-care is effective for depression but not for HF self-care or physical functioning relative to enhanced UC. Additional benefits include reduced anxiety and fatigue, improved social functioning, and better health-related quality of life. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01028625.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Michael W Rich
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Brian C Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Eugene H Rubin
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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Bunz M, Lenski D, Wedegärtner S, Ukena C, Karbach J, Böhm M, Kindermann I. Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study. Clin Res Cardiol 2015; 105:216-24. [PMID: 26481915 DOI: 10.1007/s00392-015-0909-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/20/2015] [Indexed: 01/14/2023]
Abstract
AIMS We analysed heart-focused anxiety (HFA) and its predictors in patients with heart failure before implantation of an implantable cardioverter defibrillator (ICD). Herein, we report the baseline data of the Anxiety-CHF Study which investigates HFA before and after ICD implantation. METHODS AND RESULTS HFA, general anxiety and depression, perceived quality of life (QoL) and type D personality were measured with validated psychological instruments. Clinical parameters such as severity of heart failure measured by NYHA class and left ventricular ejection fraction (EF) were determined. One hundred and ten patients were interrogated before ICD implantation (70 % male, mean age = 60.5 ± 14.9 years, mean EF = 31 % ± 9 %, 91 % NYHA II-III, 92 % primary prevention). HFA was present in 53 patients (48.6 %); 37 participants (33.9 %) showed increased levels of general anxiety and 33 patients (30.3 %) showed increased levels of depression with clinical significant levels in 16 subjects (14.7 %) for general anxiety and 13 subjects (11.9 %) for depression. Poor QoL was reported in 30 patients (27.5 %). HFA was correlated with QoL, general anxiety, depression, type D personality, myocardial infarction (MI), and systolic blood pressure. QoL, general anxiety and former MI were significant predictors of HFA (R (2) = 0.453). CONCLUSION Heart-focused anxiety is highly prevalent in heart failure patients prior to ICD implantation. Measures of disease severity such as EF or NYHA class do not predict HFA, neither does Type D personality. HFA is predicted by a history of MI and psychological parameters such as general anxiety and impaired QoL. CLINICALTRIALS. GOV IDENTIFIER NCT02226770.
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Affiliation(s)
- Maxie Bunz
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
| | - Denise Lenski
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
- Psychotherapy Practice, Saarbrücken, Germany
| | - Sonja Wedegärtner
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Julia Karbach
- Institut für Psychologie, Goethe-Universität, Frankfurt, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Ingrid Kindermann
- Klinik für Innere Medizin III-Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
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Depressive symptoms in heart failure: Independent prognostic factor or marker of functional status? J Psychosom Res 2015; 78:569-72. [PMID: 25770643 DOI: 10.1016/j.jpsychores.2015.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The prognostic potential of depressive symptoms independent of somatic features of heart failure severity has repeatedly been demonstrated. However, patient-reported functional status has rarely been accounted for in these studies. Thus, it has remained unclear to what extent the predictive power of depressive symptoms may mirror functional status. We therefore aimed to evaluate the prognostic value of depressive symptoms adjusting for patient-reported functional status in a large, well-characterized sample of patients with systolic heart failure. METHODS Eight hundred sixty-three patients, 67±12 years old, 72% men, and 42% with New York Heart Association functional classes III/IV, who participated in the extended Interdisciplinary Network Heart Failure (INH) study were investigated. We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9) and patient-reported functional status with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Data on survival was obtained after a follow-up of 18 months (100% complete). RESULTS Depressive symptoms predicted mortality risk (HR per PHQ-9 scale point=1.07, 95% CI 1.04-1.09, p<.001), even after adjustment for heart failure severity and co-morbidities (HR=1.04, 95% CI 1.01-1.07, p=.017). However, they were no longer significant predictors (HR=1.01, 95% CI 0.98-1.05, p=0.46) after additional adjustment for patient-reported functional status, which proved predictive of mortality risk (HR=0.90, 95% CI 0.82-0.99, p=.025). CONCLUSION Our results suggest that the association of depressive symptoms with functional status may at least partly explain the prognostic potential of depressive symptoms.
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Nieminen MS, Dickstein K, Fonseca C, Serrano JM, Parissis J, Fedele F, Wikström G, Agostoni P, Atar S, Baholli L, Brito D, Colet JC, Édes I, Gómez Mesa JE, Gorjup V, Garza EH, González Juanatey JR, Karanovic N, Karavidas A, Katsytadze I, Kivikko M, Matskeplishvili S, Merkely B, Morandi F, Novoa A, Oliva F, Ostadal P, Pereira-Barretto A, Pollesello P, Rudiger A, Schwinger RHG, Wieser M, Yavelov I, Zymliński R. The patient perspective: Quality of life in advanced heart failure with frequent hospitalisations. Int J Cardiol 2015; 191:256-64. [PMID: 25981363 DOI: 10.1016/j.ijcard.2015.04.235] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/30/2015] [Indexed: 12/27/2022]
Abstract
End of life is an unfortunate but inevitable phase of the heart failure patients' journey. It is often preceded by a stage in the progression of heart failure defined as advanced heart failure, and characterised by poor quality of life and frequent hospitalisations. In clinical practice, the efficacy of treatments for advanced heart failure is often assessed by parameters such as clinical status, haemodynamics, neurohormonal status, and echo/MRI indices. From the patients' perspective, however, quality-of-life-related parameters, such as functional capacity, exercise performance, psychological status, and frequency of re-hospitalisations, are more significant. The effects of therapies and interventions on these parameters are, however, underrepresented in clinical trials targeted to assess advanced heart failure treatment efficacy, and data are overall scarce. This is possibly due to a non-universal definition of the quality-of-life-related endpoints, and to the difficult standardisation of the data collection. These uncertainties also lead to difficulties in handling trade-off decisions between quality of life and survival by patients, families and healthcare providers. A panel of 34 experts in the field of cardiology and intensive cardiac care from 21 countries around the world convened for reviewing the existing data on quality-of-life in patients with advanced heart failure, discussing and reaching a consensus on the validity and significance of quality-of-life assessment methods. Gaps in routine care and research, which should be addressed, were identified. Finally, published data on the effects of current i.v. vasoactive therapies such as inotropes, inodilators, and vasodilators on quality-of-life in advanced heart failure patients were analysed.
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Affiliation(s)
| | | | - Cândida Fonseca
- S. Francisco Xavier Hospital, CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Jose Magaña Serrano
- División de Educación en Salud, UMAE Hospital de Cardiología Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico
| | - John Parissis
- Second University Cardiology Clinic, Attiko Teaching Hospital, Athens, Greece
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology and Geriatric Science, University of Rome, Italy
| | | | | | - Shaul Atar
- Department of Cardiology, Galilee Medical Center, Nahariya, Israel
| | - Loant Baholli
- Department of Intensive Care, Klinikum Dortmund, Germany
| | - Dulce Brito
- Cardiology Department, Hospital Universitario de Santa Maria, Lisbon, Portugal
| | | | - István Édes
- Department of Cardiology, University of Debrecen, Hungary
| | | | - Vojka Gorjup
- Department of Intensive Internal Medicine, University Medical Center Ljubljana, Slovenia
| | - Eduardo Herrera Garza
- Heart Failure, Heart Transplant Department, Centro Médico Zambrano Hellion, Heart Failure Clinic Unidad Médica de Alta Especialidad, Hospital de Cardiología No. 34, IMSS Monterrey Nuevo León, Mexico
| | | | - Nenad Karanovic
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital of Split, Croatia
| | - Apostolos Karavidas
- Heart Failure Clinic & Echo Lab, Gennimatas General Hospital of Athens, Greece
| | - Igor Katsytadze
- Cardiology Intensive Care Unit, O. Bogomolets National Medical University, Kiev, Ukraine
| | | | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Fabrizio Morandi
- Department of Cardiovascular Science, University of Insubria, Circolo Hospital and Macchi Foundation, Varese, Italy
| | | | - Fabrizio Oliva
- Department of Cardiology, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Petr Ostadal
- Department of Cardiology, Cardiovascular Center, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Alain Rudiger
- Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Robert H G Schwinger
- Department of Internal Medicine, Kliniken Nordoberpfalz, Weiden, Germany; Teaching Hospital of the University of Regensburg, Germany
| | - Manfred Wieser
- Department of Internal Medicine 1, University Hospital Krems, Karl Landsteiner University of Health Sciences, Austria
| | - Igor Yavelov
- Scientific Research Institute of Physico-Chemical Medicine of the Federal Medico-Biological Agency of the Russian Federation, Moscow, Russia
| | - Robert Zymliński
- Department of Cardiology, Cardiology Intensive Care Unit, The 4th Military Hospital, Wroclaw, Poland
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Raphael CE, Finegold JA, Barron AJ, Whinnett ZI, Mayet J, Linde C, Cleland JG, Levy WC, Francis DP. The effect of duration of follow-up and presence of competing risk on lifespan-gain from implantable cardioverter defibrillator therapy: who benefits the most? Eur Heart J 2015; 36:1676-88. [DOI: 10.1093/eurheartj/ehv102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 03/16/2015] [Indexed: 11/14/2022] Open
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Nahlen Bose C, Bjorling G, Elfstrom ML, Persson H, Saboonchi F. Assessment of Coping Strategies and Their Associations With Health Related Quality of Life in Patients With Chronic Heart Failure: the Brief COPE Restructured. Cardiol Res 2015; 6:239-248. [PMID: 28197233 PMCID: PMC5295536 DOI: 10.14740/cr385w] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/29/2022] Open
Abstract
Background Individuals with chronic heart failure (CHF) need to cope with both the physical limitations and the psychological impacts of the disease. Since some coping strategies are beneficial and others are linked to increased mortality and worse health-related quality of life (HRQoL), it is important to have a reliable and valid instrument to detect different coping styles. Brief COPE, a self-reporting questionnaire, has been previously used in the context of CHF. There is, however, currently a lack of consensus about the theoretical or empirical foundations for grouping the multiple coping strategies assessed by Brief COPE into higher order categories of coping. The main purpose of this study was to examine the structure of Brief COPE, founded on the higher order grouping of its subscales in order to establish an assessment model supported by theoretical considerations. Furthermore, the associations between these higher order categories of coping and HRQoL were examined to establish the predictive validity of the selected model in the context of CHF. Method One hundred eighty-three patients diagnosed with CHF were recruited at a heart failure outpatient clinic or at a cardiac ward. Self-reported questionnaires were filled in to measure coping strategies and HRQoL. Confirmatory factor analyses were performed to investigate different hierarchical structures of Brief COPE found in the literature to assess coping strategies in patients with CHF. Regression analyses explored associations of aggregated coping strategies with HRQoL. Results A four factorial structure of Brief COPE displayed the most adequate psychometric properties, consisting of problem focused coping, avoidant coping, socially supported coping and emotion focused coping. Avoidant coping was associated with worse HRQoL in CHF. Conclusions This study provides support for a four-factor model of coping strategies in patients with CHF. This could facilitate assessment of coping both in clinical and research settings.
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Affiliation(s)
- Catarina Nahlen Bose
- The Swedish Red Cross University College, Stockholm, Sweden; Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - Gunilla Bjorling
- The Swedish Red Cross University College, Stockholm, Sweden; Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - Magnus L Elfstrom
- Malardalen University, Academy of Health, Care and Social Welfare, Eskilstuna/Vasteras, Sweden
| | - Hans Persson
- Karolinska Institutet Department of Clinical Sciences Danderyd Hospital, Stockholm, Sweden
| | - Fredrik Saboonchi
- The Swedish Red Cross University College, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, Stockholm, Sweden
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Güder G, Störk S, Gelbrich G, Brenner S, Deubner N, Morbach C, Wallenborn J, Berliner D, Ertl G, Angermann CE. Nurse-coordinated collaborative disease management improves the quality of guideline-recommended heart failure therapy, patient-reported outcomes, and left ventricular remodelling. Eur J Heart Fail 2015; 17:442-52. [DOI: 10.1002/ejhf.252] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/08/2015] [Accepted: 01/16/2015] [Indexed: 12/13/2022] Open
Affiliation(s)
- Gülmisal Güder
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
| | - Stefan Störk
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
| | - Goetz Gelbrich
- University of Würzburg; Institute of Clinical Epidemiology and Biometry; Würzburg Germany
- Clinical Trial Center Würzburg; University Hospital Würzburg; Würzburg Germany
| | - Susanne Brenner
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
| | - Nikolas Deubner
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
- Department of Cardiology; Kerckhoff Klinik; Bad Nauheim Germany
| | - Caroline Morbach
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
| | - Julia Wallenborn
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
| | - Dominik Berliner
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
- Department of Internal Medicine I, Cardiology; University Hospital Hannover; Hannover Germany
| | - Georg Ertl
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
| | - Christiane E. Angermann
- Department of Internal Medicine I, Cardiology; University Hospital Würzburg; Oberdürrbacherstr 6 D-97080 Würzburg Germany
- Comprehensive Heart Failure Center; University of Würzburg; Würzburg Germany
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Tebbe U, Tschöpe C, Wirtz JH, Lokies J, Turgonyi E, Bramlage P, Strunz AM, Lins K, Böhm M. Registry in Germany focusing on level-specific and evidence-based decision finding in the treatment of heart failure: REFLECT-HF. Clin Res Cardiol 2014; 103:665-73. [PMID: 24535376 DOI: 10.1007/s00392-014-0678-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Germany, care for patients with chronic heart failure (HF) is provided by hospital-based cardiologists (HBC), office-based cardiologists (OBC) and general practitioners (GP). We aimed to compare patient characteristics, diagnostic approaches and therapeutic decisions. METHODS Multi-centre, cross-sectional, observational survey at 48 physicians. Patients (n = 384) were required to have previously diagnosed HF and NYHA class ≥ II and/or a left ventricular ejection fraction of <50 %. A total of 384 patients were included at 5 HBCs, 26 OBCs and 18 GPs. RESULTS A mean of 18.8 % of all patients at HBCs practices had heart failure, compared to a smaller proportion of 13.9 and 6.7 % at OBCs and GPs, respectively. Echo facility was available for all HBCs and OBCs, but for 16.7 % of GPs (p < 0.0001 for trend). Patients at HBCs had a higher NYHA class (65.6 % had class III/IV; p < 0.0001) compared to 36.8 % at OBCs and 39.3 % at GPs. Usage of three guideline-recommended pharmaceutical treatments was more than 80 %: diuretics (83.1 %), renin-angiotensin system blocking agents (91.4 %) and betablockers (90.1 %) with no differences between physician groups. Mineralocorticoid receptor antagonists (MRAs, overall 47.7 %) were more frequently prescribed by OBCs (54.7 %; p = 0.0007 for trend) than HBCs (43.8 %) and GPs (31.0 %). Ivabradin was not frequently used (11.0 % at OBCs, 4.9 % at HBCs and 0 % at GPs; p = 0.0163 for trend). The proportion of patients with CRT (8.6 %), ICD (23.5 %) and CABG (23.1 %) was not statistically different between groups. CONCLUSION REFLECT-HF demonstrates that there are some differences in evidence-based treatment decisions between the three main health services (HBC, OBC and GP) providing care for patients with HF in Germany. Advocating adherence to guideline recommendations and earlier adoption of these evidence-based treatments across all levels of care might further improve patient care.
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Affiliation(s)
- Ulrich Tebbe
- Klinikum Lippe-Detmold, Abteilung für Kardiologie, Angiologie und Intensivmedizin, Röntgenstrasse 18, 32756, Detmold, Germany,
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Meyer T, Hussein S, Lange HW, Herrmann-Lingen C. Transient impact of baseline depression on mortality in patients with stable coronary heart disease during long-term follow-up. Clin Res Cardiol 2014; 103:389-95. [PMID: 24464107 DOI: 10.1007/s00392-014-0666-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this prospective study was to determine the impact of depressive symptoms on long-term survival in coronary heart disease (CHD) patients treated with intracoronary stenting. METHODS Four hundred and seventy patients completed the Hospital Anxiety and Depression Scale (HADS) before undergoing stent implantation and were followed over a 5-year period. Survival data were collected from n = 462 participants (98.3 %). A cut-off ≥8 on the HADS depression subscale was used to indicate probable clinical levels of depression. RESULTS All-cause mortality rates differed significantly between depressed and non-depressed patients at 2-year follow-up, as 6 out of 98 subjects with elevated HADS-D scores (6.1 %), but only 8 out of 364 (2.2 %) patients with normal HADS-D scores had died [odds ratio = 2.9, 95 % confidence interval (95 % CI) = 1.0-8.6, p = 0.044]. In a Cox regression model adjusted for sociodemographic and clinical parameters, positive HADS-D scores [hazard ratio (HR) = 4.3, 95 % CI = 1.2-15.4, p = 0.025], body-mass index (HR = 0.8, 95 % CI = 0.7-1.0, p = 0.040) and stent length (HR = 1.1, 95 % CI = 1.0-1.1, p = 0.042) independently predicted 2-year survival. From the third to the fifth year after index PCI, the frequency of deaths in the depressed patients' group did not significantly differ from that observed in non-depressed patients (5.5 % versus 7.0 %, p = 0.607), and the predictive role of baseline HADS-D scores for survival was lost. CONCLUSION In CHD patients, self-rated depressive symptoms at baseline were negatively linked to survival at 2-year follow-up, but failed to predict mortality 3 years later. Thus, in contrast to other well-established risk factors, the prognostic value of depression for predicting adverse outcome may be temporarily limited. The mechanisms behind this transient effect need further study.
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Affiliation(s)
- Thomas Meyer
- Klinik für Psychosomatische Medizin und Psychotherapie, Deutsches Zentrum für Herz- und Kreislaufforschung, Universität Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany,
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The effect of placebo adherence on reducing cardiovascular mortality: a meta-analysis. Clin Res Cardiol 2013; 103:229-35. [PMID: 24264475 DOI: 10.1007/s00392-013-0642-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We aim to demonstrate the effect of placebo adherence on reducing CV mortality. BACKGROUNDS Good adherence, whether to drug or placebo treatment, is associated with lower CV mortality. However, current evidence for the positive effect of placebo adherence on reducing CV mortality is relatively weak. METHODS We conducted a fixed-effect meta-analysis of eight randomized clinical trials to evaluate the effect of placebo adherence on reducing CV mortality. We made a comparison between good placebo adherence and poor drug adherence. RESULTS Compared with poor adherence to drug treatment, good adherence to placebo treatment was associated with lower CV mortality (OR = 0.68, 95% CI 0.60-0.77). CONCLUSION Good adherence to placebo has a positive effect on reducing CV mortality. The effect of adherence on reducing CV mortality may be independent of the drug effect.
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