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Chen M, Liu M, Guo X, Zhou J, Yang H, Zhong G, Men L, Xie Y, Tong G, Liu Q, Luan J, Zhou H. Effects of Xinkeshu tablets on coronary heart disease patients combined with anxiety and depression symptoms after percutaneous coronary intervention: A meta-analysis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 104:154243. [PMID: 35717809 DOI: 10.1016/j.phymed.2022.154243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/17/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Xinkeshu tablets (XKS), a well-known Chinese patent drug, have been administered to coronary heart disease (CHD) patients with anxiety and depression after percutaneous coronary intervention (PCI). PURPOSE This meta-analysis aimed to systematically evaluate the clinical effects of XKS for treating CHD patients with anxiety and depression after PCI. METHODS Randomized controlled trials (RCTs) about XKS alone or combined with conventional drugs for the treatment of CHD patients with anxiety and depression after PCI were retrieved from 7 databases (MEDLINE, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) Database, Chinese Biomedical Database (CBM) and Wanfang Database) through November 2021. First, the studies were reviewed and screened by two independent assessors according to the eligibility criteria. Second, the methodological quality of the eligible studies was evaluated based on the Cochrane Collaboration's tool for assessing the risk of bias. Subsequently, meta-analysis was performed by using RevMan 5.4 software, and publication bias was evaluated by Stata 12.0 software. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to rate the quality of the evidence. RESULTS In total, 11 clinical RCTs involving 1000 patients were included in this study. This meta-analysis found that compared with conventional treatment alone, XKS combined with conventional treatment significantly improved the anxiety scale scores (SMD = -1.97, 95% CI -3.13 to -0.82; p = 0.0008; I2 = 98%), the depression scores (SMD = -2.80, 95% CI -4.49 to -1.10; p = 0.001; I2 = 98%), the scores on the Medical Outcomes Study 36 Item Short Form Health Survey (SF36) (MD = 11.22, 95% CI 4.19 to 18.26; p =0.002; I2 = 95%) and the blood lipid levels of total cholesterol (TC) (MD = -0.38, 95% CI -0.62 to -0.13; p = 0.003; I2 = 0%) and triglyceride (TG) (MD = -0.31, 95% CI -0.46 to -0.17; p < 0.0001; I2 = 0%). CONCLUSION The current evidence suggests that XKS might benefit CHD patients experiencing anxiety and depression after PCI by helping to improve their depression symptoms, TC and TG blood lipid levels. However, due to insufficient methodological quality of the studies, several risks of bias and inadequate reporting of the clinical data, more rigorous, multicenter, sufficient-sample and double-blind randomized clinical trials are warranted.
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Affiliation(s)
- Mingtai Chen
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China; Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China.
| | - Mengnan Liu
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; National Traditional Chinese Medicine Clinical Research Base and Department of Cardiovascular, Hospital (T.C.M) Affiliated to Southwest Medical University, Luzhou, Sichuan, PR China
| | - Xin Guo
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Jie Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Huayi Yang
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China
| | - Guofu Zhong
- Intensive Care Unit, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Ling Men
- Department of Neurology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Ying Xie
- School of Pharmacy and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macao, PR China
| | - Guangdong Tong
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; Department of Liver Disease, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, PR China
| | - Qiang Liu
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China
| | - Jienan Luan
- Department of Cardiovascular Disease, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, PR China
| | - Hua Zhou
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao, PR China; Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, Macau University of Science and Technology, Taipa, Macao, PR China; Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, State Key Laboratory of Dampness Syndrome of Chinese Medicine, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong-Hong Kong-Macau Joint Lab on Chinese Medicine and Immune Disease Research, Guangzhou, PR China.
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Zhang Y, Zhai Y, Niu B, Liu X, Zhang X, Wu S, Zhu C. Association between Depression and Clinical Outcomes following Percutaneous Coronary Intervention: A Meta-Analysis. Psychopathology 2022; 55:251-257. [PMID: 35421863 DOI: 10.1159/000524228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/19/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several studies suggested that depression was associated with poor prognosis following percutaneous coronary intervention (PCI) in coronary heart disease (CHD), whereas other studies showed that there were no associations between depression and poor outcomes. OBJECTIVES Considering these problems, this meta-analysis was conducted to evaluate the relationship between depression and clinical outcomes after PCI. METHODS Articles published before July 2021 were analyzed from the databases: PubMed, Web of Science, EMBASE, Medline, and Google Scholar. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed to generate a pooled effect size and 95% CI with a random or fixed effects model. Q test and I2 were used to assess heterogeneities between studies. RESULTS The meta-analysis indicated that depression was associated with a higher risk of major adverse cardiac events (MACE) after PCI with a random effects model (HR = 1.89, 95% CI: 1.33-2.68, I2 = 57.0%, p = 0.023). The study indicated that depression was associated with a higher risk of all-cause mortality after PCI with a fixed effects model (HR = 1.71, 95% CI: 1.43-2.05, I2 = 0.0%, p = 0.756). The study indicated no significant association between depression and risk of repeat revascularization after PCI with a random effects model (HR = 2.10, 95% CI: 0.96-4.58, I2 = 68.9%, p = 0.022). CONCLUSION Results indicated that depression is associated with adverse clinical outcomes in CHD patients' post-PCI. Appropriate mental health check and psychological treatment may be necessary for the prognosis of CHD patients who receive PCI.
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Affiliation(s)
- Yifan Zhang
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - You Zhai
- First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Bohan Niu
- Evidence-based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaolu Liu
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaoxiao Zhang
- First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Shangwen Wu
- First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China
| | - Cuiling Zhu
- First Affiliated Hospital, Henan University of Chinese Medicine, Zhengzhou, China
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Yu C, Zhang T, Shi S, Wei T, Wang Q. Potential biomarkers: differentially expressed proteins of the extrinsic coagulation pathway in plasma samples from patients with depression. Bioengineered 2021; 12:6318-6331. [PMID: 34488523 PMCID: PMC8806736 DOI: 10.1080/21655979.2021.1971037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Depression is a severe disabling psychiatric illness and the pathophysiological mechanisms remain unknown. In previous work, we found the changes in extrinsic coagulation (EC) pathway proteins in depressed patients compared with healthy subjects were significant. In this study, we screened differentially expressed proteins (DEPs) in the EC pathway, and explored the molecular mechanism by constructing a protein-protein interaction (PPI) network. The DEPs of the EC pathwaywere initially screened by isobaric tags for relative and absolute quantification (iTRAQ) in plasma samples obtained from 20 depression patients and 20 healthy controls, and were then identified by Enzyme-linked immunosorbent assays (ELISAs). Ingenuity Pathway Analysis (IPA) software was used to analyse pathway. The differentially expressed genes (DEGs) were identified by analyzing the GSE98793 microarray data from the Gene Expression Omnibus database using the Significance Analysis for Microarrays (SAM, version 4.1) statistical method. Cytoscape version 3.4.0 software was used to construct and visualize PPI networks. The results show that Fibrinogen alpha chain (FGA), Fibrinogen beta chain (FGB), Fibrinogen gamma chain (FGG) and Coagulation factor VII (FVII) were screened in the EC pathway from depression patient samples. FGA, FGB, and FGG were significantly up-regulated, and FVII was down-regulated. Thirteen DEGs related to depression and EC pathways were identified from the microarray database. Among them NF-κB Inhibitor Beta (NFKBIB) and Heat shock protein family B (small) member 1 (HSPB1) were highly correlated with EC pathway. We conclude that EC pathway is associated with depression, which provided clues for the biomarker development and the pathogenesis of depression.
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Affiliation(s)
- Chunyue Yu
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Teli Zhang
- Department of Pharmacy, The People's Hospital of Daqing, Daqing, China
| | - Shanshan Shi
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Taiming Wei
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
| | - Qi Wang
- College of Pharmacy, Harbin Medical University-Daqing, Daqing, China
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Marin TS, Walsh S, May N, Jones M, Gray R, Muir-Cochrane E, Clark RA. Screening for depression and anxiety among patients with acute coronary syndrome in acute care settings: a scoping review. JBI Evid Synth 2021; 18:1932-1969. [PMID: 32813429 DOI: 10.11124/jbisrir-d-19-00316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this review was to scope the literature for publications on the practice of screening for depression and anxiety in acute coronary syndrome patients in acute care by identifying instruments for the screening of anxiety and/or depression; determining if screening for anxiety and/or depression has been integrated into cardiac models of care and clinical pathways; and identifying any evidence practice gap in the screening and management of anxiety and/or depression in this population. INTRODUCTION Depression in acute coronary syndrome is bidirectional. Depression is an independent risk factor for cardiovascular disease, and comorbid depression is associated with a twofold greater risk of mortality in patients with cardiovascular disease. The presence of acute coronary syndrome increases the risk of depressive disorders or anxiety during the first one to two years following an acute event, and both depression and anxiety are associated with a higher risk of further acute coronary health concerns. Clinical practice guidelines have previously recommended routine screening for depression following a cardiac event, although many current guidelines do not include recommendations for screening in an acute setting. To date there have been no previous scoping reviews investigating depression and anxiety screening in patients with acute coronary syndrome in the acute care setting. INCLUSION CRITERIA Adults (18 years and over) with acute coronary syndrome who are screened for anxiety and/or depression (not anxiety alone) in an acute care setting. METHODS A systematic search of the literature was conducted by a research librarian. Research studies of any design published in English from January 1, 2012, to May 31, 2018, were included. Data were extracted from the included studies to address the three objectives. Purposefully designed tables were used to collate information and present findings. Data are also presented as figures and by narrative synthesis. RESULTS Fifty-one articles met the inclusion criteria. Primary research studies were from 21 countries and included 21,790 participants; clinical practice guidelines were from two countries. The most common instruments used for the screening of depression and anxiety were: i) the Hospital Anxiety and Depression Scale (n = 18); ii) the Beck Depression Inventory (n = 16); and iii) the nine-item Patient Health Questionnaire (n = 7). Eleven studies included screening for anxiety in 2181 participants (30% female) using the full version of the Hospital Anxiety and Depression Scale. The State-Trait Anxiety Inventory was used to screen 444 participants in three of the studies. Four studies applied an intervention for those found to have depression, including two randomized controlled trials with interventions targeting depression. Of the seven acute coronary syndrome international guidelines published since 2012, three (43%) did not contain any recommendations for screening for depression and anxiety, although four (57%) had recommendations for treatment of comorbidities. CONCLUSIONS This review has identified a lack of consistency in how depression and anxiety screening tools are integrated into cardiac models of care and clinical pathways. Guidelines for acute coronary syndrome are not consistent in their recommendations for screening for depression and/or anxiety, or in identifying the best screening tools.
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Affiliation(s)
- Tania S Marin
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Warnambool, Australia
| | - Nikki May
- South Australian Health Library Service, Flinders Medical Centre, Bedford Park, Australia
| | - Martin Jones
- Department of Rural Health, University of South Australia, Warnambool, Australia
| | - Richard Gray
- School of Nursing and Midwifery, LaTrobe University, Bundoora, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Wang D, Dai F, Liu W, Ge L, Qi X, Ma G. Longitudinal change and prognostic value of anxiety and depression in coronary heart disease patients. Ir J Med Sci 2020; 190:107-116. [PMID: 32661829 DOI: 10.1007/s11845-020-02302-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study aimed to investigate the longitudinal changes and risk factors of anxiety and depression, as well as their values in predicting major adverse cardiovascular events (MACE) occurrence in coronary heart disease (CHD) patients. METHODS Every 3 months until 36 months (M36), 190 newly diagnosed CHD patients were consecutively recruited and followed up. Anxiety and depression were assessed using hospital anxiety and depression scale (HADS) at each follow-up timepoint. Meanwhile, MACE occurrence was recorded. RESULTS Anxiety occurrence sustainably increased from 42.6% at baseline to 51.1% at M36; meanwhile, depression occurrence also sustainably elevated from 33.3% at baseline to 43.7% at M36. Then, independent risk factors for anxiety and depression at baseline/1 year/2 years/3 years were assessed, which revealed that female, diabetes, and higher Gensini score independently predicted anxiety occurrence at each time point, while single/divorced/widowed status independently predicted anxiety occurrence at some specific time points; regarding depression, female, single/divorced/widowed status, diabetes and higher Gensini score independently predicted depression occurrence at each time point, whereas higher education duration, family history of CHD and age > 60 years only predicted depression at some individual time points. Interestingly, baseline/1-year depression were correlated with increased accumulating MACE occurrence, while no correlation of baseline/1-year /2-year/3-year anxiety or 2-year/3-year depression with accumulating MACE occurrence was found. CONCLUSION Anxiety and depression are common and progress sustainably with female, diabetes, and higher Gensini score as their independent risk factors; meanwhile, depression but not anxiety may predict increased accumulating MACE occurrence in CHD patients.
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Affiliation(s)
- Dongdong Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
| | - Fei Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Wenjie Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Lanling Ge
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiaohong Qi
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Guodi Ma
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
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Song X, Song J, Shao M, Gao X, Ji F, Tian H, Xu Y, Zhuo C. Depression predicts the risk of adverse events after percutaneous coronary intervention: A meta-analysis. J Affect Disord 2020; 266:158-164. [PMID: 32056871 DOI: 10.1016/j.jad.2020.01.136] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/21/2019] [Accepted: 01/25/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Depression is correlated with poor prognosis in patients with coronary artery disease (CAD). The goal of this meta-analysis was to assess the influence of depression on the risks of major adverse cardiovascular events (MACEs) and all-cause mortality after percutaneous coronary intervention (PCI). METHODS Cohort studies were obtained by searching PubMed and Embase databases. Cohort studies regarding the association between depression and risks of MACEs and mortality after PCI were included. Heterogeneity was determined using the Cochrane's Q test and calculated using I2. A fixed-effect model was used if no significant heterogeneity was detected; otherwise a random-effect model was applied. The adjusted risk ratio [RR] for the incidences of MACEs and all-cause mortality in patients with depression were compared to those without depression. RESULTS Nine cohorts including 4,555 CAD patients who underwent PCI were included in this meta-analysis, and 1,108 of these patients were diagnosed with depression. There were no significant differences among studies evaluating MACEs and mortality risks (I2 = 25% and 0%, respectively). Pooled results showed that depression was associated with higher risk of MACEs (RR: 2.10, 95% confidence interval [CI]: 1.59 to 2.77, p < 0.001) and all-cause mortality (RR: 1.76, 95% CI: 1.45 to 2.13, p < 0.001) during follow-up after PCI. LIMITATIONS Available full text peer reviewed studies were limited and only studies in English were included in this analysis. CONCLUSIONS Depressive symptoms were independently associated with adverse cardiovascular outcomes in patients who received PCI. Psychological therapy that does not increase cardiac burden or induce pharmacological side effects may be a better strategy to treat depression associated with PCI.
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Affiliation(s)
- Xueqin Song
- The First Affiliated Hospital Zhengzhou University, Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, 450052, China
| | - Junxian Song
- Department of Cardiology, Peking University people's Hospital, Beijing, 100201, China
| | - Mingjing Shao
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xiangyang Gao
- Health Management Institute, Center for Statistical Analysis of Medical Data, Medical Big Data Analysis Center, Chinese PLA General Hospital, Beijing, 100191, China
| | - Feng Ji
- School of Mental Health, Jining Medical University, Jining, 272119, Shandong Province, China
| | - Hongjun Tian
- Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, School of Basic Medical Research, Tianjin Medical University, Tianjin, 300075, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China, MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Chuanjun Zhuo
- The First Affiliated Hospital Zhengzhou University, Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Henan Psychiatric Transformation Research Key Laboratory/Zhengzhou University, Zhengzhou, 450052, China; School of Mental Health, Jining Medical University, Jining, 272119, Shandong Province, China; Psychiatric-Neuroimaging-Genetics-Comorbidity Laboratory, Tianjin Mental Health Centre, Mental Health Teaching Hospital of Tianjin Medical University, Tianjin Anding Hospital, School of Basic Medical Research, Tianjin Medical University, Tianjin, 300075, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China, MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan, 030001, China.
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Wang W, Cai D. Complement Components sC5b-9 and CH50 Predict Prognosis in Heart Failure Patients Combined With Hypertension. Am J Hypertens 2020; 33:53-60. [PMID: 31429866 DOI: 10.1093/ajh/hpz140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Heart failure (HF), resulting from inflammation and vessel injury, is one of the leading causes of poor quality of life and premature death. The complement system plays a leading role in vessel integrity and inflammation response. However, the association between serum complement level and the prognosis of HF remains unclear. METHODS In our study, a total of 263 newly diagnosed hypertension patients with HF were included. Eight classical cardiovascular risk factors were collected, and plasma C3a, C3b, C5a, sC5b-9, and CH50 levels were detected. RESULTS Compared with the control group, plasma C5a (P<0.001), sC5b-9 (P<0.001), and CH50 (P = 0.004) levels of hypertension patients with HF were significantly increased. On the basis of univariate analysis, an older age, higher frequency of alcohol consumption, high level of body mass index, medium or high risk of hypertension, hyperlipidemia, and diabetes were poor prognostic factors whereas low levels of C5a, sC5b-9, and CH50 were associated with favorable overall survival (OS). When these factors fit into a multivariate regression model, patients with hyperlipidemia (P = 0.002, hazard ratio [HR] = 3.09), N-terminal pro-Brain Natriuretic Peptide (NT-pro-BNP) ≥ 14.8 (P < 0.001, HR = 11.14), sC5b-9 level ≥ 1,406.2 µg/ml (P = 0.180, HR = 5.51) or CH50 level ≥ 294.6 µg/ml (P < 0.001, HR = 4.57) remained statistically factors for worsened OS and regarded as independent risk factors. These independently associated risk factors were used to form an OS estimation nomogram. Nomogram demonstrated good accuracy in estimating the risk, with a bootstrap-corrected C index of 0.789. CONCLUSIONS sC5b-9 and CH50 levels are increased in hypertension patients with HF. Nomogram based on multivariate analysis has good accuracy in estimating the risk of OS.
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Affiliation(s)
- Wenyuan Wang
- Department of Cardiology, Jiangdu People’s Hospital ofYangzhou City, Yangzhou, Jiangsu, P.R. China
| | - Dinghua Cai
- Department of Cardiology, Jiangdu People’s Hospital ofYangzhou City, Yangzhou, Jiangsu, P.R. China
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Zhang WY, Nan N, Song XT, Tian JF, Yang XY. Impact of depression on clinical outcomes following percutaneous coronary intervention: a systematic review and meta-analysis. BMJ Open 2019; 9:e026445. [PMID: 31434764 PMCID: PMC6707663 DOI: 10.1136/bmjopen-2018-026445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The objective of this meta-analysis was to assess whether depression in percutaneous coronary intervention (PCI) patients is associated with higher risk of adverse outcomes. DESIGN Systematic review and meta-analysis. METHODS EMBASE, PubMed, CINAHL and PsycINFO were searched as data sources. We selected prospective cohort studies evaluating the relationship between depression and any adverse medical outcome, including all-cause mortality, cardiac mortality and non-fatal events, from inception to 28 February 2019. Two reviewers independently extracted information and calculated the risk of cardiovascular events in patients with preoperative or postoperative depression compared with non-depressed patients. RESULTS Eight studies (n=3297) met our inclusion criteria. Most studies found a positive association between depression and adverse cardiovascular outcomes. Meta-analysis yielded an aggregate risk ratio of 1.57 (95% CI 1.28 to 1.92, p<0.0001) for the magnitude of the relation between depression and adverse outcomes. CONCLUSIONS Our systematic review and meta-analysis suggests that depression is associated with an increased risk of worse clinical outcome or mortality in patients undergoing PCI. Assessment time and length of follow-up do not have a significant effect on this conclusion.
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Affiliation(s)
- Wen Yi Zhang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Nan Nan
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xian Tao Song
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jin Fan Tian
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xue Yao Yang
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Lee R, Yu H, Gao X, Cao J, Tao H, Yu B, Wang Y, Lin P. The negative affectivity dimension of Type D personality is associated with in-stent neoatherosclerosis in coronary patients with percutaneous coronary intervention: An optical coherence tomography study. J Psychosom Res 2019; 120:20-28. [PMID: 30929704 DOI: 10.1016/j.jpsychores.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In-stent neoatherosclerosis (ISNA) is involved in the pathogenesis of in-stent restenosis and major adverse cardiac events (MACE) in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). We aimed to explore the association between Type D personality and ISNA via in vivo optical coherence tomography (OCT). METHODS One hundred and fifty-six patients with CAD completed the Type D Scale-14 and underwent in vivo measurement of in-stent neoatherosclerosis by OCT. The Type D construct was analyzed as both the dichotomous and the dimension constructs. RESULTS After adjusting for demographic and clinical factors and presenting as a dichotomous construct, Type D personality was independently associated with the presence of in-stent neoatherosclerosis (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.35-6.63, p = 0.007) and in-stent thin-cap fibroatheroma (OR = 2.81, 95% CI = 1.27-6.23, p = 0.01). Meanwhile, the multiple logistic regression also showed that the main effect of negative affectivity was an independent risk factor of in-stent neoatherosclerosis (OR = 1.85, 95% CI = 1.25-2.75, p = 0.002) and in-stent thin-cap fibroatheroma (OR = 1.77, 95% CI = 1.18-2.67, p = 0.006). However, the main effects of social inhibition with in-stent neoatherosclerosis and in-stent thin-cap fibroatheroma (OR = 0.98, 95% CI = 0.64-1.52, p = 0.94; OR = 0.94, 95% CI = 0.63-1.39, p = 0.75, respectively) as well as the interaction of negative affectivity and social inhibition were not significant (OR = 0.71, 95% CI = 0.69-1.81, p = 0.11; OR = 0.72, 95% CI = 0.47-1.08, p = 0.12, respectively). CONCLUSIONS Type D personality was found to be independently associated with in-stent neoatherosclerosis via OCT in patients with CAD after PCI. It was negative affectivity, not social inhibition, that affected the occurrence of the in-stent neoatherosclerosis, these results challenged the usefulness of the Type D construct. Our findings may provide new insights regarding the mechanisms of the association between Type D personality and MACE after PCI.
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Affiliation(s)
- Ruxue Lee
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huai Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xueqin Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianqin Cao
- College of Nursing of Harbin Medical University, Daqing, China
| | - Hui Tao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Ping Lin
- College of Nursing of Harbin Medical University, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
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10
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Lehmann M, Kohlmann S, Gierk B, Murray AM, Löwe B. Suicidal ideation in patients with coronary heart disease and hypertension: Baseline results from the DEPSCREEN-INFO clinical trial. Clin Psychol Psychother 2018; 25:754-764. [PMID: 29971880 DOI: 10.1002/cpp.2305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND A high proportion of cardiac patients suffers from depression, which is an antecedent for suicidal ideation. This study identifies clinical vulnerabilities for suicidal ideation in cardiac patients. METHODS The primary outcome of the study was severity of suicidal ideation as measured with the Patient Health Questionnaire (PHQ-9) item No. 9. Covariates were demographics, cardiac characteristics (i.e., Canadian Cardiovascular Society angina rating of chest pain and New York Heart Association rating of shortness of breath), depression (PHQ-8,i.e., PHQ-9 minus item No. 9), anxiety (Generalized Anxiety Disorder-7, GAD-7), somatic symptoms (PHQ-15), illness perception (Brief-Illness Perception Questionnaire), and health-related quality of life (EuroQol-5D, EQ 5D). RESULTS Data from 1,976 patients were analysed. At least 14% (95% CI [12%, 16%]) of patients indicated suicidal ideations within the last 2 weeks. Bivariate analyses yielded associations between suicidal ideation and higher levels of depression severity, anxiety severity, somatic symptom burden, chest pain, shortness of breath, negative illness perceptions, reduced health-related quality of life, and a higher probability of living alone (all p < 0.001). A multivariable ordinal regression revealed depression severity and anxiety severity to show the highest associations with suicidal ideation (ORPHQ-8 = 1.22, p < 0.001; ORGAD-7 = 1.09, p < 0.001). Having a defibrillator implant was associated with a lower probability of suicidal ideation (OR = 0.27, p = 0.017). CONCLUSIONS This study identified several clinical vulnerabilities of suicidal ideation. The results stress the importance of screening for suicidal ideation in clinical practice.
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Affiliation(s)
- Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Gierk
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Ochsenzoll, Hamburg, Germany
| | - Alexandra M Murray
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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de Jager TAJ, Dulfer K, Radhoe S, Bergmann MJ, Daemen J, van Domburg RT, Lenzen MJ, Utens EMWJ. Predictive value of depression and anxiety for long-term mortality: differences in outcome between acute coronary syndrome and stable angina pectoris. Int J Cardiol 2017; 250:43-48. [PMID: 28992998 DOI: 10.1016/j.ijcard.2017.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/05/2017] [Accepted: 10/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Since the early 2000s the treatment of choice for an acute myocardial infarction has moved from thrombolytic therapy to primary PCI (pPCI). As a result, the majority of patients undergoing PCI shifted from stable angina pectoris (SA) to acute coronary syndrome (ACS). Additionally the previously observed association between depression and anxiety and long-term outcome in patients who underwent a PCI may have been changed. The main objective of this study was to investigate the predictive value of depression and anxiety for 10-year mortality, in a cohort with post-PCI patients treated for SA versus patients treated for ACS. METHODS This prospective single center cohort consists of a consecutive series of patients (n=528) treated with PCI. At 1month post-PCI, patients completed the Dutch version of the Hospital Anxiety and Depression Scale (HADS). RESULTS After adjustment for baseline characteristics depression was associated with higher 10-year mortality post-PCI (HR 1.58 95% Confidence Interval [95% CI] 1.04-2.40). In the ACS population no association between depression and 10-year mortality was found (HR 1.05 95% CI 0.62-1.79), in contrast to the SA population (HR 1.97 95% CI 1.09-3.57). After additional adjustment for anxiety, depression was no longer associated with higher mortality. CONCLUSIONS Anxiety at baseline was associated with an increased 10-year mortality rate after PCI. Depression was also associated with higher 10-year mortality, however the association disappeared after additional adjustment for anxiety. This finding was more pronounced in patients presenting with SA as compared to those presenting with ACS, which might be a result of the increasing number of ACS patients treated with pPCI.
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Affiliation(s)
- Tom A J de Jager
- Department of Cardiology, Thoraxcenter Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sumant Radhoe
- Department of Cardiology, Thoraxcenter Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michael J Bergmann
- Department of Cardiology, Thoraxcenter Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Mattie J Lenzen
- Department of Cardiology, Thoraxcenter Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands; Research Institute of Child Development and Education, University of Amsterdam/de Bascule-AMC, The Netherlands
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12
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13
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Yu HY, Park YS, Son YJ. Combined effect of left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention: a 12-month follow-up. Eur J Cardiovasc Nurs 2016; 16:37-45. [PMID: 26888962 DOI: 10.1177/1474515116634530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the technical advancement of percutaneous coronary intervention, major adverse cardiac events after percutaneous coronary intervention are still a critical issue in Korea as well as in western society. Recently, low left ventricular ejection fraction and depressive symptoms have been regarded as independent predictors of adverse outcomes after successful primary percutaneous coronary intervention. However, there are few studies on the combined effect of left ventricular ejection fraction at baseline and post-cardiac depressive symptoms on major adverse cardiac events after percutaneous coronary intervention. AIM The aim of the current study is to examine the combined effect of low left ventricular ejection fraction and post-cardiac depressive symptoms on major adverse cardiac events after successful primary percutaneous coronary intervention. METHODS A total of 221 patients who underwent successful percutaneous coronary intervention were assessed for left ventricular ejection fraction and depressive symptoms at baseline and 1 month after discharge, using the patient health questionnaire 9. Major adverse cardiac event-free survival rates during the 12-month follow-up period were analysed by Kaplan-Meier survival curves and Cox proportional hazard regression methods. RESULTS We found that the combined effect of baseline left ventricular ejection fraction less than 60% and depressive symptoms at 1 month after discharge were significantly correlated with increased incidence of major adverse cardiac events after successful primary percutaneous coronary intervention (hazard ratio 4.049; 95% confidence interval 1.365-12.011) after adjusting for sex, high sensitivity C-reactive protein, depressive symptoms at baseline and comorbidity. CONCLUSIONS Our results suggest that healthcare professionals should be aware of the necessity of early screening for post-cardiac depressive symptoms after discharge in percutaneous coronary intervention patients with a low left ventricular ejection fraction.
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Affiliation(s)
- Hye Yon Yu
- 1 Red Cross College of Nursing, Chung-Ang University, Republic of Korea
| | - Young-Su Park
- 2 College of Nursing, Yonsei University, Republic of Korea
| | - Youn-Jung Son
- 1 Red Cross College of Nursing, Chung-Ang University, Republic of Korea
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14
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Du J, Zhang D, Yin Y, Zhang X, Li J, Liu D, Pan F, Chen W. The Personality and Psychological Stress Predict Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention for Five Years. Medicine (Baltimore) 2016; 95:e3364. [PMID: 27082597 PMCID: PMC4839841 DOI: 10.1097/md.0000000000003364] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To investigate the effects of personality type and psychological stress on the occurrence of major adverse cardiovascular events (MACEs) at 5 years in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Two hundred twenty patients with stable angina (SA) or non-ST segment elevation acute coronary syndrome (NSTE-ACS) treated with PCI completed type A behavioral questionnaire, type D personality questionnaire, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Trait Coping Style Questionnaire (TCSQ), and Symptom Checklist 90 (SCL-90) at 3 days after PCI operation. Meanwhile, biomedical markers (cTnI, CK-MB, LDH, LDH1) were assayed. MACEs were monitored over a 5-year follow-up. NSTE-ACS group had higher ratio of type A behavior, type A/D behavior, and higher single factor scores of type A personality and type D personality than control group and SAP group. NSTE-ACS patients had more anxiety, depression, lower level of mental health (P < 0.05; P < 0.01), more negative coping styles and less positive coping styles. The plasma levels of biomedical predictors had positive relation with anxiety, depression, and lower level of mental health. Type D patients were at a cumulative increased risk of adverse outcome compared with non-type D patients (P < 0.05). Patients treated with PCI were more likely to have type A and type D personality and this tendency was associated with myocardial injury. They also had obvious anxiety, depression emotion, and lower level of mental health, which were related to personality and coping style. Type D personality was an independent predictor of adverse events.
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Affiliation(s)
- Jinling Du
- From the Key Laboratory of Cardiovascular Remodeling and Function Research (JD, DZ, YY, XZ, JL, WC), Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong; and Institute of Medical Psychology School of Medicine (DL, FP), Shandong University, Jinan, China
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15
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Effects of stress, health competence, and social support on depressive symptoms after cardiac hospitalization. J Behav Med 2015; 39:441-52. [PMID: 26660867 DOI: 10.1007/s10865-015-9702-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/25/2015] [Indexed: 12/23/2022]
Abstract
Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.
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16
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Albarqouni L, von Eisenhart Rothe A, Ronel J, Meinertz T, Ladwig KH. Frequency and covariates of fear of death during myocardial infarction and its impact on prehospital delay: findings from the multicentre MEDEA Study. Clin Res Cardiol 2015. [PMID: 26210771 DOI: 10.1007/s00392-015-0895-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fear of death (FoD) is an exceptionally stressful symptom of ST-elevation myocardial infarction (STEMI), which received little scientific attention in recent years. We aimed to describe the prevalence and factors contributing to FoD among STEMI patients and assess the impact of FoD on prehospital delay. METHODS This investigation was based on 592 STEMI patients who participated in the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. Multivariate logistic regression models were used to identify factors associated with FoD. RESULTS A total of 15% of STEMI patients reported FoD (n = 88), no significant gender difference was found. STEMI pain strength [OR = 2.3 (1.4-3.9)], STEMI symptom severity [OR = 3.7 (2-6.8)], risk perception pre-STEMI [OR = 1.9 (1.2-3.2)] and negative affectivity [OR = 1.9 (1.2-3.1)] were independently associated with FoD. The median delay for those who experienced FoD was 139 min compared to 218 min for those who did not (p = 0.005). Male patients with FoD were significantly more likely to delay less than 120 min [OR = 2.11(1.25-3.57); p = 0.005], whereas in women, this association was not significant. Additionally, a clear dose-response relationship between fear severity and delay was observed. Male FoD patients significantly more often used emergency services to reach the hospital (p = 0.003). CONCLUSIONS FoD is experienced by a clinically meaningful minority of vulnerable STEMI patients and is strongly associated with shorter delay times in men but not in women. Patients' uses of emergency services play an important role in reducing the delay in male FoD patients.
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Affiliation(s)
- L Albarqouni
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - A von Eisenhart Rothe
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - J Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - T Meinertz
- Department of Cardiology, University Heart Center Hamburg Eppendorf, Klinikum Stephansplatz, Hamburg, Germany
| | - K H Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
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