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Veskovic J, Cvetkovic M, Tahirovic E, Zdravkovic M, Apostolovic S, Kosevic D, Loncar G, Obradovic D, Matic D, Ignjatovic A, Cvetkovic T, Posch MG, Radenovic S, Ristić AD, Dokic D, Milošević N, Panic N, Düngen HD. Depression, anxiety, and quality of life as predictors of rehospitalization in patients with chronic heart failure. BMC Cardiovasc Disord 2023; 23:525. [PMID: 37891464 PMCID: PMC10612261 DOI: 10.1186/s12872-023-03500-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/06/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is a severe condition, often co-occurring with depression and anxiety, that strongly affects the quality of life (QoL) in some patients. Conversely, depressive and anxiety symptoms are associated with a 2-3 fold increase in mortality risk and were shown to act independently of typical risk factors in CHF progression. The aim of this study was to examine the impact of depression, anxiety, and QoL on the occurrence of rehospitalization within one year after discharge in CHF patients. METHODS 148 CHF patients were enrolled in a 10-center, prospective, observational study. All patients completed two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and the Questionnaire Short Form Health Survey 36 (SF-36) at discharge timepoint. RESULTS It was found that demographic and clinical characteristics are not associated with rehospitalization. Still, the levels of depression correlated with gender (p ≤ 0.027) and marital status (p ≤ 0.001), while the anxiety values were dependent on the occurrence of chronic obstructive pulmonary disease (COPD). However, levels of depression (HADS-Depression) and anxiety (HADS-Anxiety) did not correlate with the risk of rehospitalization. Univariate logistic regression analysis results showed that rehospitalized patients had significantly lower levels of Bodily pain (BP, p = 0.014), Vitality (VT, p = 0.005), Social Functioning (SF, p = 0.007), and General Health (GH, p = 0.002). In the multivariate model, poor GH (OR 0.966, p = 0.005) remained a significant risk factor for rehospitalization, and poor General Health is singled out as the most reliable prognostic parameter for rehospitalization (AUC = 0.665, P = 0.002). CONCLUSION Taken together, our results suggest that QoL assessment complements clinical prognostic markers to identify CHF patients at high risk for adverse events. CLINICAL TRIAL REGISTRATION The study is registered under http://clinicaltrials.gov (NCT01501981, first posted on 30/12/2011), sponsored by Charité - Universitätsmedizin Berlin.
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Affiliation(s)
- Jovan Veskovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany.
- Scirent Clinical Research and Science, 13353, Berlin, Germany.
| | - Mina Cvetkovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany
| | - Elvis Tahirovic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Marija Zdravkovic
- Department of Cardiology, Faculty of Medicine, University Clinical Hospital Center Bezanijska Kosa, University of Belgrade, Belgrade, 11000, Serbia
| | - Svetlana Apostolovic
- Department for Cardiovascular Diseases, Clinical Centre Niš, University of Niš, Niš, 18000, Serbia
| | - Dragana Kosevic
- Institute for Cardiovascular Diseases Dedinje, Department of Cardiology, Belgrade, 11000, Serbia
| | - Goran Loncar
- Institute for Cardiovascular Diseases Dedinje, Department of Cardiology, Belgrade, 11000, Serbia
- Faculty of Medicine, Department of Cardiology, University of Belgrade, University Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Danilo Obradovic
- Heart Center of Leipzig, University of Leipzig, 04289, Leipzig, Germany
| | - Dragan Matic
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, 11000, Serbia
| | | | | | | | - Sara Radenovic
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany
| | - Arsen D Ristić
- Faculty of Medicine, Department of Cardiology, University of Belgrade, University Clinical Center of Serbia, Belgrade, 11000, Serbia
| | - Danilo Dokic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Nenad Milošević
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Natasa Panic
- Scirent Clinical Research and Science, 13353, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine, Cardiology, CVK, Charité University Medicine Berlin, 13353, Berlin, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 13353, Berlin, Germany.
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Euteneuer F, Neuert M, Salzmann S, Fischer S, Ehlert U, Rief W. Does psychological treatment of major depression reduce cardiac risk biomarkers? An exploratory randomized controlled trial. Psychol Med 2023; 53:3735-3749. [PMID: 35232509 PMCID: PMC10277774 DOI: 10.1017/s0033291722000447] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/31/2021] [Accepted: 02/07/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Depression is associated with an increased risk for cardiovascular disease (CVD). Biological cardiac risk factors are already elevated in depressed patients without existing CVD. The purpose of this exploratory trial was to examine whether treating Major Depression (MD) with cognitive behavioral therapy (CBT) is associated with improvements in cardiac risk biomarkers and whether depressive symptom severity at baseline moderates treatment effects. METHODS Eighty antidepressant-free patients with MD were randomly assigned to CBT or waiting list (WL). Biological outcomes included long-term recordings (24-h, daytime, nighttime) of heart rate, heart rate variability (HRV), and blood pressure, as well as inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MD at study entry. RESULTS Compared to WL, CBT was associated with a significant increase in overall HRV, as indexed by the 24-h and daytime HRV triangular index, as well as trend improvements in 24-h low-frequency HRV and daytime systolic blood pressure. Self-rated depressive symptom severity moderated (or tended to moderate) improvements in CBT for 24-h and daytime heart rate and several indices of HRV (especially daytime measures). Inflammatory treatment effects were not observed. CONCLUSIONS CBT increased overall HRV in patients with MD. Initially more depressed patients showed the most pronounced cardiovascular improvements through CBT. These exploratory findings may provide new insights into the biological effects of psychological treatment against depression and must be confirmed through future research.
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Affiliation(s)
- Frank Euteneuer
- Clinical Psychology and Psychotherapy, Department of Psychology, Medical School Berlin, Berlin, Germany
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Marie Neuert
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Stefan Salzmann
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Susanne Fischer
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
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3
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Eisele M, Rakebrandt A, Boczor S, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. The association of general practitioners' awareness of depression and anxiety with change in quality of life in heart failure patients: results of the prospective observational RECODE-HF cohort study. Fam Pract 2022; 39:346-353. [PMID: 34694380 DOI: 10.1093/fampra/cmab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression and anxiety are more prevalent in patients with heart failure (HF) than in the general population and reduce quality of life (QoL); therefore, clinical guidelines recommend screening HF patients for depression/anxiety. OBJECTIVE We investigated, whether the general practitioners' (GPs) awareness of patients' symptoms of depression and/or anxiety (psychosocial distress) was associated with a change in QoL. METHODS In this prospective observational study, we recruited 3,129 primary care HF patients in Germany. Patients completed baseline and 12-month follow-up questionnaires. Their GPs were interviewed. We identified 666 patients with psychosocial distress and compared 2 groups by analysis of covariance: 235 patients with psychosocial distress whose GP was aware of the psychosocial distress and 431 patients with psychosocial distress whose GP was unaware of such distress. Primary outcome was the change in QoL, assessed by the EQ-5D visual analogue scale. RESULTS Patients with psychosocial distress showed lower baseline QoL than those without (45.9 vs 64.1; P < 0.001). Within the patients with psychosocial distress, the GPs' awareness of psychosocial distress was not associated with improvement of QoL (F = 1.285; P = 0.258) or remission of psychosocial distress (odds ratio = 0.887; P = 0.608). CONCLUSION We found no association between the GPs' awareness of psychosocial distress and change in QoL. Although data for effective treatments of depression in HF are currently insufficient, psychosocial distress strongly impairs the QoL in HF patients. These findings might influence the development of clinical practice guidelines in HF.
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Affiliation(s)
- Marion Eisele
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrid Boczor
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Blozik
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Luebeck, Germany
| | - Stefan Störk
- University and University Hospital Würzburg, Comprehensive Heart Failure Center Würzburg, Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Altamura M, D’Andrea G, Angelini E, Tortorelli FMP, Balzotti A, Porcelli P, Margaglione M, Brunetti ND, Cassano T, Bellomo A. Psychosomatic syndromes are associated with IL-6 pro-inflammatory cytokine in heart failure patients. PLoS One 2022; 17:e0265282. [PMID: 35271674 PMCID: PMC8912235 DOI: 10.1371/journal.pone.0265282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
Psychosomatic syndromes have emerged as an important source of comorbidity in cardiac patients and have been associated with increased risk for adverse outcomes in patients with heart failure (HF). Understanding of the mechanisms underlying this connection is limited, however immune activity represents a possible pathway. While there have been numerous studies connecting immune activity to psychosomatic psychopathology, there is a lack of research on patients with HF. We examined forty-one consecutive outpatients affected by HF. We assessed psychosomatic psychopathology using the Diagnostic Criteria for Psychosomatic Research (DCPR) and the Patient Health Questionnaire-15 (PHQ-15). The Psychosocial Index (PSI) was used for assessing stress and psychosocial dimensions. Depression was evaluated with Beck Depression Inventory-II (BDI-II). Circulating levels of proinflammatory cytokines IL-6 and TNF-alpha were ascertained. Univariate and multivariable regression models were used to test for associations between inflammatory cytokines and psychosomatic psychopathology (i.e., DCPR syndromes, PHQ-15) and psychological dimensions (i.e., BDI-II, PSI). A significant positive correlation was found between IL-6 levels and psychosomatic psychopathology even when controlling for any confounding variables (i.e., Body-mass index (BMI), New York Heart Association (NYHA) class, smoking habits, alcohol consumption, statin use, aspirin use, beta blockers use, age, and gender). In contrast, the associations between TNF-alpha levels were non-significant. These findings can contribute to research in support of a psychoneuroimmune connection between psychosomatic psychopathology and HF. Findings also suggest the possibility that elevated IL-6 levels are more relevant for the pathogenesis of psychosomatic syndromes than for depression in patients with HF.
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Affiliation(s)
- Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- * E-mail:
| | - Giovanna D’Andrea
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Eleonora Angelini
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Angela Balzotti
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Piero Porcelli
- Department of Psychological, Health and Territorial Sciences, D’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Maurizio Margaglione
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Natale D. Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tommaso Cassano
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
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Altınkaynak Yılmaz T, Ozdelikara A. The effect on the anxiety level of the social support given to multiple sclerosis patients. Perspect Psychiatr Care 2022; 58:411-417. [PMID: 33908627 DOI: 10.1111/ppc.12807] [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: 01/25/2021] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE This is a descriptive study aiming at determining the effect on the anxiety level of the social support given to multiple sclerosis (MS) patients. DESIGN AND METHODS This study was conducted with 123 MS patients. The data were collected the Multidimensional Scale of Perceived Social Support (MSPSS), the Hamilton Anxiety Rating Scale (HAM-A). RESULTS The Multidimensional Scale of Perceived Social Support total score average was 57.18 ± 18.5, and the HAM-A total score average was 20.33 ± 10.42. A negative weak significant relationship was found between the MSPSS total score average and the HAM-A total score and its sub-dimensions. PRACTICE IMPLICATIONS MS nurses should plan their anxiety management accordingly by giving holistic care and evaluating social support mechanisms.
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Affiliation(s)
| | - Afitap Ozdelikara
- Department of Internal Medicine Nursing, Faculty of Health Science, Ondokuz Mayis University Hospital, Samsun, Turkey
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Polsook R, Aungsuroch Y. A cross-sectional study of factors predicting readmission in Thais with coronary artery disease. J Res Nurs 2021; 26:293-304. [PMID: 35251254 PMCID: PMC8894994 DOI: 10.1177/1744987120946792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Coronary artery disease is a major cause of morbidity and mortality with high readmission rates. Hospital readmissions for coronary artery disease contribute to rising healthcare costs and are a marker of quality of care. Despite this, prior studies have found that readmission rates vary widely. AIMS This study aims to determine the impact of social support, depression, comorbidities, symptom severity, quality of life and readmission among coronary artery disease patients in Thailand. METHODS A total of 321 coronary artery disease patients from tertiary care hospitals across all regions of Thailand were recruited for this study. Data were analysed using multiple regression analysis. RESULTS The coefficient for social support (beta = -0.22) was found to be significant (p < 0.05), whereas comorbidity, symptom severity, depression and quality of life were not significant. Thus, social support was found to be the most significant predictive factor for readmission. CONCLUSIONS Accordingly, when designing effective nursing interventions, nurses should promote social support interventions for coronary artery disease patients to improve the quality of care, decrease readmission rates and improve patients' quality of life.
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Affiliation(s)
- Rapin Polsook
- Rapin Polsook, Faculty of Nursing, Chulalongkorn University, Floor 11, Boromarajonani Srisatapat Building, Rama 1 Road, Patumwan, Bangkok 10330, Thailand.
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Henry TL, Schmidt S, Lund MB, Haynes T, Ford D, Egwuogu H, Schmitz S, McGregor B, Toomer L, Bussey-Jones J. Improving Depression Screening in Underserved Populations in a Large Urban Academic Primary Care Center: A Provider-Centered Analysis and Approach. Am J Med Qual 2019; 35:315-322. [PMID: 31701768 DOI: 10.1177/1062860619884639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Screening for depression is paramount to identify patients with depression and link them to care, yet only 29% of patients in the primary care center (PCC) were screened for depression in 2016. A baseline survey identified provider barriers to depression screening, including lack of time, support staff, and referral resources. The purpose of this project was to increase depression screening in the PCC using the Patient Health Questionnaire (PHQ-2/9). The authors created an educational program for staff and providers that included referral resources, treatment guidelines, and a decision-support tool in the electronic medical record. A retrospective chart review was performed, from January 2016 to June 2017, to determine the percentage of patients who received annual depression screening. During the program, the PCC saw an increase in depression screening rates. Thus, it is possible to overcome barriers to depression screening in a primary care setting by providing resources and education to clinicians.
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Association of Depression Risk with Patient Experience, Healthcare Expenditure, and Health Resource Utilization Among Adults with Atherosclerotic Cardiovascular Disease. J Gen Intern Med 2019; 34:2427-2434. [PMID: 31489560 PMCID: PMC6848728 DOI: 10.1007/s11606-019-05325-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/29/2019] [Accepted: 08/07/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. OBJECTIVE To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those without depression), and those with depression (vs. risk-stratified non-depressed). DESIGN AND SETTING The 2004-2015 Medical Expenditure Panel Survey (MEPS) was used for this study. PARTICIPANTS Adults ≥ 18 years with a diagnosis of ASCVD, ascertained by ICD-9 codes and/or self-reported data. Individuals with a diagnosis of depression were identified by ICD-9 code 311. Participants were stratified by depression risk, based on the Patient Health Questionnaire-2. RESULTS A total of 19,840 participants were included, translating into 18.3 million US adults, of which 8.6% (≈ 1.3 million US adults) had a high risk for depression and 18% had a clinical diagnosis of depression. Among ASCVD patients without depression, those with a high risk (compared with low risk) had increased overall and out-of-pocket expenditures (marginal differences of $2880 and $287, respectively, both p < 0.001), higher odds for resource utilization, and worse patient experience and healthcare quality of life (HQoL). Furthermore, compared with individuals who had depression, participants at high risk also reported worse HQoL and had higher odds of poor perception of their health status (OR 1.83, 95% CI [1.50, 2.23]) and poor patient-provider communication (OR 1.29 [1.18, 1.42]). LIMITATION The sample population includes self-reported diagnosis of ASCVD; therefore, the risk of underestimation of the cohort size cannot be ruled out. CONCLUSION Almost 1 in 10 individuals with ASCVD without diagnosis of depression is at high risk for it and has worse health outcomes compared with those who already have a diagnosis of depression. Early recognition and treatment of depression may increase healthcare efficiency, positive patient experience, and HQoL among this vulnerable population.
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Abstract
BACKGROUND This study will assess the effects of high quality nursing care (HQNC) on psychological outcomes (PCO) in patients with chronic heart failure (CHF). METHODS We will carry out a through search in 7 databases: PUBMED, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database, WANGFANG, and China National Knowledge Infrastructure. Eligibility criteria will be randomized controlled trials on assessing effects of HQNC on PCO in patients with CHF. Cochrane risk of bias evaluation will be utilized for methodological quality. RESULTS This proposed study will summarize a rational synthesis of current evidence for HQNC on PCO in patients with CHF. CONCLUSION The results of this study will provide convinced evidence for judging the effects of HQNC on PCO in patients with CHF.
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10
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Factors Associated with Depression among Heart Failure Patients at Cardiac Follow-Up Clinics in Northwest Ethiopia, 2017: A Cross-Sectional Study. PSYCHIATRY JOURNAL 2019; 2019:6892623. [PMID: 31428624 PMCID: PMC6679871 DOI: 10.1155/2019/6892623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/30/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
Background Depression is a comorbid disorder in patients with heart failure and it is a major public health problem worldwide. Little is known about the depression among heart failure patients in low-income countries, while, in Ethiopia, none was studied. Objective This study is to assess the prevalence of depression and associated factors among heart failure patients at cardiac follow-up clinics at Amhara Region Referral Hospitals, Northwest Ethiopia, 2017. Methods A hospital based cross-sectional study was conducted between March 30, 2017, and May 15, 2017, G.C., by using a systematic random sampling technique to select 422 of 1395 HF patients. Structured interviewer-administered questionnaires and patient card review with a checklist that incorporates the PHQ-9 tool for depression measurement were used. The collected data were checked, coded, and entered into Epi-info version 7 and exported to SPSS version 20. Bivariate logistic regression at p-value <0.2 was exported to multivariate logistic regressions and p-value <0.05 was considered statistically significant. Results A total of 403 were included with a response rate of 95.5%. Among the participants, 51.1% had depressive symptoms. Factors associated with depressive symptoms were poor self-care behavior 1.60 [AOR (95% CI=1.01, 2.55)], poor social support 1.90 [AOR (95% CI=1.16, 3.12)], being female 2.70 [AOR (95% CI=1.44, 5.07)], current smoking history 4.96 [AOR (95% CI=1.54, 15.98)], and duration of heart failure (>1 year) 1.64 [AOR (95% CI=1.04, 2.59)]. Conclusions Around half of the patients were depressive. The patients who had poor self-care behavior, were females, had poor social support, had a current history of smoking, and had duration of chronic heart failure >1 year need special attention. Therefore, all referral hospitals need efforts to focus on those problems and target improvements of depressive symptoms.
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Endrighi R, Dimond AJ, Waters AJ, Dimond CC, Harris KM, Gottlieb SS, Krantz DS. Associations of perceived stress and state anger with symptom burden and functional status in patients with heart failure. Psychol Health 2019; 34:1250-1266. [PMID: 31111738 DOI: 10.1080/08870446.2019.1609676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Psychosocial stress and anger trigger cardiovascular events, but their relationship to heart failure (HF) exacerbations is unclear. We investigated perceived stress and anger associations with HF functional status and symptoms. Methods and Results: In a prospective cohort study (BETRHEART), 144 patients with HF (77% male; 57.5 ± 11.5 years) were evaluated for perceived stress (Perceived Stress Scale; PSS) and state anger (STAXI) at baseline and every 2 weeks for 3 months. Objective functional status (6-min walk test; 6MWT) and health status (Kansas City Cardiomyopathy Questionnaire; KCCQ) were also measured biweekly. Linear mixed model analyses indicated that average PSS and greater than usual increases in PSS were associated with worsened KCCQ scores. Greater than usual increases in PSS were associated with worsened 6MWT. Average anger levels were associated with worsened KCCQ, and increases in anger were associated with worsened 6MWT. Adjusting for PSS, anger associations were no longer statistically significant. Adjusting for anger, PSS associations with KCCQ and 6MWT remained significant. Conclusion: In patients with HF, both perceived stress and anger are associated with poorer functional and health status, but perceived stress is a stronger predictor. Negative effects of anger on HF functional status and health status may partly operate through psychological stress.
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Affiliation(s)
- Romano Endrighi
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,Center for Behavioral Science Research, Department of Health Policy, Health Services Research, Boston University Henry M. Goldman School of Dental Medicine , Boston , MA , USA
| | - Andrew J Dimond
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | | | - Kristie M Harris
- Section on Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine , New Haven , CT , USA
| | - Stephen S Gottlieb
- Department of Medicine, University of Maryland School of Medicine , Baltimore , MD , USA
| | - David S Krantz
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences , Bethesda , MD , USA
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Kang Y, Steele BG, Burr RL, Dougherty CM. Mortality in Advanced Chronic Obstructive Pulmonary Disease and Heart Failure Following Cardiopulmonary Rehabilitation. Biol Res Nurs 2018; 20:429-439. [PMID: 29706089 PMCID: PMC6346312 DOI: 10.1177/1099800418772346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiopulmonary rehabilitation (CR) improves physical function and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) and heart failure (HF), but it is unknown if CR improves outcomes in very severe disease. This study's purpose was to describe functional capacity (6-min walk distance [6MWD], steps/day), symptoms (dyspnea, depression), QoL (Short-Form Health Survey-Veterans [SF-36 V]) and cardiopulmonary function ( N-terminal pro-brain natriuretic peptide [NT-proBNP], forced expiratory volume in 1 s [FEV1]), and derive predictors of mortality among patients with severe COPD and HF who participated in CR. METHODS AND RESULTS In this secondary analysis of a randomized controlled trial comparing two CR methods in severe COPD and HF, 90 (COPD = 63, HF = 27) male veterans, mean age 66 ± 9.24 years, 79% Caucasian, and body mass index 31 kg/m2, were followed for 12 months after CR. The COPD group had greater functional decline than the HF group (6MWD, p = .006). Dyspnea was lower ( p = .001) and QoL higher ( p = .006) in the HF group. Mean NT-proBNP was higher in the HF group at all time points. FEV1 improved over 12 months in both groups ( p = .01). Mortality was 8.9%, 16.7%, and 37.8% at 12, 24, and 60 months, respectively. One-year predictors of mortality were baseline total steps (<3,000/day), 6MWD (<229 meters), and NT-proBNP level (>2,000 mg/pg). CONCLUSIONS In very severe COPD and HF, risks of mortality over 12 months can predict patients unlikely to benefit from CR and should be considered at initial referral.
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Affiliation(s)
- Youjeong Kang
- University of Utah School of Nursing, Salt Lake City, UT, USA
| | - Bonnie G. Steele
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Robert L. Burr
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, USA
| | - Cynthia M. Dougherty
- Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
- Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA, USA
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Spaderna H, Zittermann A, Reichenspurner H, Ziegler C, Smits J, Weidner G. Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation. J Am Heart Assoc 2017; 6:JAHA.117.007016. [PMID: 29187384 PMCID: PMC5779021 DOI: 10.1161/jaha.117.007016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients. Methods and Results Between 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow‐up of 70 months (<1–93 months post‐HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1‐year/5‐year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively). Conclusions Low depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.
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Affiliation(s)
- Heike Spaderna
- Division of Health Psychology, Department of Nursing Science, Trier University, Trier, Germany
| | - Armin Zittermann
- Department for Thoracic and Cardiovascular Surgery, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Hermann Reichenspurner
- University Heart Center at the University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Corinna Ziegler
- School of Education, Bergische Universitaet Wuppertal, Germany
| | - Jacqueline Smits
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Gerdi Weidner
- Department of Biology, San Francisco State University, San Francisco, CA
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May HT, Reiss-Brennan B, Brunisholz KD, Horne BD. Clinically Feasible Stratification of 3-Year Chronic Disease Risk in Primary Care: The Mental Health Integration Risk Score. PSYCHOSOMATICS 2017; 58:395-405. [DOI: 10.1016/j.psym.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 02/04/2023]
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15
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Gulati M, Buffomante AA, Wenger NK. Depression and Anxiety in Women with Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0512-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Ramos S, Prata J, Bettencourt P, Gonçalves FR, Coelho R. Depression predicts mortality and hospitalization in heart failure: A six-years follow-up study. J Affect Disord 2016; 201:162-70. [PMID: 27235819 DOI: 10.1016/j.jad.2016.05.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 05/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the prevalence of depressive symptoms (DS) and its relation on hospitalization for cardiovascular (CV) causes and all-cause mortality risk among outpatients with HF. METHODS A prospective study was conducted on 130 adult outpatients with HF. The Beck Depression Inventory Scale-second edition (BDI-II) was used to screen for DS. All-cause mortality and hospitalization for CV causes were registered over 6 years. Logistic regression and multinomial logistic regression analysis were used to evaluate the independent prognostic value of DS on mortality and hospitalization for CV causes after adjustment for clinical risk factors. RESULTS During a mean follow-up of 6 years, 44% of patients were classified as having DS. Sixty-two participants died for all causes, representing 61% of those with DS and 37% of those without (p=0.006); Forty-nine participants (38%) were hospitalized for CV causes, representing 49% of those with DS and 29% of those without (p=0.027). Logistic regression analysis indicated that DS predicted all-cause mortality (OR: 2.905; 95% CI:1.228-6.870; p=0.006) and multinomial logistic regression indicated that DS were predictive of hospitalization for CV causes (OR: 3.169; 95% CI: 1.230-8.164; p=0.027). These associations were independent of conventional risk factors. LIMITATIONS Only outpatient sample; measure of DS only at baseline; cause of death was not known. CONCLUSION This study, first held in a portuguese population, showed that DS are independent predictors of death and hospitalization for CV causes among HF patients and its impact persists over 6 years.
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Affiliation(s)
- Sónia Ramos
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal.
| | - Joana Prata
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal
| | - Paulo Bettencourt
- Cardiovascular Research Unit, Faculty of Medicine, University of Porto, Portugal
| | | | - Rui Coelho
- i3S - Instituto de Investigação e Inovação em Saúde, University of Porto, Portugal; Department of Clinical Neuroscience and Mental Health, Faculty of Medicine, University of Porto, Portugal
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Chiu DY, Green D, Abidin N, Hughes J, Odudu A, Sinha S, Kalra PA. Non-recruitment to and selection bias in studies using echocardiography in haemodialysis patients. Nephrology (Carlton) 2016; 22:864-871. [PMID: 27470704 DOI: 10.1111/nep.12865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown whether patients recruited to renal cardiac imaging studies are fully representative of the investigated population and whether there are differences in characteristics and survival between participants and non-participants (excluded or declined consent). Subjects and Methods Four hundred thirty-five maintenance haemodialysis patients were screened in an observational, prospective study. Baseline demographics, laboratory results, social deprivation scores and survival data were collected from patient records. All patients were followed-up until death, renal transplantation or 16 November 2015. RESULTS Forty-four patients were excluded (16 language barrier, 10 mental incapacity, 9 severe co-morbid illness and 9 because of immobility), 172 patients declined consent (84% due to reluctance to attend for an extra visit) and 219 patients were recruited. Excluded patients had a lower mean haemoglobin (10.2 g/dL vs 10.7 g/dL), phosphate (4.15 mg/dL vs 4.74 mg/dL), albumin (3.6 g/dL vs 3.8 g/dL) and higher C-reactive protein (3.2 mg/dL vs 1.6 mg/dL) compared with recruited patients. No difference was identified between groups for Charleston comorbidity index (P = 0.115) or social deprivation scores. After a median follow-up of 29.7 (25th-75th percentile, 21.1-34.3) months, there were 141 deaths. In a multivariable Cox regression model adjusting for BMI, age, Charleston comorbidity index, haemoglobin, albumin, smoking status and diabetes mellitus, patients who declined consent had an adjusted HR of 1.70, 95% CI 1.10-2.52, and excluded patients had an adjusted HR of 1.30, 95% CI 0.75-2.25, for all-cause mortality compared with recruited patients. CONCLUSIONS Patients recruited to the study had longer survival compared with non-participants. Research studies should document phenotypes of non-participants to aid interpretation and generalizability of results.
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Affiliation(s)
- Diana Yy Chiu
- Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre.,Departments of Renal Medicine, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
| | - Darren Green
- Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre
| | - Nik Abidin
- Departments of Cardiology, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
| | - John Hughes
- Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre
| | - Aghogho Odudu
- Division of Cardiovascular Sciences, University of Manchester, Manchester.,Departments of Renal Medicine, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
| | - Smeeta Sinha
- Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre.,Departments of Renal Medicine, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
| | - Philip A Kalra
- Vascular Research Group, Institute of Population Health, The University of Manchester, Manchester Academic Health Sciences Centre.,Departments of Renal Medicine, Salford Royal Hospital, Salford Royal NHS Foundation Trust, Salford, UK
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Kemper KJ, Carmin C, Mehta B, Binkley P. Integrative Medical Care Plus Mindfulness Training for Patients With Congestive Heart Failure. J Evid Based Complementary Altern Med 2016; 21:282-90. [DOI: 10.1177/2156587215599470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022] Open
Abstract
Congestive heart failure (CHF) has a high rate of morbidity and mortality. It is often accompanied by other medical and psychosocial comorbidities that complicate treatment and adherence. We conducted a proof of concept pilot project to determine the feasibility of providing integrative group medical visits plus mindfulness training for patients recently discharged with CHF. Patients were eligible if they had been discharged from an inpatient stay for CHF within the 12 months prior to the new program. The Compassionate Approach to Lifestyle and Mind–Body (CALM) Skills for Patients with CHF consisted of 8 weekly visits focusing on patient education about medications, diet, exercise, sleep, and stress management; group support; and training in mind–body skills such as mindfulness, self-compassion, and loving-kindness. Over two 8-week sessions, 8/11 (73%) patients completed at least 4 visits. The patients had an average age of 57 years. The most common comorbidities were weight gain, sleep problems, and fatigue. After the sessions, 100% of patients planned to make changes to their diet, exercise, and stress management practices. Over half of the patients who met with a pharmacist had a medication-related problem. Improvements were observed in depression, fatigue, and satisfaction with life. Integrative group visits focusing on healthy lifestyle, support, and skill-building are feasible even among CHF patients and should be evaluated in controlled trials as a patient-centered approach to improving outcomes related to improving medication management, depression, fatigue, and quality of life.
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Affiliation(s)
| | | | - Bella Mehta
- The Ohio State University, Columbus, OH, USA
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19
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Shen BJ, Xu Y, Eisenberg S. Psychosocial and Physiological Predictors of Mortality in Patients of Heart Failure: Independent Effects of Marital Status and C-Reactive Protein. Int J Behav Med 2016; 24:83-91. [DOI: 10.1007/s12529-016-9579-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial. Int J Nurs Stud 2016; 61:219-29. [PMID: 27400028 DOI: 10.1016/j.ijnurstu.2016.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Up to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients' sleep quality. An effective educational programme was important to improve patients' sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan. OBJECTIVES To examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure. DESIGN randomised controlled trial. PARTICIPANTS AND SETTING Eighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n=43) or the control group (n=41). METHODS Patients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients' enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression. RESULTS The intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p<.001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p>.05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β=-2.22, p<.001), daytime sleepiness (β=-4.23, p<.001), anxiety (β=-1.94, p<.001), and depression (β=-3.05, p<.001) after 12 weeks of the intervention. CONCLUSION This study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing.
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White KS, Pardue C, Ludbrook P, Sodhi S, Esmaeeli A, Cedars A. Cardiac Denial and Psychological Predictors of Cardiac Care Adherence in Adults With Congenital Heart Disease. Behav Modif 2015; 40:29-50. [DOI: 10.1177/0145445515613329] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The current study examined cardiac denial and psychological predictors (i.e., depression, anxiety) of health outcomes including medical nonadherence and physical health in a sample of 80 adults with congenital heart disease (ACHD). Results indicated that denial of impact was elevated in this patient group compared with reference groups, and denial was negatively associated with depression and anxiety at ps < .01. Results indicated that depression, anxiety, and denial predicted unique variance in medical nonadherence, and gender moderated the relationships between these psychological factors and nonadherence. For depression, men and women showed similar relationships between depression and nonadherence at high levels of depression; however, at low levels of depression (i.e., a more normal mood state), men were less adherent compared with women. For anxiety, men and women did not differ in adherence at low levels of anxiety; however, men experiencing high anxiety were less adherent compared with women experiencing high anxiety. Implications of this study are discussed including the role of gender and denial and the impact of denial functioning to reduce negative affect. Depression was the only significant predictor of physical functioning. Results of this study suggest that psychological interventions aimed at depression and anxiety may function differently across gender to improve patient medical adherence and improve physical functioning in ACHD.
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Affiliation(s)
| | | | - Philip Ludbrook
- Washington University School of Medicine, St. Louis, MO, USA
| | - Sandeep Sodhi
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Ari Cedars
- Washington University School of Medicine, St. Louis, MO, USA
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22
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Einvik G, Dammen T, Høiseth AD, Brynildsen J, Hagve TA, Christensen G, Omland T, Røsjø H. Psychological distress and mortality in patients with acute dyspnea: data from the Akershus Cardiac Examination (ACE) 2 Study. Gen Hosp Psychiatry 2015; 37:548-53. [PMID: 26298205 DOI: 10.1016/j.genhosppsych.2015.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/14/2015] [Accepted: 07/21/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To test the hypotheses that anxiety and depression are associated with etiology, disease severity and mortality in patients hospitalized with acute dyspnea. METHODS The Hospital Anxiety and Depression Scale was completed within 48h of admission in 185 patients. A subscale score of ≥8 was regarded as clinically significant. The etiology and severity of dyspnea on admission and all-cause mortality during follow-up (median, 2.3years) were recorded. RESULTS Anxiety and depression were more prevalent in patients with chronic obstructive pulmonary disease (COPD) (n=53; 42% and 31%) and heart failure (HF) (n=80; 33% and 23%) than in other causes of acute dyspnea (15% and 11%). Psychological distress was not associated with clinical status or cardiac biomarkers. Anxiety, but not depression, was associated with increased mortality, also when adjusting for cardiac biomarkers in multivariate Cox analysis. In contrast, anxiety was not associated with mortality after adjustment for body mass index, history of COPD and disease severity (hazard ratio, 1.67; 95% confidence interval, 0.92-3.00). CONCLUSION Psychological distress was associated with COPD and HF as etiology of acute dyspnea, but not with disease severity. Anxious patients had a higher mortality rate, but this association was related to the presence and severity of COPD.
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Affiliation(s)
- Gunnar Einvik
- Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway.
| | - Toril Dammen
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway.
| | - Arne Didrik Høiseth
- Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway.
| | - Jon Brynildsen
- Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway.
| | - Tor-Arne Hagve
- Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway; Division of Diagnostics and Technology, Akershus University Hospital, 1470 Lørenskog, Norway.
| | - Geir Christensen
- Institute for Experimental Medical Research, University of Oslo and Oslo University Hospital, 0450 Oslo, Norway.
| | - Torbjørn Omland
- Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway.
| | - Helge Røsjø
- Division of Medicine, Akershus University Hospital, 1470 Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, 0450 Oslo, Norway.
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23
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Rafanelli C, Gostoli S, Tully PJ, Roncuzzi R. Hostility and the clinical course of outpatients with congestive heart failure. Psychol Health 2015; 31:228-38. [PMID: 26387801 DOI: 10.1080/08870446.2015.1095299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The role of depression and quality of life on clinical outcomes of congestive heart failure (CHF) is well recognised. However, there are fewer studies investigating the prognostic role of subclinical psychological distress and well-being impairments. The aims of this study were to evaluate clinical/subclinical psychological distress and well-being in CHF outpatients, and the influence of these psychological factors on adverse cardiac events (re-hospitalisation, cardiac death), at 4-year follow-up. DESIGN Sixty-eight CHF outpatients underwent psychological assessment at baseline and, after 4 years, information about cardiac events was collected in 60 patients by means of clinical records. MAIN OUTCOME MEASURES Psychological assessment included structured clinical interview for DSM (major/minor depression), Interview for diagnostic criteria for psychosomatic research (demoralisation), symptom questionnaire, psychological well-being scales. RESULTS At follow-up, 39.7% of the baseline sample reported cardiovascular events (14 CHF-related re-hospitalisations and 13 cardiac deaths) and 5.9% other causes for death. Among the variables examined as potential risk factors for adverse cardiovascular outcomes, only hostility was significant, even after controlling for disease severity (hazard ratio = 2.38, 95%confidence interval: 1.04-5.45, p = .040). CONCLUSION In outpatients with CHF, psychological assessment should include both clinical and subclinical distress such as hostility, in order to better address psychological risk factors for cardiac outcomes.
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Affiliation(s)
- Chiara Rafanelli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Sara Gostoli
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Phillip J Tully
- b Discipline of Medicine , University of Adelaide , Adelaide , Australia
| | - Renzo Roncuzzi
- c Division of Cardiology , Bellaria Hospital , Bologna , Italy
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Mills PJ, Wilson K, Iqbal N, Iqbal F, Alvarez M, Pung MA, Wachmann K, Rutledge T, Maglione J, Zisook S, Dimsdale JE, Lunde O, Greenberg BH, Maisel A, Raisinghani A, Natarajan L, Jain S, Hufford DJ, Redwine L. Depressive symptoms and spiritual wellbeing in asymptomatic heart failure patients. J Behav Med 2014; 38:407-15. [PMID: 25533643 DOI: 10.1007/s10865-014-9615-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022]
Abstract
Depression adversely predicts prognosis in individuals with symptomatic heart failure. In some clinical populations, spiritual wellness is considered to be a protective factor against depressive symptoms. This study examined associations among depressive symptoms, spiritual wellbeing, sleep, fatigue, functional capacity, and inflammatory biomarkers in 132 men and women with asymptomatic stage B heart failure (age 66.5 years ± 10.5). Approximately 32 % of the patients scored ≥10 on the Beck Depression Inventory, indicating potentially clinically relevant depressive symptoms. Multiple regression analysis predicting fewer depressive symptoms included the following significant variables: a lower inflammatory score comprised of disease-relevant biomarkers (p < 0.02), less fatigue (p < 0.001), better sleep (p < 0.04), and more spiritual wellbeing (p < 0.01) (overall model F = 26.6, p < 0.001, adjusted R square = 0.629). Further analyses indicated that the meaning (p < 0.01) and peace (p < 0.01) subscales, but not the faith (p = 0.332) subscale, of spiritual wellbeing were independently associated with fewer depressive symptoms. Interventions aimed at increasing spiritual wellbeing in patients lives, and specifically meaning and peace, may be a potential treatment target for depressive symptoms asymptomatic heart failure.
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Affiliation(s)
- Paul J Mills
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr. #0804, La Jolla, CA, 92093-0804, USA,
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25
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Kucharska-Newton AM, Williams JE, Chang PP, Stearns SC, Sueta CA, Blecker SB, Mosley TH. Anger proneness, gender, and the risk of heart failure. J Card Fail 2014; 20:1020-6. [PMID: 25284390 PMCID: PMC4250280 DOI: 10.1016/j.cardfail.2014.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/19/2014] [Accepted: 09/26/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence regarding the association of anger proneness with incidence of heart failure is lacking. METHODS AND RESULTS Anger proneness was ascertained among 13,171 black and white participants of the Atherosclerosis Risk in Communities (ARIC) study cohort with the use of the Spielberger Trait Anger Scale. Incident heart failure events, defined as occurrence of ICD-9-CM code 428.x, were ascertained from participants' medical records during follow-up in the years 1990-2010. Relative hazard of heart failure across categories of trait anger was estimated with the use of Cox proportional hazard models. Study participants (mean age 56.9 [SD 5.7] years) experienced 1,985 incident HF events during 18.5 (SD 4.9) years of follow-up. Incidence of HF was greater among those with high, as compared to those with low or moderate trait anger, with higher incidence observed for men than for women. The relative hazard of incident HF was modestly high among those with high trait anger, compared with those with low or moderate trait anger (age-adjusted hazard ratio for men: 1.44 (95% confidence interval [CI] 1.23-1.69). Adjustment for comorbidities and depressive symptoms attenuated the estimated age-adjusted relative hazard in men to 1.26 (95% CI 1.00-1.60). CONCLUSIONS Assessment of anger proneness may be necessary in successful prevention and clinical management of heart failure, especially in men.
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Affiliation(s)
| | - Janice E Williams
- Department of Epidemiology and Biostatistics, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia
| | - Patricia P Chang
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Sally C Stearns
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, North Carolina
| | - Carla A Sueta
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, North Carolina
| | - Saul B Blecker
- Departments of Population Health and Medicine, New York University, New York, New York
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi, Jackson, Mississippi
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Alhurani AS, Dekker R, Tovar E, Bailey A, Lennie TA, Randall DC, Moser DK. Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure. SAGE Open Med 2014; 2. [PMID: 26246898 PMCID: PMC4523379 DOI: 10.1177/2050312114552093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival. Method: A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol. Results: Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95–1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99–5.927; p = 0.05), but not in the adjusted model. Stress (β 1.06; 95% confidence interval = 0.95–1.18; p = 0.32) was not a significant predictor of salivary cortisol level. Conclusion: Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers.
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Affiliation(s)
- Abdullah S Alhurani
- College of Nursing, University of Kentucky, Lexington, KY, USA
- The University of Jordan, Amman, Jordan
| | - Rebecca Dekker
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Elizabeth Tovar
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Alison Bailey
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - David C Randall
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Modica M, Ferratini M, Torri A, Oliva F, Martinelli L, De Maria R, Frigerio M. Quality of life and emotional distress early after left ventricular assist device implant: a mixed-method study. Artif Organs 2014; 39:220-7. [PMID: 25205291 DOI: 10.1111/aor.12362] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Patients who temporarily or permanently rely on left ventricular assist devices (LVADs) for end-stage heart failure face complex psychological, emotional, and relational problems. We conducted a mixed-method study to investigate quality of life, psychological symptoms, and emotional and cognitive reactions after LVAD implant. Twenty-six patients admitted to cardiac rehabilitation were administered quality of life questionnaires (Short Form 36 of the Medical Outcomes Study and Minnesota Living with Heart Failure Questionnaire), the Hospital Anxiety and Depression Scale, and the Coping Orientation for Problem Experiences inventory, and underwent three in-depth unstructured interviews within 2 months after LVAD implant. Quality of life assessment (Short Form 36) documented persistently low physical scores whereas mental component scores almost achieved normative values. Clinically relevant depression and anxiety were observed in 18 and 18% of patients, respectively; avoidant coping scores correlated significantly with both depression and anxiety (Pearson correlation coefficients 0.732, P < 0.001 and 0.764, P < 0.001, respectively). From qualitative interviews, factors that impacted on LVAD acceptance included: device type, disease experience during transplant waiting, nature of the assisted organ, quality of patient-doctor communication, the opportunity of sharing the experience, and recipient's psychological characteristics. Quality of life improves early after LVAD implant, but emotional distress may remain high. A multidimensional approach that takes into account patients' psychological characteristics should be pursued to enhance LVAD acceptance.
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Affiliation(s)
- Maddalena Modica
- Cardiac Rehabilitation S. Maria Nascente, IRCCS Fondazione Don Gnocchi, Milan, Italy
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Fan H, Yu W, Zhang Q, Cao H, Li J, Wang J, Shao Y, Hu X. Depression after heart failure and risk of cardiovascular and all-cause mortality: a meta-analysis. Prev Med 2014; 63:36-42. [PMID: 24632228 DOI: 10.1016/j.ypmed.2014.03.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 03/01/2014] [Accepted: 03/03/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study is to investigate whether depression after heart failure (HF) was a predictor for subsequent cardiovascular and all-cause mortality in prospective observational studies. METHODS Pubmed, Embase, and PsycInfo databases were searched for prospective studies reported depression after HF and subsequent risk of cardiovascular or all-cause mortality (prior to May 2013). Pooled adjust hazard ratio (HR) and corresponding 95% confidence intervals (CI) were calculated separately for categorical risk estimates. RESULTS Nine studies with 4012 HF patients were identified and analyzed. Pooled HR of all-cause mortality was 1.51 (95% CI 1.19-1.91) for depression compared with non-depressive patients. Subgroup analyses showed that major depression significantly increased all-cause mortality (HR=1.98, 95% CI 1.23-3.19), but not mild depression (HR=1.04, 95% CI 0.75-1.45). Pooled HR of cardiovascular mortality was 2.19 (95% CI 1.46-3.29) for depression compared with non-depressive patients. CONCLUSION Major depression after HF was a predictor for subsequent all-cause mortality, but not mild depression. More well-designed studies are needed to explore the influence of depression and antidepressant medication use on cardiovascular and all-cause mortality in HF patients.
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Affiliation(s)
- Hongjie Fan
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Weidong Yu
- Department of Geriatrics, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Qiang Zhang
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Hui Cao
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Jun Li
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Junpeng Wang
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Yang Shao
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
| | - Xinhua Hu
- Department of Surgery, the First Affiliated Hospital of China Medical University, Shenyang 110001, China.
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Suzuki T, Shiga T, Kuwahara K, Kobayashi S, Suzuki S, Nishimura K, Suzuki A, Minami Y, Ishigooka J, Kasanuki H, Hagiwara N. Impact of clustered depression and anxiety on mortality and rehospitalization in patients with heart failure. J Cardiol 2014; 64:456-62. [PMID: 24755202 DOI: 10.1016/j.jjcc.2014.02.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 02/02/2014] [Accepted: 02/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anxiety is often present in patients with depression. The aim of this study was to evaluate the impact of clustered depression and anxiety on mortality and rehospitalization in hospitalized patients with heart failure (HF). METHODS A total of 221 hospitalized patients with HF, who completed the questionnaires, were analyzed in this prospective study (mean age 62±13 years; 28% female). One-third patients had implanted cardiac devices. Depression was defined as a Zung Self-Rating Depression Scale index score of ≥60 and anxiety was defined as a State-Trait Anxiety Inventory score of ≥40 (male) or ≥42 (female). The primary outcome was the composite of death from any cause or rehospitalization due to worsened HF and refractory arrhythmia. RESULTS Of the 221 HF patients, 29 (13%) had depression alone, 80 (36%) had anxiety alone, and 46 patients (21%) had both depression and anxiety. During an average follow-up of 41±21 months, patients with depression alone and those with clustered depression and anxiety were at an increased risk of the primary outcome [hazard ratio (HR) 2.24, 95% confidence interval (CI): 1.17-4.28, p=0.01 and HR 2.75, 95% CI: 1.51-4.99, p=0.01, respectively] compared to patients with no symptoms. Multivariate analysis after adjusting for age, gender, New York Heart Association functional class, B-type natriuretic peptide, device implantation, renal dysfunction, and left ventricular dysfunction showed clustered depression and anxiety, but not depression alone or anxiety alone, was an independent predictor of the primary outcome (HR 1.96, 95% CI: 1.00-3.27, p=0.04). CONCLUSIONS Our results showed that clustered depression and anxiety were associated with worse outcomes in patients with HF.
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Affiliation(s)
- Tsuyoshi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Kazue Kuwahara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Shinichi Suzuki
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Jun Ishigooka
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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Brouwers C, Kupper N, Pelle AJ, Szabó BM, Westerhuis BL, Denollet J. Depressive symptoms in outpatients with heart failure: Importance of inflammatory biomarkers, disease severity and personality. Psychol Health 2014; 29:564-82. [DOI: 10.1080/08870446.2013.869813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pujol R, Puig L, Daudén E, Sánchez-Carazo J, Toribio J, Vanaclocha F, Yébenes M, Sabater E, Casado M, Caloto M, Aragón B. Mental Health Self-Assessment in Patients With Moderate to Severe Psoriasis: An Observational, Multicenter Study of 1164 Patients in Spain (The VACAP Study). ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:897-903. [DOI: 10.1016/j.ad.2013.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 03/21/2013] [Accepted: 04/14/2013] [Indexed: 11/29/2022] Open
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Pujol R, Puig L, Daudén E, Sánchez-Carazo J, Toribio J, Vanaclocha F, Yébenes M, Sabater E, Casado M, Caloto M, Aragón B. Mental Health Self-Assessment in Patients With Moderate to Severe Psoriasis: An Observational, Multicenter Study of 1164 Patients in Spain (The VACAP Study). ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2013.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Eisele M, Blozik E, Störk S, Träder JM, Herrmann-Lingen C, Scherer M. Recognition of depression and anxiety and their association with quality of life, hospitalization and mortality in primary care patients with heart failure - study protocol of a longitudinal observation study. BMC FAMILY PRACTICE 2013; 14:180. [PMID: 24279590 PMCID: PMC4222561 DOI: 10.1186/1471-2296-14-180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND International disease management guidelines recommend the regular assessment of depression and anxiety in heart failure patients. Currently there is little data on the effect of screening for depression and anxiety on the quality of life and the prognosis of heart failure (HF). We will investigate the association between the recognition of current depression/anxiety by the general practitioner (GP) and the quality of life and the patients' prognosis. METHODS/DESIGN In this multicenter, prospective, observational study 3,950 patients with HF are recruited by general practices in Germany. The patients fill out questionnaires at baseline and 12-month follow-up. At baseline the GPs are interviewed regarding the somatic and psychological comorbidities of their patients. During the follow-up assessment, data on hospitalization and mortality are provided by the general practice. Based on baseline data, the patients are allocated into three observation groups: HF patients with depression and/or anxiety recognized by their GP (P+/+), those with depression and/or anxiety not recognized (P+/-) and patients without depression and/or anxiety (P-/-). We will perform multivariate regression models to investigate the influence of the recognition of depression and/or anxiety on quality of life at 12 month follow-up, as well as its influences on the prognosis (hospital admission, mortality). DISCUSSION We will display the frequency of GP-acknowledged depression and anxiety and the frequency of installed therapeutic strategies. We will also describe the frequency of depression and anxiety missed by the GP and the resulting treatment gap. Effects of correctly acknowledged and missed depression/anxiety on outcome, also in comparison to the outcome of subjects without depression/anxiety will be addressed. In case results suggest a treatment gap of depression/anxiety in patients with HF, the results of this study will provide methodological advice for the efficient planning of further interventional research.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Eva Blozik
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Straubmühlweg 2a, Würzburg 97078, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research, von-Siebold-Str. 5, Göttingen 37075, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Jiménez JA, Redwine LL, Rutledge TR, Dimsdale JE, Pung MA, Ziegler MG, Greenberg BH, Mills PJ. Depression ratings and antidepressant use among outpatient heart failure patients: implications for the screening and treatment of depression. Int J Psychiatry Med 2013; 44:315-34. [PMID: 23885515 DOI: 10.2190/pm.44.4.c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the characteristics of antidepressant use among heart failure (HF) outpatients. METHODS Self-reported data on antidepressant use, Beck Depression Inventory (BDI) ratings, and demographics, as well as HF diagnosis severity, was collected from 218 New York Heart Association (NYHA) Classes I-IV HF outpatients (mean age 57.29 years). RESULTS The overall prevalence of depressive symptoms (BDI > 10) was 43.1% (n = 94); 23.4% had a prior diagnosis of depression. Thirty-three percent of patients were taking antidepressants but, despite this treatment, 64% still showed at least mild-moderate depressive symptoms (BDI > or = 10) compared to 34% of patients not currently receiving antidepressants (p = 0.05). When asked if their mood had improved as a result of antidepressant therapy, 45% reported responses ranging from "halfway back to normal" to no improvement at all; BDI scores were related to self-reports of how well antidepressant therapy affected patient's mood (p < .01). Among patients receiving antidepressants (primarily SSRIs), 26% did not have a formal depression diagnosis prior to receiving antidepressants, and 39.1% reported never having had a dose adjustment in antidepressant medication. Similar numbers of patients were prescribed antidepressants by primary care physicians as mental health providers, while much fewer cardiologists prescribed antidepressants. CONCLUSIONS Findings provide insight into practice and provider patterns related to antidepressant use in HF. HF patients treated with antidepressants still show high rates of depressed mood, and follow-up and monitoring of effectiveness of antidepressant therapy needs attention. Effective treatment of depression could support improved clinical outcomes and better quality of life for HF patients.
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Affiliation(s)
- Jessica A Jiménez
- SDSU/UCSD Joint Doctoral Program in Public Health and University of California, San Diego. La Jolla, CA, USA
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Moraska AR, Chamberlain AM, Shah ND, Vickers KS, Rummans TA, Dunlay SM, Spertus JA, Weston SA, McNallan SM, Redfield MM, Roger VL. Depression, healthcare utilization, and death in heart failure: a community study. Circ Heart Fail 2013; 6:387-94. [PMID: 23512984 DOI: 10.1161/circheartfailure.112.000118] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The increasing prevalence of heart failure (HF) and high associated costs have spurred investigation of factors leading to adverse outcomes in patients with HF. Studies to date report inconsistent evidence on the link between depression and outcomes with only limited data on emergency department and outpatient visits. METHODS AND RESULTS Olmsted, Dodge, and Fillmore county, Minnesota residents with HF were prospectively recruited between October 2007 and December 2010 and completed a 1-time 9-item Patient Health Questionnaire for depression categorized as: none to minimal (Patient Health Questionnaire score, 0-4), mild (5-9), or moderate to severe (≥10). Andersen-Gill models were used to determine whether depression predicted hospitalizations and emergency department visits, whereas negative binomial regression models explored the association of depression with outpatient visits. Cox proportional hazards regression characterized the relationship between depression and all-cause mortality. Among 402 patients with HF (mean age, 73±13 years; 58% men), 15% had moderate to severe depression, 26% mild, and 59% none to minimal depression. During a mean follow-up of 1.6 years, 781 hospitalizations, 1000 emergency department visits, 15 515 outpatient visits, and 74 deaths occurred. After adjustment, moderate to severe depression was associated with nearly a 2-fold increased risk of hospitalization (hazard ratio, 1.79; 95% confidence interval, 1.30-2.47) and emergency department visits (hazard ratio, 1.83; 95% confidence interval, 1.34-2.50), a modest increase in outpatient visits (rate ratio, 1.20; 95% confidence interval, 1.00-1.45), and a 4-fold increase in all-cause mortality (hazard ratio, 4.06; 95% confidence interval, 2.35-7.01). CONCLUSIONS In this prospective cohort study, depression independently predicted an increase in the use of healthcare resources and mortality. Greater recognition and management of depression in HF may optimize clinical outcomes and resource utilization.
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Affiliation(s)
- Amanda R Moraska
- Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Gordon RJ, Weinberg AD, Pagani FD, Slaughter MS, Pappas PS, Naka Y, Goldstein DJ, Dembitsky WP, Giacalone JC, Ferrante J, Ascheim DD, Moskowitz AJ, Rose EA, Gelijns AC, Lowy FD. Prospective, multicenter study of ventricular assist device infections. Circulation 2013; 127:691-702. [PMID: 23315371 DOI: 10.1161/circulationaha.112.128132] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ventricular assist devices (VADs) improve survival and quality of life in patients with advanced heart failure, but their use is frequently complicated by infection. There are limited data on the microbiology and epidemiology of these infections. METHODS AND RESULTS One hundred fifty patients scheduled for VAD implantation were enrolled (2006-2008) at 11 US cardiac centers and followed prospectively until transplantation, explantation for recovery, death, or for 1 year. Eighty-six patients (57%) received HeartMate II devices. Data were collected on potential preoperative, intraoperative, and postoperative risk factors for infection. Clinical, laboratory, and microbiological data were collected for suspected infections and evaluated by an infectious diseases specialist. Thirty-three patients (22%) developed 34 VAD-related infections with an incidence rate of 0.10 per 100 person-days (95% confidence interval, 0.073-0.142). The median time to infection was 68 days. The driveline was the most commonly infected site (n=28); 18 (64%) were associated with invasive disease. Staphylococci were the most common pathogen (47%), but pseudomonas or other Gram-negative bacteria caused 32% of infections. A history of depression and elevated baseline serum creatinine were independent predictors of VAD infection (adjusted hazard ratio=2.8 [P=0.007] and 1.7 [P=0.023], respectively). The HeartMate II was not associated with a decreased risk of infection. VAD infection increased 1-year mortality (adjusted hazard ratio=5.6; P<0.0001). CONCLUSIONS This prospective, multicenter study demonstrates that infection frequently complicates VAD placement and is a continuing problem despite the use of newer, smaller devices. Depression and renal dysfunction may increase the risk of VAD infection. VAD infection is a serious consequence because it adversely affects patient survival. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01471795.
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Affiliation(s)
- Rachel J Gordon
- Departments of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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A comparison of psychosocial risk factors between 3 groups of cardiovascular disease patients referred for outpatient cardiac rehabilitation. J Cardiopulm Rehabil Prev 2012; 32:175-81. [PMID: 22426505 DOI: 10.1097/hcr.0b013e31824cc1f7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Few studies have examined psychosocial risk factors for cardiovascular disease (CVD) between diagnostic groups of CVD patients. We compared levels of depression, anxiety, hostility, exhaustion, positive affect, and social support, and the prevalence of type D personality between patient groups with a primary diagnosis of coronary heart disease (CHD), chronic heart failure (CHF), or peripheral arterial disease (PAD). METHODS We examined 548 CHD patients, 105 CHF patients, and 79 PAD patients who completed the Hospital Anxiety and Depression Scale, the cynical hostility subscale of the Minnesota Multiphasic Personality Inventory-2, the short form of the Maastricht Vital Exhaustion Questionnaire, the type D personality questionnaire, the positive mood scale of the Global Mood Scale, and the Enhancing Recovery in CHD Social Support Inventory, all in the first week of cardiac rehabilitation. Group differences in psychosocial factors were adjusted for sociodemographic factors, previous myocardial infarction, traditional cardiovascular risk factors, and medications. RESULTS Relative to patients with PAD, those with CHD and those with CHF both showed greater exhaustion (P ≤ .001) and lower positive affect (P ≤ .03). The effect sizes of these differences were clinically relevant (Cohen's d between 0.32 and 0.49). There were no significant differences in psychosocial risk factors between CHD and CHF patients. CONCLUSIONS The profile of psychosocial risk factors for CVD revealed clinically relevant variability between different diagnostic groups of CVD patients. The findings imply that patients with distinct cardiac diagnosis might additionally benefit from comprehensive cardiac rehabilitation if the program includes psychosocial risk factor-specific interventions.
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Damen NL, Pelle AJ, Szabó BM, Pedersen SS. Symptoms of anxiety and cardiac hospitalizations at 12 months in patients with heart failure. J Gen Intern Med 2012; 27:345-50. [PMID: 21892660 PMCID: PMC3286556 DOI: 10.1007/s11606-011-1843-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 06/01/2011] [Accepted: 08/09/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients. METHODS HF outpatients (N = 237) completed the Hospital Anxiety and Depression Scale (HADS) at baseline (i.e., inclusion into the study). A cutoff ≥8 was used to indicate probable clinical levels of anxiety and depression. At 12 months, a medical chart abstraction was performed to obtain information on cardiac hospitalizations. RESULTS The prevalence of symptoms of anxiety was 24.9% (59/237), and 27.0% (64/237) of patients were admitted for cardiac reasons at least once during the 12-month follow-up period. Symptoms of anxiety were neither significantly associated with cardiac hospitalizations in univariable logistic analysis [OR = 1.13, 95% CI (0.59-2.17), p = 0.72] nor in multivariable analysis [OR = 0.94, 95% CI (0.38-2.31), p = 0.89]. New York Heart Association (NYHA) functional class III [OR = 3.00, 95% CI (1.08-8.12), p = 0.04] and a history of HF-related hospitalizations [OR = 1.18, 95% CI (1.01-1.38), p = 0.03] were independently associated with 12-month cardiac admissions. CONCLUSIONS The current study found no significant association between symptoms of anxiety and cardiac hospitalizations at 12 months in HF patients. In contrast, clinical indicators (i.e., NYHA class III and a history of HF-related hospitalizations) were significantly associated with admissions due to a cardiac cause. Future studies are warranted to investigate the importance of symptoms of anxiety in HF using a larger sample size and a longer follow-up duration.
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Affiliation(s)
- Nikki L Damen
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical Psychology, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
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Type D personality and persistence of depressive symptoms in a German cohort of cardiac patients. J Affect Disord 2012; 136:1183-7. [PMID: 22226380 DOI: 10.1016/j.jad.2011.11.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/30/2011] [Accepted: 11/30/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depression is associated with a negative prognosis in coronary heart disease and heart failure patients. Type D personality has been shown to predict the persistence of depressive symptoms over 12 months. Data on longer follow-up periods and on the effectiveness of Type D as a screening tool compared to established measures of depressive symptoms are missing. METHODS Type D personality and depressive mood were assessed with the DS14 and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) in 679 consecutive cardiac patients (22.2% female, mean age 62.4±10.2 years) over a period of 6 years. Latent class and growth mixture models with Type D, comorbidity, age, and sex as covariates were used to model individual depression trajectory classes and to predict trajectories and class membership. Estimates of specificity and sensitivity were calculated for Type D and the HADS-D baseline cut-off point. RESULTS In a model with four latent classes (mild symptoms, moderate and increasing symptoms, significant but decreasing symptoms, and significant and increasing symptoms), Type D predicted the membership in the class with significant and increasing symptoms (OR=10.94, 4.93, and 3.15). Sensitivity and specificity were 59% and 78% for Type D and 47% and 80% for the HADS-D. LIMITATIONS Some possible confounders might be missing. With just two measurement points only linear trajectories could be modeled. CONCLUSIONS Type D personality is a stronger predictor for persistent depressive symptoms than the baseline HADS-D score, but the predictive power seems low for clinical practice.
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Mommersteeg PMC, Pelle AJ, Ramakers C, Szabó BM, Denollet J, Kupper N. Type D personality and course of health status over 18 months in outpatients with heart failure: multiple mediating inflammatory biomarkers. Brain Behav Immun 2012; 26:301-10. [PMID: 21983280 DOI: 10.1016/j.bbi.2011.09.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 09/21/2011] [Accepted: 09/22/2011] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The distressed (Type D) personality is associated with poor health status (HS) and increased inflammatory activation in heart failure (HF). We tested whether multiple inflammatory biomarkers mediated the association between Type D personality and the course of self-reported HS over 18 months. METHODS HF outpatients (n=228, 80% male, mean age 67.0±8.7 years), filled out the Type D questionnaire (DS14) at inclusion and the Short Form-12 (SF12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 0, 6, 12, and 18 months. Blood samples at inclusion were analyzed for high sensitive C-reactive protein (hsCRP), interleukin (IL)-6, tumor necrosis factor (TNF)-α, and its soluble receptors (sTNFr1, sTNFr2). A multiple mediation latent growth model was tested using structural equation modeling. RESULTS Type D personality (prevalence=21%) was associated with poorer HS (all scales p<0.001), deterioration of mental HS (p<0.001), and higher TNF-α and sTNFr2 levels in the full mediation model. A higher inflammatory burden was associated with a poorer baseline level and a deterioration of generic physical, mental and disease-specific HS. No mediating effects were found for the multiple inflammatory biomarkers on the association between Type D and baseline self-reported HS, whereas change in physical HS was significantly mediated by the group of five inflammatory biomarkers (p=0.026). CONCLUSIONS Only the association between Type D personality and change in self-reported physical health status was significantly mediated by inflammatory biomarkers. Future research should investigate whether the association between Type D personality and poor health status may be explained by other biological or behavioral factors.
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Affiliation(s)
- Paula M C Mommersteeg
- Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands.
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Rollman BL, Herbeck Belnap B, Mazumdar S, Houck PR, He F, Alvarez RJ, Schulberg HC, Reynolds CF, McNamara DM. A positive 2-item Patient Health Questionnaire depression screen among hospitalized heart failure patients is associated with elevated 12-month mortality. J Card Fail 2011; 18:238-45. [PMID: 22385945 DOI: 10.1016/j.cardfail.2011.11.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 11/15/2011] [Accepted: 11/17/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the association of depression with poorer cardiac outcomes, an American Heart Association Science Advisory has advocated routine screening of cardiac patients for depression using the 2-item Patient Health Questionnaire (PHQ-2) "at a minimum." However, the prognostic value of the PHQ-2 among HF patients is unknown. METHODS AND RESULTS We screened hospitalized HF patients (ejection fraction [EF] <40%) that staff suspected may be depressed with the PHQ-2, and then determined vital status at up to 12-months follow-up. At baseline, PHQ-2 depression screen-positive patients (PHQ-2+; n = 371), compared with PHQ-2 screen-negative patients (PHQ-2-; n = 100), were younger (65 vs 70 years) and more likely to report New York Heart Association (NYHA) functional class III/IV than class II symptoms (67% vs. 39%) and lower levels of physical and mental health-related quality of life (all P ≤ .002); they were similar in other characteristics (65% male, 26% mean EF). At 12 months, 20% of PHQ-2+ versus 8% of PHQ-2- patients had died (P = .007) and PHQ-2 status remained associated with both all-cause (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.4-6.7; P = .003) and cardiovascular (HR 2.7, 95% CI 1.1-6.6; P = .03) mortality even after adjustment for age, gender, EF, NYHA functional class, and a variety of other covariates. CONCLUSIONS Among hospitalized HF patients, a positive PHQ-2 depression screen is associated with an elevated 12-month mortality risk.
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Affiliation(s)
- Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Khalil AA, Hall LA, Moser DK, Lennie TA, Frazier SK. The psychometric properties of the Brief Symptom Inventory depression and anxiety subscales in patients with heart failure and with or without renal dysfunction. Arch Psychiatr Nurs 2011; 25:419-29. [PMID: 22114796 DOI: 10.1016/j.apnu.2010.12.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 12/24/2010] [Accepted: 12/31/2010] [Indexed: 11/30/2022]
Abstract
More than 5 million Americans have heart failure (HF); approximately one third have concomitant renal dysfunction. Anxiety and depressive symptoms are the most common psychological responses of these individuals and may influences outcomes; thus a reliable valid instrument to measure these is needed. This article reports a psychometric evaluation of the Brief Symptom Inventory (BSI) depression and anxiety subscales in patients with HF and with or without renal dysfunction, as these scales are commonly used in this population for research studies. This rigorous psychometric analysis used existing data from 590 patients with HF with an average ejection fraction of 35% ± 15% and average age of 63 ± 13 years. Patients were categorized as normal renal function (n = 495) or renal dysfunction (n = 95), and groups were compared and analyzed separately. Cronbach's alpha for the BSI subscales was .82 for those with normal renal function and .88 for those with renal dysfunction. Factor analysis determined that the subscales evaluated one dimension, psychological distress, in both groups. Construct validity was examined using hypothesis testing, and construct validity was supported in patients with HF and with normal renal function by significant associations of the BSI subscales with another measure of depression and a measure of perceived control. Construct validity in patients with HF and renal dysfunction was not strongly supported. Only the BSI depression subscale predicted poorer outcomes in patients with HF and with normal renal function; neither subscale was associated with event-free survival at 12 months in those with renal dysfunction. The BSI anxiety and depression subscales provide reliable and valid data in patients HF and normal renal function. Although reliability is excellent, construct validity was weak in those patients with HF and with concomitant renal dysfunction, which may reduce the validity of those data.
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Affiliation(s)
- Amani A Khalil
- College of Nursing-University of Jordan Amman, Jordan; and University of Kentucky College of, Nursing Lexington, KY, USA.
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Rod NH, Andersen I, Prescott E. Psychosocial risk factors and heart failure hospitalization: a prospective cohort study. Am J Epidemiol 2011; 174:672-80. [PMID: 21821541 DOI: 10.1093/aje/kwr144] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prospective studies on the role of psychosocial factors in heart failure development are virtually nonexistent. The authors aimed to address the effect of psychosocial factors on the risk of heart failure hospitalization in men and women free of cardiovascular disease. In 1991-1993, the 8,670 participants of the Copenhagen City Heart Study (Denmark) were asked comprehensive questions on major life events, work-related stress, social network, vital exhaustion, and sleep medication and were followed in nationwide registries until 2007, with less than 0.2% loss to follow-up. Almost one-fourth of the population reported some degree of vital exhaustion. The vital exhaustion score was associated with a higher risk of heart failure in a dose-response manner (P < 0.002), with high vital exhaustion being associated with a 2-fold higher risk of heart failure in both men (hazard ratio = 1.93, 95% confidence interval: 1.20, 3.10) and women (hazard ratio = 2.56, 95% confidence interval: 1.80, 3.65). Contrary to expectation, major life events, social network, and sleeping medication did not play an individual role for heart failure hospitalization. Because of the high prevalence of vital exhaustion in the population, even a modestly higher risk of heart failure associated with vital exhaustion may be of importance in the planning of future preventive strategies for heart failure.
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Affiliation(s)
- Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postbox 2099, 1014 Copenhagen K, Denmark.
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De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung 2011; 40:393-404. [PMID: 21453974 PMCID: PMC3149715 DOI: 10.1016/j.hrtlng.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/29/2011] [Accepted: 02/06/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. CONCLUSION This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
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Affiliation(s)
- Marla J De Jong
- TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
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Coyne JC, Jaarsma T, Luttik ML, van Sonderen E, van Veldhuisen DJ, Sanderman R. Lack of prognostic value of type D personality for mortality in a large sample of heart failure patients. Psychosom Med 2011; 73:557-62. [PMID: 21862826 DOI: 10.1097/psy.0b013e318227ac75] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Type D personality has been proposed as a prognostic indicator for mortality in cardiovascular disease. Most research examining this construct originates from one research group, and it is critical that the predictive value of Type D personality for adverse outcomes is independently cross-validated. This study examined its prognostic value in heart failure, relative to B-type natriuretic peptide (BNP) and depressive symptoms. METHODS We studied 706 patients with complete BNP, depressive symptom, and Type D personality and mortality data from 958 patients with heart failure enrolled after hospitalization for a multisite study of a disease management program. Multivariable models were adjusted for BNP and depression. RESULTS At 18 months, there were 192 deaths (27.2%). No evidence was found for a prognostic value of Type D personality in the unadjusted model (hazard ratio [HR] = 0.893, 95% confidence interval [CI] = 0.582-1.370). In contrast, BNP was significantly predictive of mortality (HR = 1.588, 95% CI = 1.391-1.812), whereas depression was not (HR = 1.011, 95% CI = 0.998-1.024). Type D was also not predictive in covariate-adjusted models (HR = 0.779, 95% CI = 0.489-1.242). Similar results were obtained when analyzing Type D as the interaction between continuous z scores of its two components, negative affectivity and social inhibition (p = .144). CONCLUSIONS In the largest study to date, Type D does not predict mortality. Future research should construe Type D as the interaction of continuous negative affectivity and social inhibition z scores, rather than as a typology, and consider analyses replacing negative affectivity with depression.
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Affiliation(s)
- James C Coyne
- Health Psychology Section, Department of Health Science, University Medical Center Groningen, University of Groningen, HPC FA12, PO Box 196, NL-9700 AD Groningen, The Netherlands.
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Weidner G, Zahn D, Mendell NR, Smits JMA, Deng MC, Zittermann A, Spaderna H. Patients' sex and emotional support as predictors of death and clinical deterioration in the waiting for a new heart study: results from the 1-year follow-up. Prog Transplant 2011. [PMID: 21736238 DOI: 10.7182/prtr.21.2.j779w1q6k61k0jk4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates. OBJECTIVE To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study. DESIGN, SETTING, AND PARTICIPANTS The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs. low support]) were assessed at the time of wait-listing. Main Outcomes-Time until death/delisting due to deteriorated tealth, considering competing outcomes (e.g., transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models. RESULTS By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs. 8.6%) and being a past or current smoker (80.4% vs. 56.9%). More women than men had low vocational level (93.1% vs. 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04-5.12; P = .04); low emotional support further tended to increase the risk for this outcome (P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04-4.82; P = .04). CONCLUSION Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
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Affiliation(s)
- Gerdi Weidner
- Department of Biology, Romberg Tiburon Center, San Francisco State University, 3150 Paradise Drive, Tiburon, CA 94920, USA.
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Weidner G, Zahn D, Mendell NR, Smits JMA, Deng MC, Zittermann A, Spaderna H. Patients' Sex and Emotional Support as Predictors of Death and Clinical Deterioration in the Waiting for a New Heart Study: Results from the 1-Year Follow-up. Prog Transplant 2011; 21:106-14. [DOI: 10.1177/152692481102100204] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Context Little is known about the role of patient's sex and emotional support in the prognosis of heart transplant candidates. Objective To examine patient's sex and emotional support as predictors of outcomes in the Waiting for a New Heart Study. Design, Setting, and Participants The Waiting for a New Heart Study is a prospective observational study of 318 patients (18% female) newly added to the waiting list for a heart transplant. Demographic, medical, psychosocial characteristics (including social support [ENRICHD Social Support Index; high vs low support]) were assessed at the time of wait-listing. Main Outcomes Time until death/delisting due to deteriorated health, considering competing outcomes (eg, transplantation) during the first 12 months after wait-listing were analyzed via cause-specific Cox proportional hazard models. Results—By 12 months, 32 men (12%) and 10 women (17%) had died/deteriorated. Medical risk was comparable across sexes. More men than women reported low emotional support (20.4% vs 8.6%) and being a past or current smoker (80.4% vs 56.9%). More women than men had low vocational level (93.1% vs 69.6%; all P values < .05). With medical risk and other confounding variables controlled for, female sex significantly increased risk of death/deterioration (hazard ratio, 2.30; 95% confidence interval, 1.04–5.12; P = .04); low emotional support further tended to increase the risk for this outcome ( P = .07). As none of the 5 women with low emotional support had reached this end point, analyses were performed in the male sample and revealed that men with low emotional support were more than twice as likely to die/deteriorate than were men with high support (hazard ratio, 2.23; 95% confidence interval, 1.04–4.82; P = .04). Conclusion Women had worse survival while awaiting a heart transplant than men had, independent of confounding variables. Even though emotional support may be an important buffer for men, protective factors for women warrant further investigation with larger samples and/or longer follow-ups.
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Affiliation(s)
- Gerdi Weidner
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Daniela Zahn
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Nancy R. Mendell
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Jacqueline M. A. Smits
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Mario C. Deng
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Armin Zittermann
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
| | - Heike Spaderna
- San Francisco State University, San Francisco, California (GW); University Clinic of the Ruhr-University Bochum, Bochum, Germany (DZ); Stony Brook University, Stony Brook, New York (NRM); Eurotransplant International Foundation, Leiden, The Netherlands (JMAS); Columbia University Medical Center, New York (MCD); Heart Center North Rhine-Westphalia, Germany (AZ), Johannes Gutenberg-University Mainz, Germany (HS)
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Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. DIALOGUES IN CLINICAL NEUROSCIENCE 2011. [PMID: 21485743 PMCID: PMC3181964 DOI: 10.31887/dcns.2011.13.1/wkaton] [Citation(s) in RCA: 435] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.
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Affiliation(s)
- Wayne J Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
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Sherwood A, Blumenthal JA, Hinderliter AL, Koch GG, Adams KF, Dupree CS, Bensimhon DR, Johnson KS, Trivedi R, Bowers M, Christenson RH, O'Connor CM. Worsening depressive symptoms are associated with adverse clinical outcomes in patients with heart failure. J Am Coll Cardiol 2011; 57:418-23. [PMID: 21251581 DOI: 10.1016/j.jacc.2010.09.031] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the impact of changes in symptoms of depression over a 1-year period on subsequent clinical outcomes in heart failure (HF) patients. BACKGROUND Emerging evidence shows that clinical depression, which is prevalent among patients with HF, is associated with a poor prognosis. However, it is uncertain how changes in depression symptoms over time may relate to clinical outcomes. METHODS One-hundred forty-seven HF outpatients with ejection fraction of less than 40% were assessed for depressive symptoms using the Beck Depression Inventory (BDI) at baseline and again 1 year later. Cox proportional hazards regression analyses, controlling for established risk factors, were used to evaluate how changes in depressive symptoms were related to a combined primary end point of death or cardiovascular hospitalization over a median follow-up period of 5 years (with a range of 4 to 7 years and no losses to follow-up). RESULTS The 1-year change in symptoms of depression, as indicated by higher BDI scores over a 1-year interval (1-point BDI change hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02 to 1.12, p = 0.007), was associated with death or cardiovascular hospitalization after controlling for baseline depression (baseline BDI HR: 1.1, 95% CI: 1.06 to 1.14, p < 0.001) and established risk factors, including HF cause, age, ejection fraction, plasma N-terminal pro-B-type natriuretic peptide level, and prior hospitalizations. CONCLUSIONS Worsening symptoms of depression are associated with a poorer prognosis in HF patients. Routine assessment of symptoms of depression in HF patients may help to guide appropriate medical management of these patients who are at increased risk for adverse clinical outcomes.
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Affiliation(s)
- Andrew Sherwood
- Duke University Medical Center, Durham, North Carolina 27710, USA.
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