Prevalence and patterns of anxiety and depression in patients undergoing elective percutaneous transluminal coronary angioplasty

Factors which facilitate or impede patient engagement with pulmonary and cardiac rehabilitation: a rapid evaluation mapping review

Background

There is a considerable body of systematic review evidence considering the effectiveness of rehabilitation programmes on clinical outcomes. However, much less is known about effectively engaging and sustaining patients in rehabilitation. There is a need to understand the full range of potential intervention strategies.

Methods

We conducted a mapping review of UK review-level evidence published 2017-21. We searched MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health (CINAHL) and conducted a narrative synthesis. Included reviews reported factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation, or an intervention to facilitate these factors. Study selection was undertaken independently by two reviewers.

Results

In total, we identified 20 review papers that met our inclusion criteria. There was a bias towards reviews considering cardiac rehabilitation, with these numbering 16. An additional 11 unpublished interventions were also identified through internet searching of key websites. The reviews included 60 identifiable UK primary studies that considered factors which affected attendance at rehabilitation; 42 considered cardiac rehabilitation and 18 considering pulmonary rehabilitation. They reported on factors from the patients' point of view, as well as the views of professionals involved in referral or treatment. It was more common for factors to be reported as impeding attendance at rehabilitation rather than facilitating it. We grouped the factors into patient perspective (support, culture, demographics, practical, health, emotions, knowledge/beliefs and service factors) and professional perspective (knowledge: staff and patient, staffing, adequacy of service provision and referral from other services, including support and wait times). We found considerably fewer reviews (n = 3) looking at interventions to facilitate participation in rehabilitation. Although most of the factors affecting participation were reported from a patient perspective, most of the identified interventions were implemented to address barriers to access in terms of the provider perspective. The majority of access challenges identified by patients would not therefore be addressed by the identified interventions. The more recent unevaluated interventions implemented during the COVID-19 pandemic may have the potential to act on some of the patient barriers in access to services, including travel and inconvenient timing of services.

Conclusions

The factors affecting commencement, continuation or completion of cardiac or pulmonary rehabilitation consist of a web of complex and interlinked factors taking into consideration the perspectives of the patients and the service providers. The small number of published interventions we identified that aim to improve access are unlikely to address the majority of these factors, especially those identified by patients as limiting their access. Better understanding of these factors will allow future interventions to be more evidence based with clear objectives as to how to address the known barriers to improve access.

Limitations

Time limitations constrained the consideration of study quality and precluded the inclusion of additional searching methods such as citation searching and contacting key authors. This may have implications for the completeness of the evidence base identified.

Future work

High-quality effectiveness studies of promising interventions to improve attendance at rehabilitation, both overall and for key patient groups, should be the focus moving forward.

Funding

This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HSDR programme or the Department of Health.

Study registration

The study protocol is registered with PROSPERO [CRD42022309214].

Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis

BACKGROUND

Cardiovascular disease is one of the most common chronic and life-threatening diseases. Due to the changes made in the normal living conditions of people after suffering from cardiovascular diseases, the appearance of symptoms of depression, anxiety, and stress is common among these patients. The results of the studies show the different prevalence of these disorders, so this study aimed to standardize the global prevalence of depression, anxiety, and stress in Cardiac patients by a systematic review and meta-analysis approach.

METHODS

The present systematic review and meta-analysis were conducted from 2000 to 2022. National and international databases were considered to retrieve related studies, including SID, Magiran, Scopus, Embase, PubMed, and Web of Science (WoS). Joanna Briggs Institute (JBI) checklist was used to evaluate studies qualitatively. Heterogeneity between studies was assessed by I2 index, and data analysis was performed in Comprehensive Meta-Analysis software.

RESULTS

After reviewing the retrieved studies, finally 68 studies on the prevalence of depression with a sample size of 110,219, 36 studies on the prevalence of anxiety with a sample size of 72,374 and 5 studies on the prevalence of stress with a sample size of 533 considered for the meta-analysis. Based on the results of the Meta-Analysis, the overall estimation of the prevalence of depression was 31.3 % (95 % confidence interval: 25.4/0.38 %), anxiety prevalence; 32.9 % (95 % confidence interval: 21.9-46.6 %) and stress prevalence was 57.7 % (95 % confidence interval: 45.3-3.3 %).

CONCLUSION

The result of the present study shows the high prevalence rate of depression, anxiety, and stress in cardiac patients. Therefore, it is recommended that health professionals and policymakers pay more attention to preventing and controlling these disorders.

Clinical predictors and management for radial artery spasm: an Australian cross-sectional study

INTRODUCTION

The transradial approach for coronary artery catheterisation has increased in popularity compared to the transfemoral approach for patients undergoing percutaneous coronary interventions. However, radial artery spasm continues to be a major complication of the procedure. Current management strategies vary concerning radial artery spasm and there is limited evidence of practice in the Australian context.

AIM

To identify the predictors of radial artery spasm and the medications used for its prevention and management.

METHODS

A descriptive cross-sectional study was carried out over a three-month period in two tertiary hospitals in NSW, Australia. A self-administered pre-procedural survey was completed by patients undergoing coronary artery catheterisation. This survey collected socio-demographic data and assessed anxiety using the Spielberger State-Trait Anxiety Inventory. Procedural data, including length of procedure, equipment used, occurrence of radial artery spasm, and medications given, were collected post-procedure by the interventionalist.

RESULTS

Of the 169 participants, over half were male (59.8%) and aged 66 years or older (56.8%). Radial artery spasm was reported in 24 (14.2%) participants. Rates of spasm were significantly higher among females (66.6%, p = 0.004), those aged under 65 years (62.5%, p = 0.001) and those who reported a medical history of anxiety (33.3%, p = 0.0004). There were no significant differences in State and Trait anxiety scores among those who had RAS and those who did not. Logistic regression identified younger age as the only statistically significant predictor of RAS (OR 0.536; 95% CI 0.171-1.684; p = 0.005). To prevent radial artery spasm most patients received midazolam (n = 158; 93.5%), nitrates (n = 133; 78.7%) and/or fentanyl (n = 124; 73.4%) prophylactically. Nitrates were the most frequently administered medication to treat radial artery spasm (78.7%).

CONCLUSION

This study highlights that there is a need to develop a clearer understanding of the predictors of RAS, as identifying patients at risk can ensure prophylactic measures are implemented. This study identified nitrates as the preferred vasodilator as a preventative measure along with the use of sedation.

Prevalence and characteristics of anxiety in patients with unconfirmed pulmonary nodules

This study focuses on the prevalence and characteristics of anxiety in patients with pulmonary nodules that was assessed by Hamilton Anxiety Scale (HAMA) scores. A total of 890 patients were enrolled in this study, including incidence of absence of anxiety n = 343 (38.54%), mild or probable anxiety n = 459 (51.57%) and moderate or definite anxiety n = 79 (8.88%) and obvious anxiety n = 9 (1.01%), respectively. According to the definition of anxiety, 88 (9.89%) patients were enrolled in anxiety group. The incidence of anxiety in females was significantly higher than male (11.98% vs. 7.20%, p = 0.018), patients with respiratory symptoms were significantly higher than without respiratory symptoms (13.33% vs. 8.50%, p = 0.029) and diameter of pulmonary nodules >8 mm is significantly higher than ≤8 mm (13.35% vs. 7.10%, p = 0.002). Regression analysis showed that female (OR = 0.548, 95% CI: 0.340-0.884), family history of malignant tumour (OR = 1.691, 95% CI: 1.067-2.678), respiratory symptoms (OR = 1.713, 95% CI: 1.073-2.733) and diameter >8 mm (OR = 2.135, 95% CI: 1.350-3.375) were independent risk factors of anxiety. Further analysis of 88 patients with anxiety showed the sum of psychic anxiety was significantly higher than somatic anxiety (16.66 ± 2.46 vs. 0.97 ± 1.10, p < 0.0001). Hence, vast majority of patients with unconfirmed pulmonary nodules suffered various severity of anxiety and manifested as psychic anxiety. And gender, respiratory symptoms, family history of malignant tumour and diameter of pulmonary nodules were independent influencing factors of anxiety. Effective strategies urgently need exploring and providing for improving the mental health.

Effectiveness of Hypnosis for the Prevention of Anxiety During Coronary Angiography (HYPCOR study): a prospective randomized study

BACKGROUND

Coronary angiography is the gold standard for the diagnosis of coronary artery disease. This intervention is nevertheless a source of anxiety for the patient both by its discomfort and by the consequences linked to the discovery of potential diseases.

OBJECTIVES

The aim of this study was to determine the effectiveness of hypnosis in reducing anxiety in patients undergoing coronary angiography.

METHODS

One hundred sixty-nine patients with planned coronary angiography and no history of coronary angiography were randomized to a hypnosis or control group. Patients in the hypnosis group underwent a hypnosis session with self-hypnosis posthypnotic suggestions, while those in the control group had a conversational interview with the hypnotherapist. The primary endpoint was pre-exam anxiety level assessed by the Spielberger State-Trait Anxiety Inventory (STAI-Y A).

RESULTS

Performing a hypnosis session did not result in a significant decrease in anxiety before the intervention. Age, high trait anxiety, high state anxiety the day before, and belief that hypnosis works in general were associated with increased anxiety before the procedure. No adverse events were reported after hypnosis. There was no statistically significant difference between the 2 groups for the occurrence of complications of the intervention.

CONCLUSION

In this study, performing a hypnosis session before coronary angiography did not reduce the state of anxiety measured just before the intervention. In all cases, the hypnotic experience appears to be positive for the patient, encouraging further research efforts.

TRIAL REGISTRATION

The research protocol has been registered on the ClinicalTrials.gov registry (NCT02818101; 29/06/2016) and with the ANSM (IDRCB 2016-A00205-46; 02/02/2016).

Evaluating anxiety in elective coronary angiography study: rationale, design, and study methodology

AIMS

Prevalence of anxiety disorder in coronary artery disease reaches up to 15% and about half of patients with coronary artery disease have anxiety or depression comorbidity. Prevalence of anxiety in patients undergoing percutaneous coronary intervention ranges 24-72%. Depression can often overlap with anxiety symptoms and the evaluation of anxiety in elective coronary angiography study (ANGST) aims to determine the prevalence of anxiety by excluding patients with comorbid depressive symptoms. ANGST also aims to determine how anxiety correlates with psychological parameters (personality traits, coping strategies) and with outcome of elective coronary angiography (ECA).

METHODS

We will conduct a prospective single-center cross-section study in patients undergoing ECA. Anxiety will be evaluated at four time points using self-rating questionnaires: 14 days prior to ECA; 2-4 h before ECA; 24 h after ECA, but prior to discharge; and 4-6 weeks after discharge. The primary outcome of ANGST is the burden of anxiety experienced by patients without depressive symptoms and a correlation of anxiety with ECA outcome.

CONCLUSION

Our study aims to provide evidence on which personality traits and coping strategies affect the levels of anxiety. We will also determine psychometric properties of the two questionnaires used in our study. The results will have implications for improvement of interventions designed to recognize anxiety and will offer future research of psychological and/or pharmacological interventions to reduce the burden of anxiety.

Preprocedural Anxiety in the Transradial Cardiac Catheterization Era

BACKGROUND

Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce.

OBJECTIVE

The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures.

METHODS

Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety.

RESULTS

A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety.

CONCLUSION

Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.

Emergency percutaneous coronary intervention and stent implantation: Patients' lived experiences

INTRODUCTION

Given that emergency procedures must be performed immediately and without the possibility of sufficiently informing and preparing a patient, the lived experiences of patients who undergo emergency procedures and those who undergo elective procedures may well differ. Elucidating the lived experiences of patients who underwent percutaneous coronary intervention (PCI) with stent implantation in an emergency situation is crucial because such knowledge might prove helpful in tailoring post-procedure interventions intended to improve the lives of PCI patients.

AIM

To describe the experiences of patients 1 month after they underwent emergency PCI with coronary stent implantation.

METHODS

Cohen's phenomenology was applied in this study. This method combines the characteristics of descriptive (Husserlian) phenomenology with those of interpretative (Gadmerian) phenomenology, and it is by nature an inductive approach. The participants were enrolled 1 month after undergoing PCI with coronary stent implantation. They were interviewed using open-ended questions to provide them full freedom of expression. They were asked to describe their experiences of the PCI and stent implementation they have gone through. This study followed the recommendations of the Standard for Reporting Qualitative Research.

RESULTS

Our sample consisted of 15 participants. Data analysis revealed three main themes: (1) catheter lab and pain, (2) anxiety and feeling uncertain about the future, and (3) lifestyle changes. The anxiety theme encompassed two subthemes: (a) anxiety related to the procedure and (b) anxiety related to the continuation of life.

CONCLUSION

Our study is one of the first works to explicitly investigate the lived experiences of patients who underwent emergency PCI. Understanding the experiences of these patients is key in understanding their realistic needs and concerns.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of the lived experiences of patients who underwent emergency PCI with coronary stent implantation is fundamental in identifying aspects that warrant tailored interventions.

Medication Adherence and its Related Factors in Patients Undergoing Coronary Artery Angioplasty

Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients.

Methods: In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient’s self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity.

Results: The results showed that 75 patients (28%) didn’t adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence.

Conclusion: The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society.

Physician-patient interactions and communication with conscious patients during simulated cath lab procedures: an exploratory study

Background

This exploratory study investigates the feasibility for observing and evaluating intraoperative communication practices using simulation techniques. Complex procedures are increasingly performed on patients under local anaesthesia, where patients are fully conscious. Interventional cardiac procedures are one such example where patients have reported high levels of anxiety undergoing procedures. Although communication styles can serve to alleviate patient anxiety during interventions, leading to a better patient experience, there has been little observational research on communication, while patient perspectives in intraoperative contexts have been underexplored.

Methods

In this mixed-methods study, observational analysis was conducted on 20 video-recorded simulated scenarios, featuring physician operators (of varied experience levels), communication and interactions with a simulated patient (trained actor), in a controlled and highly realistic catheter laboratory setting. Two independent raters and the simulated patient embedded in scenarios retrospectively rated physician communication styles and interactions with the patient via four key parameters. Patient perspectives of communication were further explored via a quantitative measure of anxiety and semistructured qualitative interviews.

Results

While independent ratings of physician-patient communications demonstrated few discernible differences according to physicians' experience level, patient ratings were consistently higher for experienced physicians and lower for novice physicians for the four interaction styles. Furthermore, the patient's anxiety scores were differentiable according to operators' experience level. Thematic analysis provided further insights into how patient perspectives, including affective dimensions are characterised, and how physician interactions can amplify or attenuate feelings of anxiety through tone of voice, continuity in communication during the procedure, communicating while multitasking and connecting with the patient.

Conclusions

Our findings indicate underlying patient assumptions about physicians' experience levels, intraoperative communication styles and impact on anxiety. While observational methods can be applied to simulated intraoperative clinical contexts, evaluation techniques such as observational rating tools need to incorporate patient perspectives about undergoing conscious surgery.

Premedication to reduce anxiety in patients undergoing coronary angiography and percutaneous coronary intervention

Aims

In this study, we examined the effects of the routinely administration of benzodiazepines on reducing periprocedural anxiety versus no premedication.

Methods

In this open label study, we enrolled 1683 patients undergoing diagnostic coronary angiograms (CAG) or percutaneous coronary interventions (PCI). Randomisation was simulated by systematically allocating patients in monthly rotational periods to lorazepam 1  mg/sl, oxazepam 10  mg/po, diazepam 5  mg/po, midazolam 7.5  mg/po or no premedication. Anxiety was measured at four different time points using the one-item Visual Analogue Scale for Anxiety (VAS score) ranging from 0 to 10. The primary outcome was the difference in anxiety reduction (ΔVAS, preprocedure to postprocedure), between the different premedication strategies versus no premedication.

Results

Anxiety reduction was larger in patients premedicated with lorazepam (ΔVAS=−2.0, SE=1.6, P=0.007) or diazepam (ΔVAS=−2.0, SE=1.5, p=0.003) compared with patients without any premedication (ΔVAS=−1.4, SE=1.2). The use of midazolam or oxazepam did not lead to a significant reduction in anxiety compared with patients who did not receive premedication. Additionally, a high number of patients treated with midazolam (N=39, 19.8%) developed side effects.

Conclusions

In this study, the use of lorazepam or diazepam was associated with a significant, but modest anxiety reduction in patients undergoing CAG or PCI. This study does not support the standard use of oxazepam or midazolam as premedication to reduce anxiety.

Factors associated with depressive symptoms in patients with acute coronary syndrome undergoing percutaneous coronary intervention: A prospective cohort study

AIM

To identify the association between possible factors and depression among post-percutaneous coronary intervention patients with acute coronary syndrome.

DESIGN

Prospective cohort study.

METHODS

Sixty-eight post-percutaneous coronary intervention patients with acute coronary syndrome were enrolled between January 2016 - June 2017. The Hospital Anxiety and Depression Scale scores at 1-3 months after discharge were regressed onto uncertainty in illness and other clinical factors based on the Roy Adaptation Model.

RESULTS

Thirty-six patients were included in the final analysis. Higher baseline depression scores, higher changes in uncertainty in illness and feeling annoyed by troublesome tasks after discharge were associated with higher depressive scores at 1 month after discharge. Careful observation and support of patients' ineffective responses in self-concept mode may be effective in preventing depression.

Auswirkung motivierender Gesprächsführung auf die Krankheitswahrnehmung bei stabiler koronarer Herzkrankheit. Eine randomisiert-kontrollierte Studie

Zusammenfassung.Hintergrund: Koronare Herzkrankheit ist eine der häufigsten Todesursachen für Menschen > 60 Jahre. Vom Lebensstil abhängige Risikofaktoren sind wesentlich beteiligt. Kardiale Rehabilitation ist daher essenziell für eine optimale Behandlung. Leider verstehen die Betroffenen ihre Krankheit kaum. Motivierende Gesprächsführung kann die Krankheitswahrnehmung verbessern. Ziel / Methode: In einer randomisiert-kontrollierten Studie wurde die Wirksamkeit einer Intervention mit motivierender Gesprächsführung auf die Krankheitswahrnehmung untersucht. Personen mit stabiler koronarer Herzkrankheit wurden konsekutiv nach perkutaner transluminaler Koronarangioplastie (PTCA) in die Studie aufgenommen. Die Interventionsgruppe erhielt ein kurzes motivierendes Gespräch zur Erkrankung und den Risikofaktoren als Intervention. Die Kontrollgruppe erhielt die Standardbetreuung. Vor der Intervention und sechs Monate später wurden Daten zur Krankheitswahrnehmung (Illness Perception Questionnaire-Revised) erhoben. Ergebnisse: Total wurden 312 Personen (n = 148 Intervention, n = 164 Kontrollgruppe) in die Studie aufgenommen (Durchschnittsalter: 66,2 Jahre). Nach der Intervention zeigte sich eine signifikante Veränderung im Bereich der emotionalen Reaktionen auf die Erkrankung. Schlussfolgerung: Um die Krankheitswahrnehmung bei Personen mit stabiler koronarer Herzkrankheit zu verbessern, ist eine kurze Intervention mit motivierender Gesprächsführung möglicherweise wirksam. Ob eine Intensivierung der Intervention das Resultat weiter verbessert, muss noch untersucht werden.

Effects of a psychological intervention programme on mental stress, coping style and immune function in percutaneous coronary intervention patients

PURPOSE

This study aimed to assess the effects of a psychological intervention programme on the mental stress, coping style and cortisol and IL-2 levels of patients undergoing percutaneous coronary intervention (PCI).

METHODS

A total of sixty cardiovascular patients scheduled for PCI with clear anxiety and depression screened by the Hospital Anxiety and Depression Scale were randomly divided into an experimental (n = 30) and control (n = 30) group. The participants in the experimental group received cognitive therapy, relaxation therapy and emotional support. Self-reported questionnaires, including the Self-Report Symptom Checklist (SCL-90) and the Medical Coping Mode Questionnaire (MCMQ), and levels of IL-2 and cortisol were collected at baseline and the day before discharge.

RESULTS

Compared with the controls, patients in the intervention group had a better mental state and coping style (confrontation), higher levels of IL-2 and lower levels of cortisol (all P<0.05).

CONCLUSIONS

The psychological intervention programme effectively improved mental state, reduced negative coping styles, increased levels of IL-2, and decreased cortisol levels in patients undergoing PCI. This programme may be an effective preoperative nursing intervention for PCI patients.

TRIAL REGISTRATION

Chinese Clinical Trail Registry ChiCTR-IOR-16007864.

Sex-Based Differences in Discharge Disposition and Outcomes for ST-Segment Elevation Myocardial Infarction Patients Within a Regional Network

BACKGROUND

It is known that women with ST-segment elevation myocardial infarction (STEMI) have higher mortality in comparison to men. While the reasons for this sex-based difference are not completely understood, biologic differences and disparities in care have been implicated. Whether these differences persist within an urban, regional STEMI system of care with defined protocols is unclear. Our objective was to explore sex-related effects in outcomes in a large regional system of care.

MATERIALS AND METHODS

Data were drawn from a regional subset of the National Cardiovascular Data Registry for 33 hospitals in and around Dallas County, Texas from 2010 to 2015. We explored adjusted differences between women and men for discharge disposition, door to balloon (D2B), total ischemic time (TIS), length of stay, and in-hospital mortality rates.

RESULTS

Multivariate regressions to control for confounding factors, including age, D2B, and TIS, were significantly prolonged in women compared to men (D2B 58 vs. 54 minutes; TIS 206 vs. 178 minutes; both p < 0.001). Length of stay was 0.45 median days longer. Women were also much less likely to survive at discharge than men [odds ratio (OR): 0.63; 95% confidence interval (CI): 0.52-0.76]. Most notably, they were much less likely to be discharged to home than men (88% vs. 92%, p < 0.001).

CONCLUSIONS

In this study, we found that sex-based disparities persist for both cardiovascular outcomes and discharge disposition, even in a modern regionalized system of care.

Depressive symptoms impact health-promoting lifestyle behaviors and quality of life in healthy women

BACKGROUND

Depressive symptoms are an independent risk factor of cardiovascular disease (CVD). More than 15% of persons with CVD have depressive symptoms, which are twice as likely to occur in women. Depressive symptoms in women being screened for CVD have not been well studied.

OBJECTIVE

The relationships between depressive symptoms, health-promoting lifestyle behaviors, heart disease risk awareness, cardiac risk, and quality of life (QOL) in women were investigated. Whether the effect of depressive symptoms on QOL was mediated by cardiac risk and/or health-promoting lifestyle behaviors was also examined.

METHODS

The Wilson-Cleary Health-Related Quality of Life Model guided this descriptive study. A convenience sample of 125 women was recruited from cardiac health screening events. The study measurements were the Center for Epidemiologic Studies Depression Scale; the Framingham risk score; the Ferrans-Powers Quality of Life Index Generic Version-III; the Health-Promoting Lifestyle Profile-II; and questions related to heart disease risk, awareness of heart disease risk, health history, and demographics. Body mass index, percentage of body fat, and lipid profile were also measured.

RESULTS

More than one-third (34%) of the women reported significant depressive symptoms. Depressive symptoms were not associated with cardiac risk or risk awareness but were inversely associated with health-promoting lifestyle behaviors (r = -0.37, P < 0.01) and QOL (r = -0.51, P < 0.01). There was a dose-response relationship with health-promoting lifestyle behaviors (odds ratio, 0.92; 95% confidence interval, 0.88-0.97; P < 0.001) and QOL (odds ratio, 0.85; 95% confidence interval, 0.79-0.92; P < 0.001) and depressive symptoms. Health-promoting lifestyle behaviors mediated the association between depressive symptoms and QOL.

CONCLUSIONS

Depressive symptoms contribute significantly to health-promoting lifestyle behaviors and QOL for women. Early detection and treatment of depressive symptoms are important for participation in healthy lifestyle behaviors, which could result in improved QOL.

Relationships between coronary angiography, mood, anxiety and insomnia

The purpose of this study was to investigate and compare the anxiety, depression and insomnia levels in the pre- and post-coronary angiography in patients undergoing elective coronary angiography due to suspected coronary artery disease. This prospective cross-sectional study consisted of 120 patients consecutively underwent coronary angiogram (CAG) between January and August 2014 in Departments of Cardiology. The mean age was 57.49 (SD±9.73), and 58.3% of the sample were women. The Hospital Anxiety and Depression Scale, Profile of Mood States Scale, Spielberger's State-Trait Anxiety Inventory, and Insomnia Severity Index were used. Patients were subsumed under 2 groups as normal and critical according to the presence or the absence of visually severe stenosis in at least one coronary artery. Subjects with significant stenosis had greater mean scores on depression-dejection and anger-hostility sub-scales of the POMS in the post-angiography than pre-angiography scores. We found that older age and having a physical illness significantly contributed to the risk of having significant stenosis in coronary vasculature. Subjects with severe coronary artery stenosis scored higher on depression-dejection and anger-hostility sub-scales at the post-angiography time period relative to pre-angiography scores. Trait and state anxiety levels were found to be moderate higher in both groups.

Effect of Music Therapy on Patients' Anxiety and Hemodynamic Parameters During Coronary Angioplasty: A Randomized Controlled Trial

Background:

A cardiac catheterization laboratory can be a frightening environment and music can be a supportive source of environmental sound that stimulates and maintains relaxation. However, the results of studies are conflicting in this regard.

Objectives:

The aim of this study was to investigate the effect of music therapy on patients’ anxiety and hemodynamic parameters during percutaneous transluminal coronary angioplasty.

Patients and Methods:

This was a randomized controlled trial, conducted in the Catheterization Laboratory Unit of Baqiyatallah Hospital, in Tehran, Iran. A sample of 64 patients, who were planned to undergo coronary angioplasty, was recruited. Patients were randomly allocated to either the control or the experimental groups. In the experimental group, patients received a 20 to 40-minute music therapy intervention, consisting of light instrumental music albums by Johann Sebastian Bach and Mariko Makino. Patients in the control group received the routine care of the study setting, which consisted of no music therapy intervention. Study data were collected by a demographic questionnaire, the Spielberger’s State Anxiety Inventory, and a data sheet for documenting hemodynamic parameters. Chi-square, independent-samples t tests, paired-samples t-test and repeated measures analysis of variance were used to analyze the data.

Results:

Before the intervention, the study groups did not differ significantly in terms of anxiety level and hemodynamic parameters. Moreover, the differences between the two groups, regarding hemodynamic parameters, were not significant after the intervention (P > 0.05). However, the level of post-intervention anxiety in the experimental group was significantly lower than the control group (32.06 ± 8.57 and 38.97 ± 12.77, respectively; P = 0.014). Compared with the baseline readings, the level of anxiety in the control group did not change significantly after the study (41.91 ± 9.88 vs. 38.97 ± 12.77; P = 0.101); however, in the experimental group, the level of post-intervention anxiety was significantly lower than the pretest readings (32.06 ± 8.57 vs. 41.16 ± 10.6; P = 0.001).

Conclusions:

Music therapy is a safe, simple, inexpensive, and non-invasive nursing intervention, which can significantly alleviate patients’ anxiety during coronary angioplasty.

Anxiety and adverse health outcomes among cardiac patients: a biobehavioral model

BACKGROUND

Anxiety is a common experience among patients with acute coronary syndrome (ACS) that can have a negative impact on health outcomes. Nonetheless, the negative role of anxiety remains underappreciated, as reflected by clinicians' underrecognition and undertreatment of anxious hospitalized and nonhospitalized patients with ACS. Underappreciation of the role of anxiety is possibly related to inadequate understanding of the mechanisms whereby anxiety may adversely affect health outcomes.

PURPOSE

The aim of this study was to synthesize the evidence about potential mechanisms by which anxiety and adverse health outcomes are related.

CONCLUSIONS

A biobehavioral model links anxiety to the development of thrombogenic and arrhythmic events in patients with ACS. Biologically, anxiety may interfere with the immune system, lipid profile, automatic nervous system balance, and the coagulation cascade, whereas behaviorally, anxiety may adversely affect adoption of healthy habits and cardiac risk-reducing behaviors. The biological and behavioral pathways complement each other in the production of poor outcomes.

CLINICAL IMPLICATIONS

Anxiety requires more attention from clinical cardiology. The adverse impact of anxiety on health outcomes could be avoided by efficient assessment and treatment of anxiety.

Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses

Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety-six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire-12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.

Relation of depression, anxiety, and quality of life with outcome after percutaneous transluminal coronary angioplasty

Background. Despite, increasing number of percutaneous transluminal coronary angioplasty (PTCA) being performed, there is a paucity of Indian studies on the psychological effects of PTCA. Aim. To study the relation of anxiety, depression, and health related quality of life with outcome after PTCA. Methods. A total of 35 patients undergoing PTCA were included in the present project with their informed consent. All patients filled a specially designed proforma, the Hospital Anxiety and Depression Scale, Coronary Scale, Seattle Angina Questionnaire, and a health related quality of life measure (EQ 5D) one day before undergoing PTCA. Three days after PTCA patients were reassessed with the Hospital anxiety & depression scale, Seattle angina questionnaire and the EQ 5D. Results. Analysis showed that 46% had significant anxiety and 32.1% had significant depression before PTCA. Following successful PTCA, none of the patients had significant anxiety, and only 2 (3.6%) had significant depression. On the Seattle Angina Questionnaire, physical limitation reduced from 67.9 to 48. Disease perception improved from 21.2 to 37.1. On the EQ5D, the health status improved from 42.7 before PTCA to 78.7 after PTCA. Conclusion. Successful PTCA resulted in significant reduction in anxiety, depression, and physical limitation and improvement in disease perception and health status.

Health related quality of life and mental distress after PCI: restoring a state of equilibrium

BACKGROUND

Patient self reported measures for Health Related Quality of Life (HRQOL) and mental distress are frequently used to evaluate outcome of therapeutic strategies in cardiac patients.Our study aims to describe changes in HRQOL and mental distress after percutaneous coronary intervention (PCI) focusing on temporal pattern of change and interdependences between both outcome measures.

METHOD

163 PCI patients recruited at 7 cardiovascular care units in Austria answered MacNew Health Related Quality of Life and Hospital Anxiety and Depression Scale (HADS) questionnaires during hospital stay after intervention and at 1, 6, 12 and 24 months.

RESULTS

Improvement of MacNew HRQOL was found up to 6 month after PCI. Mental distress declined during the first month of the follow-up period. MacNew HRQOL is negatively correlated to mental distress. The relationship could be well described by a linear regression with MacNew HRQOL as dependent and HADS Total score as independent variable. The explained variance (R2) of the regression equation increases drastically from 45% at the baseline to a level between 67% and 77% in the follow up.

CONCLUSION

Our data suggest that the regression equation describing the relation between MacNew HRQOL and HADS-Total score six month after PCI defines a state of equilibrium: In absence of actual symptoms of coronary artery disease (CAD) both measures reflect the general health status and the general attitude underlying the self-assessment of health. At the baseline this equilibrium is imbalanced because the symptoms of CAD have a more pronounced impact on the disease specific MacNew HRQOL measure than on the non-disease specific HADS measure for mental distress. In order to use the MacNew questionnaire as a monitoring and/or prognostic tool it seems promising to refer to the state of equilibrium to define expectancy values for successful treatment.

Effects of Informational Sessions on Anxiety Precardiovascular Procedure

To measure the effect of an informational video intervention (IVI) compared to standard care (SC) preparation on anxiety and satisfaction prior to percutaneous cardiovascular procedure (PCVP). A quasi-experimental, randomized, prepost design was used to measure the effect of IVI, provided pre-PCVP, compared with SC only preparation on admission anxiety compared with post the IVI and SC preparation. There were 113 males/72 females, mean age of 61.8 years, assigned to IVI ( n = 94) or SC group ( n = 91). After the preparatory information session, there was no difference between groups on state anxiety (37.6 ± 11.7 vs. 36.3 ± 10.7; z = –.500, p = .617). There was a significant improvement in satisfaction in IVI group (54.23 ± 5.5 vs. 50.7 ± 6.6 ( z = −2.9, p = .003). IVI session improved satisfaction with preparation. Viewing the IVI within hours of a PCVP did not reduce measurable anxiety. Further research may reveal a more ideal viewing time.

Psychometric properties of the cardiac depression scale in patients with coronary heart disease

BACKGROUND

This study examined the psychometric properties of the Cardiac Depression Scale (CDS) in a sample of coronary heart disease (CHD) patients.

METHODS

A total of 152 patients were diagnosed with coronary heart disease and were administered the CDS along with the Beck Depression Inventory- 2 (BDI-2) and the State Trait Anxiety Inventory (STAI) 3.5-months after cardiac hospitalization.

RESULTS

The CDS's factorial composition in the current sample was similar to that observed in the original scale. Varimax-rotated principal-components analyses extracted six factors, corresponding to mood, anhedonia, cognition, fear, sleep and suicide. Reliability analyses yielded internal consistency α - coefficients for the six subscales ranging from 0.62 to 0.82. The CDS showed strong concurrent validity with the BDI-II (r = 0.64). More patients were classified as severely depressed using the CDS. Both the CDS and the BDI-2 displayed significantly strong correlations with the STAI (r = 0.61 and r = 0.64), respectively.

CONCLUSIONS

These findings encourage the use of the CDS for measuring the range of depressive symptoms in those with CHD 3.5 months after cardiac hospitalization.

Emotional functioning of patients with neurofibromatosis tumor suppressor syndrome

PURPOSE

Although patients with neurofibromatosis are predisposed to multiple nerve sheath tumors that can develop anywhere in the body and cause significant morbidity (e.g., hearing loss; pain), little research has examined emotional correlates of neurofibromatosis. The purpose of this study was to examine emotional functioning among adult patients with neurofibromatosis.

METHODS

A total of 248 patients with neurofibromatosis (neurofibromatosis 1, neurofibromatosis 2, or schwannomatosis) who received care at a specialized clinic completed validated measures to assess symptoms of depression and anxiety, level of perceived stress, and self-esteem.

RESULTS

Patients with neurofibromatosis reported significantly more symptoms of depression and anxiety, higher levels of perceived stress, and lower levels of self-esteem as compared with general population norms. No significant differences were found among patients with neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis, and emotional functioning was not significantly associated with disease severity. However, increased symptoms of depression and anxiety, higher levels of perceived stress, and lower levels of self-esteem were associated with a higher frequency of self-reported medical visits in the past year (P values ≤0.05).

CONCLUSION

Neurofibromatosis appears to be associated with reduced emotional functioning. Although further research is needed, these findings suggest a role for a multidisciplinary treatment approach to address emotional distress among adult patients with neurofibromatosis.

Reduced positive affect (anhedonia) is independently associated with 7-year mortality in patients treated with percutaneous coronary intervention: results from the RESEARCH registry

AIMS

Negative mood states (e.g., anxiety and depression) have been associated with increased cardiovascular morbidity and mortality in coronary artery disease (CAD), but little is known about the impact of positive emotions on these health outcomes. We examined whether anhedonia (i.e., reduced positive affect) was associated with 7-year mortality in patients treated with percutaneous coronary intervention (PCI).

METHODS

Consecutive PCI patients (n = 1206; 71.5% men; mean age 62.0 ± 11.1 years) from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry completed the Hospital Anxiety and Depression Scale (HADS) to assess anhedonia at baseline. Anhedonia was defined as a score ≤ 7 (i.e., one SD below the mean) on the positive affect scale of the HADS. The endpoint was defined as all-cause mortality.

RESULTS

The prevalence of anhedonia was 23.7% (286/1206). After a median follow up of 7.0 ± 1.6 years, 186 deaths (15.4%) from any cause were recorded. The incidence of mortality in anhedonic patients was 22.7% (65/286) vs. 13.2% (121/920) in non-anhedonic patients (HR = 1.66, 95% CI [1.19-2.32], p = 0.003). Cumulative hazard functions were significantly different for anhedonic vs. non-anhedonic patients (log-rank χ(2) = 16.61, p < 0.001). In multivariable analysis, anhedonia remained independently associated with all-cause mortality (HR = 1.51, 95% CI [1.03-2.22], p = 0.036), after adjusting for socio-demographics, clinical characteristics, and negative and relaxed affect.

CONCLUSION

Anhedonia was independently associated with a 1.5-fold increased risk for all-cause mortality in patients who survived the first 6 months post-PCI. Enhancing positive emotions, in addition to reducing negative emotions, may constitute an important target for future psychological intervention trials in CAD patients.

Anxiety in patients undergoing percutaneous coronary interventions

OBJECTIVE

Many patients undergoing percutaneous coronary intervention (PCI) experience symptoms of anxiety; however, it is unclear whether anxiety is an issue in the early recovery period and the types of factors and patient concerns that are associated. This study set out to determine the patterns of anxiety and concerns experienced by patients undergoing PCI and the contributing factors in the time period surrounding PCI.

METHODS

A convenience sample of patients undergoing PCI (n = 100) were recruited, and anxiety was measured using the Spielberger State Anxiety Inventory immediately before the PCI, the first day postprocedure, and 1 week postdischarge. Patients were also asked to identify their most important concern at each time. Independent predictors of anxiety at each time were determined by multiple regression analysis.

RESULTS

Anxiety scores were highest pre-procedure (35.72, standard deviation [SD] 11.75), decreasing significantly by the postprocedure time (31.8, SD 10.20) and further still by the postdischarge time (28.79, SD 9.78) (repeated-measures analysis of variance: F = 39.72, P < .001). The concerns patients identified most frequently as most important were the outcome of the PCI and the possibility of surgery pre-procedure (37%) and postdischarge (31%), and the limitations and discomfort arising from the access site wound and immobility postprocedure (25%). The predictor of anxiety at the pre-procedure time was taking medication for anxiety and depression (b = 7.12). The predictors of anxiety at the postprocedure time were undergoing first-time PCI (b = 4.44), experiencing chest pain (b = 7.63), and experiencing pre-procedural anxiety (b = .49). The predictors of anxiety at the postdischarge time were reporting their most important concern as the future progression of CAD (b = 7.51) and pre-procedural anxiety (b = .37).

CONCLUSION

Symptoms of anxiety were common, particularly before PCI. These symptoms are important to detect and treat because pre-procedural anxiety is predictive of anxiety on subsequent occasions. Patients who have had chest pain or their first PCI should be targeted for intervention during the early recovery period after PCI, and information on CAD should be provided postdischarge.

Feelings of being disabled as a prognostic factor for mortality in the drug-eluting stent era

OBJECTIVE

It remains unclear whether feelings of being disabled are a relevant psychological factor that determines outcome after percutaneous coronary intervention (PCI). Therefore, we evaluated "feelings of being disabled" as an independent risk factor for mortality 4 years post-PCI.

METHODS

As part of the Taxus-Stent Evaluated At Rotterdam Cardiology Hospital (T-SEARCH) Registry, 658 consecutive patients (age 63 years, 75% male) completed the subscale "feelings of being disabled" of the Heart Patients Psychological Questionnaire (HPPQ), within the first month after PCI.

RESULTS

At 4-year follow-up, 8% of the patients (n=55) had died, 2% (n=16) underwent a myocardial infarction (MI), 13% (n=90) had a target-vessel revascularization (TVR), and 21% (n=137) had one or more major adverse cardiac events (MACE). One-third of the patients (32%) had high scores on "feelings of being disabled" at baseline. After adjusting for baseline characteristics, including symptoms of anxiety and depression, patients with a high score on "feelings of being disabled" had an increased risk for all cause mortality (HR=2.9, 95% CI=1.5-5.6), the composite end point mortality/MI (HR=2.4, 95% CI=1.3-4.4), and the occurrence of MACE (HR=1.7, 95% CI=1.1-2.7).

CONCLUSION

Feelings of being disabled were an independent predictor of all-cause mortality, mortality/MI, and MACE 4 years post-PCI. These patients should be identified in clinical practice, as they warrant additional treatment, e.g., of a psychosocial nature, in addition to the standard medical treatment.

Symptoms of fatigue and depression in ischemic heart disease are driven by personality characteristics rather than disease stage: a comparison of CAD and CHF patients

Background

Symptoms of fatigue and depression are prevalent across stages of ischemic heart disease (IHD). We examined (i) the effect of both the IHD stage and type-D personality on fatigue and depressive symptoms at 12-month follow-up, and (ii) whether the effect of type-D personality on these symptoms is moderated by IHD stage.

Methods

Two different samples of patients were included to represent IHD stage: 401 percutaneous coronary intervention patients (early-stage IHD) and 105 ischemic chronic heart failure patients (end-stage IHD) completed the DS14 Type-D Scale at baseline. Logistic regression analysis was used to examine the impact of IHD stage and type-D personality on fatigue and depression at follow-up.

Results

Disease stage was neither associated with symptoms of fatigue ( P = 0.99) nor depression ( P = 0.29) at 12 months. In contrast, type-D personality was shown to predict both symptoms of fatigue [odds ratio (OR) = 2.96; 95% confidence interval (CI): 1.92–4.58, P < 0.001] and depression (OR = 4.91; 95% CI: 3.16–7.65, P < 0.001) at follow-up; the effect of type-D personality on these symptoms was not moderated by disease stage. In multivariable analysis, type-D remained a significant predictor of symptoms of fatigue (OR = 3.14; 95% CI: 1.98–4.99, P < 0.001) and depression (OR = 5.90; 95% CI: 3.60–9.67, P < 0.001), also after controlling for symptom levels at baseline.

Conclusion

Type-D personality but not disease stage predicted symptoms of fatigue and depression at 12-month follow-up.

Uncertainty and Health-Related Quality of Life 1 Year After Coronary Angiography

Background Little is known about illness-related uncertainty and decreased health-related quality of life in patients undergoing initial coronary angiography or about the long-term effects of uncertainty.

Objectives To compare patients with and without high levels of uncertainty before angiography and to examine the influence of uncertainty on health-related quality of life 1 year after angiography.

Methods In a prospective, longitudinal study, measurements of perceived control, uncertainty, affective distress, and health-related quality of life were collected from 93 patients before angiography (baseline) and 1 year later. At baseline, patients were classified into high- and low-uncertainty groups by median split. At 1 year, analysis of variance was used to compare health-related quality of life and psychological outcomes in the 2 groups, and multiple linear regression with stepwise entry was used to identify independent determinants of health-related quality of life.

Results Compared with patients with low baseline uncertainty, patients with high baseline uncertainty had higher levels of anxiety and depression and lower levels of perceived control and health-related quality of life 1 year after angiography. Baseline health-related quality of life, uncertainty, and life stress accounted for 54% of the variance in health-related quality of life, even when angiographic outcome was controlled for (P &lt; .001). Baseline uncertainty was independently associated with health-related quality of life (β = −0.25; 95% confidence interval, −9.40 to −0.05; P = .02).

Conclusions At initial angiography, high levels of uncertainty about illness portend negative health-related quality of life outcomes up to 1 year later.

Course of anxiety symptoms over an 18-month period in exhausted patients post percutaneous coronary intervention

OBJECTIVE

Anxiety is a neglected risk factor in coronary artery disease. We examined the different courses of anxiety over an 18-month period in patients post percutaneous coronary prevention (PCI) and the predictors of group membership of these courses.

METHODS

Consecutive exhausted PCI patients (n = 638), participating in the EXhaustion Intervention Trial (EXIT), were assessed for depression at baseline using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and for symptoms of anxiety at baseline, 6, and 18 months using the State Trait Anxiety Inventory (state only). SAS procedure TRAJ was used to examine courses of anxiety symptoms over an 18-month period.

RESULTS

Five trajectories were identified: nonanxious (13.2%), mildly anxious (39.7%), decreasingly anxious (11.6%), moderately anxious (29.3%), and severely anxious (6.3%), with four of them being stable over 18 months. Multinomial logistic regression analyses showed that angina pectoris, major depression, the use of anxiolytics, and low educational level distinguished moderate-to-severe anxious patients from nonanxious. The absence of angina and major depression and not using diuretics explained the decreasing trend in anxiety in one of the trajectories.

CONCLUSIONS

Anxiety trajectories varied across patients, with four of five being stable over 18 months. In clinical practice, knowledge of these trajectories and their determinants may help identify distinct groups of patients with potentially differential risks of adverse health outcomes.

Improvement in psychosocial functioning during an intensive cardiovascular lifestyle modification program

PURPOSE

Psychosocial factors have significant effects on development and progression of coronary artery disease (CAD), but appropriate strategies for clinical management of multiple risk factors in persons with CAD are not well defined. This study evaluated changes in psychosocial functioning in patients with cardiovascular disease participating in an intensive lifestyle modification program.

METHODS

One hundred seventy-six patients participated in a prospective, nonrandomized intervention designed to stabilize or reverse progression of CAD through dietary changes, exercise, stress management, and group support. Three examinations over the course of 1 year assessed psychosocial functioning, physiological and biochemical CAD risk factors, and risk for future coronary events.

RESULTS

Most patients showed significant improvements in mental health and quality of life as well as significant reductions in traditional CAD risk factors and cardiovascular risk. The intervention was effective in producing clinically meaningful changes in psychosocial functioning. Response rates were approximately 90% for clinical depression, 85% for stress, and 87% for mental health.

CONCLUSIONS

A comprehensive lifestyle intervention can reduce multiple psychometric risk factors and produce clinically relevant improvement in measures of depression, stress, and mental health. Cardiac rehabilitation programs that effectively address psychosocial and physiological outcomes may be valuable alternatives or supplements to pharmacologic treatments for reducing multiple psychosocial risk factors for CAD.

Type-D personality and depressive symptoms predict anxiety 12 months post-percutaneous coronary intervention

BACKGROUND

We examined whether type-D personality exerts a stable effect on anxiety over time and the clinical relevance of type-D personality as a predictor of anxiety 12 months post-percutaneous coronary intervention (PCI).

METHODS

Consecutive patients (n=416) with stable or unstable angina pectoris treated with PCI completed the Type-D Scale (DS14) at baseline and the Hospital Anxiety and Depression Scale (HADS) at baseline and 12 months.

RESULTS

At baseline, 26% of the patients were anxious, with 67% of these patients still being anxious 12 months post-PCI (p<0.001). There was no significant change in anxiety between baseline and 12 months (p=0.96) nor was the interaction effect type-D personality by time significant (p=0.41). However, type-D patients experienced significantly higher levels of anxiety than non-type-D patients (p<0.001). Type-D personality (OR: 2.89; CI: 1.57-5.34), depressive symptoms (OR: 3.27; CI: 1.73-6.18) and anxiety at baseline (OR: 8.38; CI: 4.65-15.12) were independent predictors of anxiety 12 months post-PCI, adjusting for baseline demographic and clinical characteristics.

LIMITATIONS

A limitation of the study is the attrition rate of 105 patients who did not complete the HADS at 12 months. No information was available on the use of psychotropic medication and participation in cardiac rehabilitation, which could serve as confounders.

CONCLUSION

Type-D exerted a stable effect on anxiety over time and was an independent predictor of anxiety 12 months post-PCI together with depressive symptoms and anxiety at baseline. The DS14 could be used as a screening tool in clinical practice to identify high-risk patients post-PCI.

Changes in patients’ illness representations before and after elective percutaneous transluminal coronary angioplasty

BACKGROUND

Elective percutaneous transluminal coronary angioplasty (PTCA) is an increasingly popular treatment for coronary heart disease, but little is known about individuals' cognitive responses to this intervention. As part of adapting to living with chronic disease, individuals develop unique models, or illness representations, which enable them to "make sense" of their predicament. Inaccurate illness representations have a negative affect on patient behaviors and outcomes.

OBJECTIVE

This purpose of this study was to examine changes in patients' self-reported illness representations before and after first-time elective PTCA.

METHODS

In this descriptive, repeated-measures design, illness representations were evaluated in 117 consecutive patients attending a pre-PTCA clinic using the Illness Perceptions Questionnaire. Data were collected pre- and 6 to 8 months post-elective PTCA.

RESULTS

A typical participant was male (75%), of European ethnicity (90%), and aged 62 years (+/-10.7). Six to 8 months post-PTCA self-reported symptom frequency (Z = 8.034, N-ties, P = .000) and duration decreased significantly (Z = 8.361, N-ties 20, P = .000) compared with pre-PTCA levels. Timeline scores increased significantly (Z = 3.46, N-ties 10, P = .001) indicating a shift in patients' representations of their disease from an acute to a chronic model. Cure/control and consequence scores decreased significantly, indicating that representations regarding personal control over their illness weakened (Z = 3.251, N-ties 18, P = .001), as did their representation of their illness as having serious consequences (Z = 5.250, N-ties 0, P = .00).

CONCLUSION

Some inaccuracies in illness representations were evident, some of which evolved to more realistic representations, whereas others did not. In the era of promoting effective self-management among those living with chronic diseases a clear understanding of illness representation in the context of coronary heart disease is valuable, particularly as inaccuracies are associated with negative outcomes.