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Yip E, Fleck D. The Use of Prophylactic Ketamine to Mitigate Postoperative Depressive Symptoms: A Systematic Review. J Perianesth Nurs 2024:S1089-9472(24)00210-7. [PMID: 39365203 DOI: 10.1016/j.jopan.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE Depression is predicted to be the leading burden of disease worldwide by 2030 with a prevalence of 10% to 60% in the surgical population. Depressive symptoms in the perioperative population are associated with a myriad of grave complications, including higher morbidity and mortality. This systematic review aims to determine whether a single dose of intravenous ketamine can be used prophylactically as a routine resilience-enhancing agent in all high-risk adult patients undergoing surgery to mitigate depressive symptoms postoperatively by appraising evidence of existing literature. DESIGN An evidence-based systematic review. METHODS The databases PubMed, CINAHL, and Scopus were searched, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search and Medical Subject Headings (MeSH) terms used: "ketamine," "surgical procedures," "surgical," "surgery," "depression," and "depressive disorder." FINDINGS In 9 randomized controlled trials (RCTs), bolus ketamine doses of 0.1 mg/kg to 1 mg/kg were administered intraoperatively or in the postanesthesia care unit. The primary outcome was the subjective feelings of depression as evaluated by different validated depression screening tools and seven RCTs observed statistically significant findings between the control and intervention (ketamine) groups with postoperative depression scores. Two RCTs did not find a significant change in depression scores. CONCLUSIONS Research on the use of prophylactic ketamine as an antidepressant in the perioperative population offers insight into changing routine practices and can shape how mental health is viewed in hospitals. Further research is warranted on the safety profile of ketamine, and risk stratification with careful consideration of baseline depressive symptoms, timing, and its use across a wider variety of surgical subspecialties.
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Affiliation(s)
- Eleanor Yip
- University of Pennsylvania School of Nursing, Philadelphia, PA.
| | - Desiree Fleck
- University of Pennsylvania School of Nursing, Philadelphia, PA
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2
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Oldham MA, Kukla B, Walsh P, Lee HB. Sex Differences in Delirium after Coronary Artery Bypass Graft Surgery and Perioperative Neuropsychiatric Conditions: A Secondary Analysis of a Cohort Study. J Geriatr Psychiatry Neurol 2024:8919887241246226. [PMID: 38604978 DOI: 10.1177/08919887241246226] [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: 04/13/2024]
Abstract
BACKGROUND Biological sex influences the risk of depression and cognitive impairment, but its role in relation to postoperative delirium is unclear. This analysis investigates sex differences in delirium risk after coronary artery bypass graft (CABG) surgery and sex-related differences in relation to affective and cognitive symptoms. METHODS This is a secondary analysis of the Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study, a single-site, observational study of a CABG surgery cohort (n = 149). Preoperative characteristics are stratified by sex, and baseline variables that differ by sex are evaluated to understand whether sex modifies their relationships with delirium. We also evaluate sex differences in one-month depression and cognition. RESULTS Female sex is associated with several delirium risk factors, including higher risk of preoperative depression and middle cerebral artery (MCA) stenosis. MCA stenosis was statistically associated with delirium only among women (OR 15.6, 95% CI 1.5, 164.4); mild cognitive impairment (MCI) was associated with delirium only in men (OR 4.6, 95% CI 1.2, 17.9). Other sex-based differences failed to reach statistical significance. Depression remained commoner among women 1 month post-CABG. CONCLUSIONS Women in this CABG cohort were more likely to have depression at baseline and 1 month postoperatively, as well as MCA stenosis and postoperative delirium. Sex might modify the relationship between post-CABG delirium and its risk factors including MCA stenosis and MCI. Cerebrovascular disease deserves study as a potential explanation linking female sex and a range of poor outcomes among women with coronary heart disease.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Bennett Kukla
- College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Patrick Walsh
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
| | - Hochang B Lee
- Department of Psychiatry University of Rochester Medical Center, Rochester, NY, USA
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Sadeh M, Fulman N, Agay N, Levy I, Ziv A, Chudnovsky A, Brauer M, Dankner R. Residential Greenness and Long-term Mortality Among Patients Who Underwent Coronary Artery Bypass Graft Surgery. Epidemiology 2024; 35:41-50. [PMID: 37820249 DOI: 10.1097/ede.0000000000001687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Studies have reported inverse associations between exposure to residential greenness and mortality. Greenness has also been associated with better surgical recovery. However, studies have had small sample sizes and have been restricted to clinical settings. We investigated the association between exposure to residential greenness and all-cause mortality among a cohort of cardiac patients who underwent coronary artery bypass graft (CABG) surgery. METHODS We studied this cohort of 3,128 CABG patients between 2004 and 2009 at seven cardiothoracic departments in Israel and followed patients until death or 1st May 2021. We collected covariate information at the time of surgery and calculated the patient-level average normalized difference vegetation index (NDVI) over the entire follow-up in a 300 m buffer from the home address. We used Cox proportional hazards regression models to estimate associations between greenness and death, adjusting for age, sex, origin, socioeconomic status, type of hospital admission, peripherality, air pollution, and distance from the sea. RESULTS Mean age at surgery was 63.8 ± 10.6 for men and 69.5 ± 10.0 for women. During an average of 12.1 years of follow-up (37,912 person-years), 1,442 (46%) patients died. A fully adjusted Cox proportional hazards model estimated a 7% lower risk of mortality (HR: 0.93, 95% CI = [0.85, 1.00]) per 1 interquartile range width increase (0.04) in NDVI. Results were robust to the use of different buffer sizes (100 m-1,250 m from the home) and to the use of average NDVI exposure during the first versus the last 2 years of follow-up. CONCLUSIONS Residential greenness was associated with lower risk of mortality in CABG patients.
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Affiliation(s)
- Maya Sadeh
- From the Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Fulman
- GIScience Research Group, Institute of Geography, Heidelberg University, Heidelberg, Germany
| | - Nirit Agay
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilan Levy
- Air Quality Division, Israel Ministry of Environmental Protection
| | - Arnona Ziv
- Unit for Data Management and Computerization, the Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Alexandra Chudnovsky
- AIR-O Lab, Porter School of Environment and Geosciences, Faculty of Exact Sciences, Department of Geography and Human Environment, Tel Aviv University, Israel
| | - Michael Brauer
- School of Population & Public Health, University of British Columbia, Canada
| | - Rachel Dankner
- From the Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
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Vu T, Smith JA. The pathophysiology and management of depression in cardiac surgery patients. Front Psychiatry 2023; 14:1195028. [PMID: 37928924 PMCID: PMC10623009 DOI: 10.3389/fpsyt.2023.1195028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023] Open
Abstract
Background Depression is common in the cardiac surgery population. This contemporary narrative review aims to explore the main pathophysiological disturbances underpinning depression specifically within the cardiac surgery population. The common non-pharmacological and pharmacological management strategies used to manage depression within the cardiac surgery patient population are also explored. Methods A total of 1291 articles were identified through Ovid Medline and Embase. The findings from 39 studies were included for qualitative analysis in this narrative review. Results Depression is associated with several pathophysiological and behavioral factors which increase the likelihood of developing coronary heart disease which may ultimately require surgical intervention. The main pathophysiological factors contributing to depression are well characterized and include autonomic nervous system dysregulation, excessive inflammation and disruption of the hypothalamic-pituitary-adrenal axis. There are also several behavioral factors in depressed patients associated with the development of coronary heart disease including poor diet, insufficient exercise, poor compliance with medications and reduced adherence to cardiac rehabilitation. The common preventative and management modalities used for depression following cardiac surgery include preoperative and peri-operative education, cardiac rehabilitation, cognitive behavioral therapy, religion/prayer/spirituality, biobehavioral feedback, anti-depressant medications, and statins. Conclusion This contemporary review explores the pathophysiological mechanisms leading to depression following cardiac surgery and the current management modalities. Further studies on the preventative and management strategies for postoperative depression in the cardiac surgery patient population are warranted.
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Affiliation(s)
- Tony Vu
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Julian A. Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Cardiothoracic Surgery, Monash Health, Melbourne, VIC, Australia
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Holcomb RM, Zil-E-Ali A, Gonzalez R, Dowling RD, Shen C, Aziz F. Depression Is Associated With Non-Home Discharge After Coronary Artery Bypass Graft. J Surg Res 2023; 290:232-240. [PMID: 37301175 DOI: 10.1016/j.jss.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Depression is disproportionately high in patients with coronary artery disease and has been associated with adverse outcomes following coronary artery bypass graft (CABG). One quality metric, non-home discharge (NHD), can have substantial implications for patients and health care resource utilization. Depression increases the risk of NHD after many operations, but it has not been studied after CABG. We hypothesized that a history of depression would be associated with an increased risk of NHD following CABG. METHODS CABG cases were identified from the 2018 National Inpatient Sample using ICD-10 codes. Depression, demographic data, comorbidities, length of stay (LOS), rate of NHD were analyzed using appropriate statistical tests where a P-value < 0.05 was defined as statistically significant. Adjusted multivariable logistic regression models were used to assess independent association between depression and NHD as well as LOS while controlling for confounders. RESULTS There were 31,309 patients, of which 2743 (8.8%) had depression. Depressed patients were younger, females, in a lower income quartile, and more medically complex. They also demonstrated more frequent NHD and prolonged LOS. After adjusted multivariable analysis, depressed patients had a 70% increased odds of NHD (adjusted odds ratio: 1.70 [1.52-1.89] P < 0.001) and a 24% increased odds of prolonged LOS (AOR: 1.24 [1.12-1.38] P < 0.001). CONCLUSIONS From a national sample, depressed patients were associated with more frequent NHD following CABG. To our knowledge, this is the first study to demonstrate this, and it highlights the need for improved preoperative identification in order to improve risk stratification and timely allocation of discharge services.
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Affiliation(s)
- Ryan M Holcomb
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania.
| | - Ahsan Zil-E-Ali
- Division of Vascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Robert Gonzalez
- Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Robert D Dowling
- Division of Cardiac Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Chan Shen
- Division of Outcomes Research and Quality, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Faisal Aziz
- Division of Vascular Surgery, Department of Surgery, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Choi JJ, Kukla B, Walsh P, Oldham MA, Lee HB. Functional, cognitive, and cerebrovascular aspects of depression before coronary artery bypass graft surgery: Testing the vascular depression hypothesis. Int J Geriatr Psychiatry 2023; 38:e6000. [PMID: 37684728 PMCID: PMC10544764 DOI: 10.1002/gps.6000] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE Depression in patients undergoing coronary artery graft bypass (CABG) surgery is associated with morbidity and mortality, making its early identification and clinical management crucial. Vasculopathy and older age, hallmarks of patients requiring CABG, are also features of vascular depression. In this study, we assess for features of vascular depression in patients undergoing CABG surgery. METHODS This is a cross-sectional analysis of a single-site prospective observational cohort study of patients undergoing CABG surgery. Subjects were assessed preoperatively using the Depression Interview and Structured Hamilton (DISH), depression scales, transcranial Doppler, neuropsychological testing, and clinical dementia rating (CDR). RESULTS Of 161 subjects (mean age 66.2 ± 9.3, female 25%) who completed DISH, 18 had major or minor depression, 17 of whom had a past history of major or minor depression (mean age of onset 35.8 years-old). Pre-CABG depression was associated with greater functional impairment on CDR Sum of Boxes (OR = 3.7, 95% CI: 1.4, 9.7) and worse performance on letter fluency test (OR = 0.90, 95% CI: 0.81, 0.99) and trail-making tests (A: OR = 1.06, 95% CI: 1.01, 1.12; B: OR 1.02, 95% CI: 1.01, 1.04). Pre-CABG depression was not associated with middle cerebral artery (MCA) stenosis. CONCLUSIONS Pre-CABG depression is associated with cognitive and functional impairment similar to vascular depression, but we did not find evidence of an association with older age of onset and MCA stenosis. Further studies on white matter disease in this population are needed to examine the vascular depression hypothesis for pre-CABG depression.
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Affiliation(s)
- Joy J. Choi
- University of Rochester Medical Center, Rochester, New York
| | - Bennett Kukla
- Canandaigua Veterans Affairs Medical Center, Canandaigua, New York
| | - Patrick Walsh
- University of Rochester Medical Center, Rochester, New York
| | - Mark A. Oldham
- University of Rochester Medical Center, Rochester, New York
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Nowicka-Sauer K, Jarmoszewicz K, Molisz A, Sobczak K, Sauer M, Topolski M. Applying Machine Learning to Construct a Model of Risk of Depression in Patients Following Cardiac Surgery with the Use of the SF-12 Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4876. [PMID: 36981783 PMCID: PMC10048966 DOI: 10.3390/ijerph20064876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Depression is a common problem in patients with cardiovascular diseases. Identifying a risk factor model of depression has been postulated. A model of the risk of depression would provide a better understanding of this disorder in this population. We sought to construct a model of the risk factors of depression in patients following cardiac surgery, with the use of machine learning. METHODS AND MEASURES Two hundred and seventeen patients (65.4% men; mean age 65.14 years) were asked to complete the short form health survey-12 (SF-12v.2), three months after hospital discharge. Those at risk of depression were identified based on the SF-12 mental component summary (MCS). Centroid class principal component analysis (CCPCA) and the classification and regression tree (CART) were used to design a model. RESULTS A risk of depression was identified in 29.03% of patients. The following variables explained 82.53% of the variance in depression risk: vitality, limitation of activities due to emotional problems (role-emotional, RE), New York Heart Association (NYHA) class, and heart failure. Additionally, CART revealed that decreased vitality increased the risk of depression to 45.44% and an RE score > 68.75 increased it to 63.11%. In the group with an RE score < 68.75, the NYHA class increased the risk to 41.85%, and heart failure further increased it to 44.75%. CONCLUSION Assessing fatigue and vitality can help health professionals with identifying patients at risk of depression. In addition, assessing functional status and dimensions of fatigue, as well as the impact of emotional state on daily functioning, can help determine effective intervention options.
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Affiliation(s)
- Katarzyna Nowicka-Sauer
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Dębinki 2 Str., 80-211 Gdańsk, Poland
- Department of Cardiac Surgery, Kashubian Centre for Cardiac and Vascular Diseases, Ceynowa Specialist Hospital, Jagalskiego 10 Str., 84-200 Wejherowo, Poland;
| | - Krzysztof Jarmoszewicz
- Department of Cardiac Surgery, Kashubian Centre for Cardiac and Vascular Diseases, Ceynowa Specialist Hospital, Jagalskiego 10 Str., 84-200 Wejherowo, Poland;
| | - Andrzej Molisz
- Department of Otolaryngology, University Clinical Centre, Medical University of Gdańsk, Smoluchowskiego 17 Str., 80-214 Gdansk, Poland;
| | - Krzysztof Sobczak
- Division of Medical Sociology and Social Pathology, Faculty of Health Sciences, Medical University of Gdańsk, Tuwima 15 Str., 80-210 Gdańsk, Poland;
| | - Marta Sauer
- Radiation Protection Office, University Clinical Centre, Medical University of Gdańsk, Smoluchowskiego 17 Str., 80-214 Gdańsk, Poland;
| | - Mariusz Topolski
- Department of Systems and Computer Networks, Faculty of Information and Communication Technology, Wroclaw University of Science and Technology, Janiszewskiego 11/17 Str., 50-372 Wroclaw, Poland;
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Zhang W, Sun T, Wang S, Zhang J, Yang M, Li Z. Influence of preoperative depression on clinical outcomes after cervical laminoplasty: A retrospective study. Front Surg 2023; 9:1098043. [PMID: 36700019 PMCID: PMC9869422 DOI: 10.3389/fsurg.2022.1098043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Background Depression is a highly prevalent mental disorder, and we found that patients with preoperative depression had worse postoperative improvement in lumbar fusion. Are mental factors related to the prognosis of laminoplasty? Objective To analyze the relationship between depression and clinical outcomes after laminoplasty for the treatment of multilevel CSM. Methods In this retrospective study, 115 patients with multilevel cervical spondylotic myelopathy (CSM), who underwent laminoplasty and were followed up for more than 1 year, were enrolled in this study from October 2018 to October 2021. Patients with the scores of 21-item Beck Depression Inventory (BDI) ≥ 15 or Hamilton Depression Scale-24 (HAMD-24) > 20 were included in the depression group. The clinical outcomes were evaluated by the changes and recovery rate (RR) of Japanese Orthopaedic Association Scores (JOA) and Neck Disability Index (NDI) respectively. Univariate and multiple linear regression analyses were performed to reveal the relationship between preoperative depressive states and clinical outcomes. Results Fourteen patients were diagnosed with depression by BDI and twenty-nine by HAMD-24. Between the depression group and the non-depression group, the age, gender, smoking history, and duration of symptoms were statistically significant (P < 0.05). Multiple linear regression showed that the BDI scores had a negative relationship with the changes and RR of JOA and NDI, and the HAMD-24 scores had a negative relationship with the changes and RR of JOA. Conclusions Preoperative depression in patients with multilevel CSM can lead to worse prognosis. In order to improve the curative effect of the operation, we should pay attention to the psychological state monitoring and intervention of patients before they receive laminoplasty.
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Affiliation(s)
- Wentao Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, China
| | - Tianze Sun
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, China
| | - Shiyuan Wang
- Department of Medical Engineering, The 967th Hospital of Chinese People's Liberation Army, Dalian, China
| | - Jing Zhang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, China
| | - Ming Yang
- Department of Orthopedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhonghai Li
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.,Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopaedic Diseases, Dalian, China
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Pre-existing and new-onset depression among patients undergoing esophageal cancer surgery: a nationwide cohort study in South Korea. Esophagus 2023; 20:55-62. [PMID: 35904644 DOI: 10.1007/s10388-022-00947-0] [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] [Received: 04/06/2022] [Accepted: 07/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Esophageal cancer is believed to be related to psychological stress. This study aimed to examine the prevalence and risk factors for new-onset depression after esophageal cancer surgery among patients who had no pre-existing depression. In addition, we examined whether pre-existing depression affected postoperative 1-year mortality. METHODS The National Health Insurance Service database in South Korea was used for data extraction in this population-based cohort study. This study included all adult patients diagnosed with esophageal cancer who underwent esophageal surgery between January 1, 2011, and December 31, 2018. RESULTS A total of 7039 adult patients who underwent esophageal cancer surgery at 95 South Korean hospitals were included in the analyses. Of the total, 608 patients (8.6%) were diagnosed with new-onset depression within 1 year after esophageal cancer surgery. Female sex, adjuvant chemotherapy, increased Charlson comorbidity index, pre-existing anxiety disorder, and pre-existing insomnia disorder were potential risk factors for new-onset depression. In multivariable Cox regression analysis, the pre-existing depression group showed a 1.27-fold (hazard ratio: 1.27; 95% confidence interval: 1.08-1.48; P = 0.004) higher risk of 1-year all-cause mortality than those who had no pre-existing depression. CONCLUSION In South Korea, 8.6% of patients are newly diagnosed with depression after esophageal cancer surgery, and some potential risk factors have been identified. Moreover, pre-existing depression was associated with increased 1-year all-cause mortality. Patients with esophageal cancer and pre-existing depression may be at high risk, requiring interventions after esophageal cancer surgery.
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Scierka LE, Mena-Hurtado C, Ahmed ZV, Yousef S, Arham A, Grimshaw AA, Harris KM, Burg M, Vriens PW, Heyligers J, Lee M, Yazgan I, Smolderen KG. The association of depression with mortality and major adverse limb event outcomes in patients with peripheral artery disease: A systematic review and meta-analysis. J Affect Disord 2023; 320:169-177. [PMID: 36179780 DOI: 10.1016/j.jad.2022.09.098] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/28/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is highly prevalent and associated with poor outcomes. Depression is a risk factor for adverse outcomes in patients with coronary artery disease. Despite evidence showing that depression is common in patients with PAD, less is known about its association with adverse prognostic outcomes. To address this, we conducted a systematic review and meta-analysis to summarize the association between depression and outcomes in patients with PAD. METHODS We performed a systematic search of eight databases to January 2022 including studies that reported a risk estimate for the association of depression or depressive symptoms with all-cause mortality or major adverse limb events (MALE) in patients with PAD and pooled results in a meta-analysis. Risk of bias was assessed using ROBINS-I. RESULTS Of the 7048 articles screened, 5 observational studies with 119,123 patients were included. A total of 16.2 % had depression or depressive symptoms. Depression was associated with a statistically significant increased risk of all-cause mortality (HR 1.24, confidence interval 1.07-1.25, p = .005). The association between depression and MALE was not significant but trended toward a positive association. LIMITATIONS Due to lack of data, results were limited by a single study with a large sample size, overrepresentation of men, and lack of information of depression severity or treatment status. CONCLUSION Depression or depressive symptoms are associated with a 24 % increased risk of all-cause mortality in patients with PAD. Future work should explore the mechanisms and directionality of this association and identify depression as an important comorbidity to address for patients with PAD. REGISTRATION PROSPERO CRD 42021223694.
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Affiliation(s)
- Lindsey E Scierka
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Zain V Ahmed
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sameh Yousef
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ahmad Arham
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Alyssa A Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Kristie M Harris
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Matthew Burg
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Patrick W Vriens
- Department of Surgery, St. Elisabeth Hospital, Tilburg, the Netherlands
| | - Jan Heyligers
- Department of Surgery, St. Elisabeth Hospital, Tilburg, the Netherlands
| | - Megan Lee
- Yale School of Medicine, New Haven, CT, USA
| | | | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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11
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Bielas H, Meister-Langraf RE, Schmid JP, Barth J, Znoj H, Schnyder U, Princip M, von Känel R. Relationship between a Self-Reported History of Depression and Persistent Elevation in C-Reactive Protein after Myocardial Infarction. J Clin Med 2022; 11:jcm11092322. [PMID: 35566447 PMCID: PMC9100988 DOI: 10.3390/jcm11092322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Elevated levels of C-reactive protein (CRP) are associated with both an increased risk of cardiovascular disease (CVD) and depression. We aimed to test the hypothesis that a self-report history of depression is associated with a smaller decrease in CRP levels from hospital admission to 3-month follow-up in patients with acute myocardial infarction (MI). Methods: We assessed 183 patients (median age 59 years; 84% men) with verified MI for a self-report history of lifetime depression and plasma CRP levels within 48 h of an acute coronary intervention and again for CRP levels at three months. CRP values were categorized according to their potential to predict CVD risk at hospital admission (acute inflammatory response: 0 to <5 mg/L, 5 to <10 mg/L, 10 to <20 mg/L, and ≥20 mg/L) and at 3 months (low-grade inflammation: 0 to <1 mg/L, 1 to <3 mg/L, and ≥3 mg/L). Additionally, in a subsample of 84 patients showing admission CRP levels below 20 mg/L, changes in continuous CRP values over time were also analyzed. Results: After adjustment for a range of potentially important covariates, depression history showed a significant association with a smaller decrease in both CRP risk categories (r = 0.261, p < 0.001) and log CRP levels (r = 0.340, p = 0.005) over time. Conclusions: Self-reported history of depression may be associated with persistently elevated systemic inflammation three months after MI. This finding warrants studies to test whether lowering of inflammation in patients with an acute MI and a history of depression may improve prognosis.
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Affiliation(s)
- Hannes Bielas
- Department of Child and Adolescent Psychiatry, Technische Universität Dresden, 01307 Dresden, Germany
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.); (R.v.K.)
- Correspondence: ; Tel.: +49-(0)30-7882-2036; Fax: +49-(0)30-7882-2030
| | - Rebecca E. Meister-Langraf
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8901 Zurich, Switzerland;
- Clienia Schlössli AG, 8618 Oetwil am See, Switzerland
| | - Jean-Paul Schmid
- Department of Cardiology, Clinic Barmelweid, 5017 Barmelweid, Switzerland;
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zürich, University of Zürich, 8091 Zurich, Switzerland;
| | - Hansjörg Znoj
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012 Bern, Switzerland;
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zürich, 8901 Zurich, Switzerland;
| | - Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8901 Zurich, Switzerland;
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zürich, 8091 Zurich, Switzerland; (R.E.M.-L.); (M.P.); (R.v.K.)
- Faculty of Medicine, University of Zürich, 8901 Zurich, Switzerland;
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12
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 596] [Impact Index Per Article: 298.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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13
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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14
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Cromhout PF, Thygesen LC, Moons P, Nashef S, Damgaard S, Berg SK. Social and emotional factors as predictors of poor outcomes following cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 34:193-200. [PMID: 34606597 PMCID: PMC8766216 DOI: 10.1093/icvts/ivab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Existing risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients’ lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS The study included adults undergoing cardiac surgery in Denmark 2014–2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors. RESULTS Amongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17–1.51) and living alone (1.25; 1.14–1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00–1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70–0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes. CONCLUSIONS Social disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE. Subj collection 105, 123
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Affiliation(s)
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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15
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Ryder AL, Cohen BE. Evidence for depression and anxiety as risk factors for heart disease and stroke: implications for primary care. Fam Pract 2021; 38:365-367. [PMID: 34109973 DOI: 10.1093/fampra/cmab031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Annie L Ryder
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Beth E Cohen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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16
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Patients with psychiatric disease: implications for anesthesiologists. Curr Opin Anaesthesiol 2021; 34:345-351. [PMID: 33935183 DOI: 10.1097/aco.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Psychiatric illness is common in patients presenting for surgery. Overall health and surgical outcomes are adversely affected by the presence of psychiatric comorbidities. RECENT FINDINGS As new treatment modalities become available, their perioperative implications need to be evaluated. These implications include drug-drug interactions, hemodynamic effects, bleeding risk, and factors affecting perioperative exacerbation of the underlying psychiatric illness. SUMMARY From our review of the recent literature we continue to support the continuation of psychoactive agents in the perioperative period, taking into consideration the effects these agents have on concomitant drug use in the perioperative period; and the risks of withholding them at a high-stress time.
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17
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Falk A, Kåhlin J, Nymark C, Hultgren R, Stenman M. Depression as a predictor of postoperative delirium after cardiac surgery: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2021; 32:371-379. [PMID: 33831217 PMCID: PMC8906754 DOI: 10.1093/icvts/ivaa277] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Depression is common in patients with cardiac disease. The importance of preoperative depression for development of postoperative delirium (POD) following cardiac surgery is not well known. The aim is to provide a summary estimate of depression as a predictor of POD following cardiac surgery. METHODS Systematic search of MEDLINE, EMBASE, Cochrane Library, Web of Science Core Collection and Psycinfo (Ovid) was performed from inception to October 2019, including cohort studies reporting odds ratios (ORs) and 95% confidence intervals (CIs) for POD following cardiac surgery in patients with preoperative depression compared to patients without depression. ORs and 95% CIs for POD were calculated using random-effects meta-analyses. Subgroup and sensitivity analyses were performed. RESULTS Seven studies were included with a combined study population of 2066 patients. The pooled prevalence of POD in the combined study population was 26% and preoperative depression was present in ∼9% of the total study population. All studies showed a positive association between preoperative depression and POD; and in 5 studies, the association was statistically significant. Patients with depression had a pooled OR of 2.31 (95% CI 1.37-3.90) for POD. CONCLUSIONS This systematic review and meta-analysis confirm the findings that the previous association between preoperative depression and increased risk for developing POD reported for other patient groups is found also in cardiac surgery. Depression screening prior to cardiac surgery may be effective in identifying patients at higher risk for POD.
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Affiliation(s)
- Anna Falk
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
| | - Jessica Kåhlin
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Carolin Nymark
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Malin Stenman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden
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18
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Bendig E, Bauereiß N, Buntrock C, Habibović M, Ebert DD, Baumeister H. Lessons learned from an attempted randomized-controlled feasibility trial on "WIDeCAD" - An internet-based depression treatment for people living with coronary artery disease (CAD). Internet Interv 2021; 24:100375. [PMID: 33732627 PMCID: PMC7941156 DOI: 10.1016/j.invent.2021.100375] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 12/22/2022] Open
Abstract
Despite the high prevalence of comorbid depression in people living with coronary artery disease (CAD), uptake of psychological treatment is generally low. This study was designed to investigate the feasibility of an internet-based cognitive-behavioral (iCBT) depression intervention for people with CAD and depressive symptoms. METHODS People with CAD and depressive symptoms (PHQ-9 ≥ 5) were randomly assigned to the eight modules comprising iCBT (N = 18), or waitlist-control (N = 16). Measures were taken at baseline (t1) and at post-treatment (eight weeks after randomization, t2). Feasibility-related outcomes were recruitment strategy, study attrition, intervention dropout, satisfaction, negative effects as well as the potential of the intervention to affect likely outcomes in a future full-scale trial (depression, anxiety, quality of life, fear of progression). Data analyses were based on intention-to-treat principles. Linear regression models were used to detect between group differences. Linear Mixed Models were used to model potential changes over time. RESULTS This trial was terminated prior to a-priori defined sample size has been reached given low recruitment success as well as high intervention dropout (88%) and study attrition (23%). On average, participants in the intervention group completed M = 2.78 (SD = 3.23) modules. Participants in the waitlist control group barely started one module (M = 0.82, SD = 1.81). The satisfaction with the intervention was low (M = 20.6, SD = 0.88). Participants reported no negative effects attributed to the iCBT. Differences between groups with regard to depression, anxiety, fear of progression and quality of life remained non-significant (p > 0.05). CONCLUSION This trial failed to recruit a sufficient number of participants. Future work should explore potential pitfalls with regards to the reach and persuasiveness of internet interventions for people living with CAD. The study gives important indications for future studies with regard to the need for new ideas to reach and treat people with CAD and depression.
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Key Words
- APOI, Attitudes towards Psychological Online Interventions Questionnaire
- AQoL-8D, Inventory for the Assessment of Quality of Life
- CAD, Coronary artery disease
- CBT, Cognitive Behavioral Therapy
- CG, waitlist control group
- CSQ, Client Satisfaction Questionnaire
- Cognitive behavioral therapy
- Coronary artery disease
- Depression
- EG, intervention group
- FOP-Q-SF, Fear of Progression Questionnaire
- GAD-7, Generalized Anxiety Disorder 7-item Scale
- HADS, Hospital Anxiety and Depression Scale
- INEP, Inventory for the assessment of negative effects of psychotherapy
- ITT, intention-to-treat
- Internet and mobile-based intervention
- PHQ-9, Patient Health Questionnaire
- Psychological intervention
- SMS, short message service
- WIDeCAD, Web- and mobile-based Intervention for DEpression in people with CAD
- iCBT, internet-based cognitive behavioral therapy
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Affiliation(s)
- Eileen Bendig
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Natalie Bauereiß
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
| | - Claudia Buntrock
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen-Nürnberg, Germany
| | - Mirela Habibović
- Department of Medical and Clinical Psychology, Tilburg School of Social and Behavioral Sciences, Tilburg University, Netherlands
| | - David Daniel Ebert
- Faculty of Behavioral and Movement Sciences, Clinical Psychology, Vrije University Amsterdam, Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University Ulm, Ulm, Germany
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19
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Pilowsky JK, Elliott R, Roche MA. Pre-existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta-analysis of prevalence. J Adv Nurs 2021; 77:2214-2227. [PMID: 33426719 DOI: 10.1111/jan.14753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/15/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS To determine the reported prevalence rate of pre-existing mental health disorders in patients admitted to adult ICUs and identify the most commonly occurring types of these disorders. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases were searched from 1 January 2000 -15 April 2020. Google Scholar was used to perform forwards citation searching. METHODS This review was conducted in line with the PRISMA guidelines and protocol registered with PROSPERO CRD42020181818. Meta-analyses were performed using the quality effects model to calculate weighted pooled prevalence estimates and heterogeneity was tested using the I2 statistic. RESULTS Seven articles were included in the final review and meta-analysis (143,179 participants). Identified prevalence rates varied considerably, ranging from 6.2-28.0%, reflecting variation in each study's clinical context, as well as different patient selection and identification methodologies. The pooled prevalence rate of all pre-existing mental health disorders was 19.4% (95% CI 8.9-32.6%). Depression was the most common subtype, accounting for an estimated 60.5% (95% CI 54.4-66.5%) of identified mental health disorders. All analyses showed significant heterogeneity with I2 > 95%. CONCLUSION Approximately 19% of adult ICU patients have a history of a mental health disorder, most commonly depression. Further research is needed to improve the accuracy of this estimate as well as determine the best identification method. IMPACT This study has demonstrated that patients with pre-existing mental health disorders, particularly depression, constitute a significant subgroup in ICU. Given that the presence of a pre-existing mental health disorder appears to confer an increased mortality risk following ICU discharge, clinicians need to be made aware of this group of patients to provide additional support. Further research is needed to more accurately quantify this vulnerable group and establish methods to enable clinicians to readily identify and refer these patients for appropriate follow-up treatment.
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Affiliation(s)
- Julia K Pilowsky
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Rosalind Elliott
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Michael A Roche
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, North Ryde, NSW, Australia
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20
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Sveinsdóttir H, Zoëga S, Ingadóttir B, Blöndal K. Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study. Nurs Open 2021; 8:210-223. [PMID: 33318829 PMCID: PMC7729539 DOI: 10.1002/nop2.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 11/12/2022] Open
Abstract
Aims To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design Prospective, explorative two-site follow-up study. Methods Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Sigríður Zoëga
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Brynja Ingadóttir
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Katrín Blöndal
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
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21
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Preoperative Anxiety and Depression Increases the Incidence of Delirium After Coronary Artery Bypass Graft Surgery. J Perianesth Nurs 2020; 35:496-501. [DOI: 10.1016/j.jopan.2020.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/19/2020] [Accepted: 01/19/2020] [Indexed: 12/18/2022]
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22
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Nielsen SN, Rasmussen TB, Lassen JF, Berg SK, Thrysoee L, Møller JE, Jensen LO, Thuesen AL, Christensen AV, Ekholm O, Mols R, Thorup CB, Borregaard B. The association between self-reported health status and adverse events: a comparison among coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI). Qual Life Res 2020; 29:3017-3029. [PMID: 32857268 DOI: 10.1007/s11136-020-02573-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE While several studies have investigated clinical outcomes following coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI), studies investigating self-reported health and the association with adverse outcomes are limited. Thus, the aim was to investigate differences in health-related quality of life (HRQoL), anxiety and depression at discharge and the association with a composite endpoint of the first event of acute cardiac readmission, revascularisation or 1-year mortality among patients undergoing CABG vs. PCI. METHODS Data from the national cohort study, DenHeart, were used, including measures of HRQoL; EuroQoL-5D-5L (EQ-5D Index Score and VAS) and HeartQoL (Global, Physical and Emotional), anxiety and depression (Hospital Anxiety and Depression Scale, HADS) and register-based follow-up. A total of 7000 patients were included (CABG n = 652, PCI n = 6348) (median age 65, 75% men). Cox Proportional Hazard models were performed among a propensity-matched population of responders (n = 520). RESULTS HRQoL was significantly better among patients undergoing PCI vs. CABG, but with no differences in time to readmission or revascularisation. HRQoL, anxiety and depression were significantly associated with the risk of the composite endpoint among the PCI group (Hazard Ratio, HR (95% confidence intervals, CI) [EQ-5D index score 3.07 (1.67-5.67), EQ-5D VAS 0.97 (0.96-0.99), HeartQol Global 0.61 (0.38-0.95), HeartQol Emotional 0.56 (0.39-0.80), HADS-D ≥ 8 3.12 (1.61-6.01), HADS-A ≥ 8 2.08 (1.14-3.80)]. CONCLUSION Patients undergoing PCI reported better HRQoL at discharge compared with patients undergoing CABG, whereas readmission rates were similar. Self-reported health was associated with the risk of adverse events among patients undergoing PCI, but not among patients undergoing CABG. CLINICAL TRIAL REGISTRATION NCT01926145.
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Affiliation(s)
- Stine Nørris Nielsen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark. .,University of Southern Denmark, Odense, Denmark.
| | | | - Jens Flensted Lassen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,University of Copenhagen, Copenhagen, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Anne Langhoff Thuesen
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Anne Vinggaard Christensen
- Department of Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Rikke Mols
- Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology, Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark.,University of Southern Denmark, Odense, Denmark.,Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
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23
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Sever S, Doherty P, Golder S, Harrison AS. Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics? Open Heart 2020; 7:e001264. [PMID: 32847994 PMCID: PMC7451288 DOI: 10.1136/openhrt-2020-001264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/24/2020] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR. METHODS Analysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population. RESULTS The analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement. CONCLUSION The study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Su Golder
- Department of Health Sciences, University of York, York, North Yorkshire, UK
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Jannat-Khah DP, Khodneva Y, Bryant K, Ye S, Richman J, Shah R, Safford M, Moise N. Depressive symptoms do not discriminate: racial and economic influences between time-varying depressive symptoms and mortality among REGARDS participants. Ann Epidemiol 2020; 46:31-40.e2. [PMID: 32451197 DOI: 10.1016/j.annepidem.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/30/2020] [Accepted: 04/25/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Depressive symptoms relapse and remit over time, perhaps differentially by race and income. Few studies have examined whether time-varying depressive symptoms (TVDS) differentially predict mortality. We sought to determine whether race (white/black) and income (</≥$35,000) moderate the association between TVDS and mortality in a large cohort. METHODS The REGARDS study is a prospective cohort study among community-dwelling U.S. adults aged 45 years or older. Cox proportional hazard models were constructed to separately analyze the association between mortality (all cause, cardiovascular death, noncardiovascular death, and cancer death) and TVDS in race and income stratified models. RESULTS Point estimates were similar and statistically significant for white (aHR = 1.24 [95% CI: 1.10, 1.41]), black (aHR = 1.26 [95% CI: 1.11, 1.42]), and low-income participants (aHR = 1.28 [95% CI: 1.16, 1.43]) for the association between TVDS and mortality. High-income participants had a lower hazard (aHR = 1.19 [95% CI: 1.02, 1.38]). Baseline depressive symptoms predicted mortality in blacks only (aHR = 1.17, 95% CI: [1.00, 1.35]). CONCLUSIONS We found that TVDS significantly increased the immediate hazard of mortality similarly across race and income strata. TVDS may provide more robust evaluations of depression impact compared with the baseline measures, making apparent racial disparities cited in the extant literature a reflection of the imperfection of using baseline measures.
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Affiliation(s)
- Deanna P Jannat-Khah
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of Rheumatology, Hospital for Special Surgery, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Yulia Khodneva
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | | | - Siqin Ye
- Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY
| | - Joshua Richman
- Division of Preventative Medicine, Department of Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Ravi Shah
- Columbia University Medical Center, Psychiatry Faculty Practice Organization, New York, NY
| | - Monika Safford
- Department of Medicine, Weill Cornell Medicine, New York, NY; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Nathalie Moise
- Columbia University Medical Center, New York, NY; Columbia University Medical Center, Center for Behavioral Cardiovascular Health, New York, NY.
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Falk A, Eriksson M, Stenman M. Depressive and/or anxiety scoring instruments used as screening tools for predicting postoperative delirium after cardiac surgery: A pilot study. Intensive Crit Care Nurs 2020; 59:102851. [PMID: 32223922 DOI: 10.1016/j.iccn.2020.102851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Depression is common in patients with cardiac disease. Depression is a risk factor for developing postoperative delirium, a common and serious complication to cardiac surgery. OBJECTIVES The aim was to evaluate if screening tools for depression can be used to predict postoperative delirium after cardiac surgery. METHODS This was a prospective population-based pilot study including 26 patients between 23 and 80 years of age undergoing cardiac surgery in Sweden during 2018. The day before surgery the participants filled out the depression screening instruments Hospital Anxiety and Depression Scale and Patient Health Questionnaire. After discharge the patient charts were examined for documentation of symptoms of delirium. RESULTS Five (20%) patients screened positive regarding depression using the Hospital Anxiety and Depression Scale and 7 patients (27%) screened positive using The Patient Health Questionnaire. Four (22%) patients showed symptoms of postoperative delirium, none of them screened positive for depression prior to surgery. CONCLUSION We found no difference between the questionnaires PHQ-9 and HADS regarding identifying depressive symptoms. Moreover, we found that post-operative delirium, to a certain extent, can be detected by reading the patient́s charts postoperatively. However, this pilot study showed that screening tools for delirium need to be better implemented.
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Affiliation(s)
- Anna Falk
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Malin Stenman
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Correa-Rodríguez M, Abu Ejheisheh M, Suleiman-Martos N, Membrive-Jiménez MJ, Velando-Soriano A, Schmidt-RioValle J, Gómez-Urquiza JL. Prevalence of Depression in Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E909. [PMID: 32225052 PMCID: PMC7230184 DOI: 10.3390/jcm9040909] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 02/07/2023] Open
Abstract
Coronary artery bypass graft surgery (CABG) might adversely affect the health status of the patients, producing cognitive deterioration, with depression being the most common symptom. The aim of this study is to analyse the prevalence of depression in patients before and after coronary artery bypass surgery. A systematic review and meta-analysis was carried out, involving a study of the past 10 years of the following databases: CINAHL, LILACS, MEDLINE, PsycINFO, SciELO, Scopus, and Web of Science. The total sample comprised n = 16,501 patients. The total number of items was n = 65, with n = 29 included in the meta-analysis. Based on the different measurement tools used, the prevalence of depression pre-CABG ranges from 19-37%, and post-CABG from 15-33%. There is a considerable presence of depression in this type of patient, but this varies according to the measurement tool used and the quality of the study. Systematically detecting depression prior to cardiac surgery could identify patients at potential risk.
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Affiliation(s)
- María Correa-Rodríguez
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
- Instituto de Investigación Biosanitaria, IBS, 18012 Granada, Spain
| | - Moath Abu Ejheisheh
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Campus Universitario de Ceuta, C/Cortadura del Valle s/n, 51001 Ceuta, Spain
| | | | - Almudena Velando-Soriano
- University Hospital Virgen de las Nieves. Andalusian Health Service. Av. de las Fuerzas Armadas 2, 18014 Granada, Spain
| | | | - José Luis Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración N. 60, 18016 Granada, Spain
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Sever S, Doherty P, Harrison AS, Golder S. To what extent is multi-morbidity associated with new onset depression in patients attending cardiac rehabilitation? BMC Cardiovasc Disord 2019; 19:256. [PMID: 31726981 PMCID: PMC6857318 DOI: 10.1186/s12872-019-1245-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background Depression is associated with increased mortality and poor prognosis in patients with cardiovascular disease (CVD). However, little is known about the patient characteristics associated with new onset post heart event depressive symptoms, specifically medical comorbidities, among cardiac rehabilitation (CR) participants. Therefore, this paper examines the comorbidity profile and characteristics associated with new onset depressive symptoms in patients attending CR. Methods An observational study using the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation (NACR) from the last six years between April 2012 and March 2018. Patients with new onset post heart event depression and no previous documented history of depression were selected as the study population. An independent samples t-test and chi square tests were used to compare the association between new onset depressive symptoms and patient variables including demographics, clinical measures and comorbidities. A binary logistic regression was conducted to investigate the predictors of new onset depressive symptoms employing log-likelihood ratio statistic. Results The analyses included 109,055 CR patients with new onset depression measured by Hospital Anxiety and Depression Scale (HADS). At baseline assessment, comorbidity measures associated with new onset depressive symptoms were increased total number of comorbidities and a range of comorbidities - including diabetes, angina, arthritis, chronic back problems, asthma, stroke, anxiety, rheumatism, claudication, osteoporosis, chronic bronchitis and emphysema. After multivariate adjustments were done, at the start of CR, the significant predictors of new onset depressive symptoms were physical inactivity, high HADS anxiety score measurement, increased weight, total number of comorbidities, diabetes, stroke, chronic back problems, being from areas with higher levels of social deprivation, being single, and male. Conclusion The research findings establish new insights into the association between patient demographic and clinical variables across a range of comorbidities in patients with new onset post heart event depressive symptoms. At the start of CR, patients with new onset depressive symptoms need to be assessed skilfully as they tend to have a complex multi-morbid presentation linked to psychosocial risk factors known to hinder CR engagement.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, Faculty of Science, University of York, York, UK.
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Alexander Stephen Harrison
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
| | - Su Golder
- Department of Health Sciences, Faculty of Science, University of York, ATB/255 Seebohm Rowntree Building, York, UK
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Nyrønning LÅ, Stenman M, Hultgren R, Albrektsen G, Videm V, Mattsson E. Symptoms of Depression and Risk of Abdominal Aortic Aneurysm: A HUNT Study. J Am Heart Assoc 2019; 8:e012535. [PMID: 31642357 PMCID: PMC6898822 DOI: 10.1161/jaha.119.012535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Depression is associated with cardiovascular diseases, but the evidence is scarce regarding depression and risk of abdominal aortic aneurysms (AAA). The aim was to determine whether individuals with depressive symptoms have increased risk of AAA. Methods and Results This population‐based prospective study included 59 136 participants (52.4% women) aged 50 to 106 years from the HUNT (Norwegian Nord‐Trøndelag Health Study). Symptoms of depression were assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS). During a median follow‐up of 13 years, there were 742 incident cases of AAA (201 women). A total of 6401 individuals (12.3%) reported depressive symptoms (defined as HADS depression scale [HADS‐D]) ≥8) (52.5% women). The annual incidence rate of AAA was 1.0 per 1000 individuals. At all ages, the estimated proportion of individuals diagnosed with AAA was higher among those with depressive symptoms (log‐rank test, P<0.001). People with HADS‐D ≥8 were older than those with HADS‐D<8 (median 57.8 versus 52.3 years, P<0.001) and a statistically significantly higher proportion of them (P<0.001) were smokers, overweight or obese, and reported a history of coronary heart disease, diabetes mellitus, and hypertension. In a Cox proportional hazard regression model adjusted for these factors, individuals with depressive symptoms had a ≈30% higher risk of AAA than those without (hazard ratio, 1.32, 95% CI 1.08–1.61, P=0.007). Conclusions This study shows that individuals with depressive symptoms have significantly higher risk of incident AAA, after adjustments for established risk factors.
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Affiliation(s)
- Linn Åldstedt Nyrønning
- Department of Vascular Surgery St. Olavs Hospital Trondheim Norway.,Department of Circulation and Medical Imaging NTNU- Norwegian University of Science and Technology Trondheim Norway
| | - Malin Stenman
- Perioperative Medicine and Intensive Care Function University Hospital Stockholm Sweden.,Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Rebecka Hultgren
- Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden.,Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Grethe Albrektsen
- Department of Public Health and Nursing NTNU- Norwegian University of Science and Technology Trondheim Norway
| | - Vibeke Videm
- Department of Immunology and Transfusion Medicine St. Olavs Hospital Trondheim Norway.,Department of Clinical and Molecular Medicine NTNU- Norwegian University of Science and Technology Trondheim Norway
| | - Erney Mattsson
- Department of Vascular Surgery St. Olavs Hospital Trondheim Norway.,Department of Circulation and Medical Imaging NTNU- Norwegian University of Science and Technology Trondheim Norway
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Nilsson U, Dahlberg K, Jaensson M. Low Preoperative Mental and Physical Health is Associated with Poorer Postoperative Recovery in Patients Undergoing Day Surgery: A Secondary Analysis from a Randomized Controlled Study. World J Surg 2019; 43:1949-1956. [PMID: 30937487 DOI: 10.1007/s00268-019-04995-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Day surgical procedures are increasing both in Sweden and internationally. Day surgery patients prepare for and handle their recovery on their own at home. The aim of this study was to investigate patients' preoperative mental and physical health and its association with the quality of their recovery after day surgery. METHOD This was a secondary analysis of a randomized controlled trial. Data were collected at four-day surgery units in Sweden. Health-related quality of life was measured using the Short Form 36 (SF-36) Health Survey, and postoperative recovery was assessed using the Swedish web version of the Quality of Recovery (SwQoR) scale. RESULT This study included 756-day surgery patients. A low, compared with a high, preoperative mental component score was associated with poorer recovery as shown by responses to 21/24 and 22/24 SwQoR items, respectively, on postoperative days (PODs) 7 and 14. A low compared with a high preoperative physical component score was associated with poorer recovery in 18/24 SwQoR items on POD 7 and 13/24 on POD 14. CONCLUSION A clear message from this study is for surgeons, anaesthetists and nurses to consider the fact that postoperative recovery largely depends on patients' preoperative mental and psychical status. A serious attempt must be made, as a part of the routine preoperative assessment, to assess and document not only the physical but also the mental status of patients undergoing anaesthesia and surgery. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT0249219.
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Affiliation(s)
- Ulrica Nilsson
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, and Perioperative Medicine and Intensive Care, Karolinska University Hospital, 141 83, Huddinge, Stockholm, Sweden.
| | - Karuna Dahlberg
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Soltanpour A, Alijaniha F, Naseri M, Kazemnejad A, Heidari MR. Effects of Melissa officinalis on anxiety and sleep quality in patients undergoing coronary artery bypass surgery: A double-blind randomized placebo controlled trial. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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Implementación de un programa de cribado del malestar emocional en un servicio de cirugía torácica. Cir Esp 2019; 97:275-281. [DOI: 10.1016/j.ciresp.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 11/17/2022]
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Sever S, Harrison AS, Golder S, Doherty P. Determinants of depression in patients with comorbid depression following cardiac rehabilitation. Open Heart 2019; 6:e000973. [PMID: 31168379 PMCID: PMC6519417 DOI: 10.1136/openhrt-2018-000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
Background A prior history of depression, at the point patients start cardiac rehabilitation (CR), is associated with poor outcomes; however, little is known about which factors play a part in determining the extent of benefit following CR. Therefore, we aim to identify and evaluate determinants of CR depression outcomes in patients with comorbid depression. Methods An observational study of routine practice using the British Heart Foundation National Audit of Cardiac Rehabilitation data between April 2012 and March 2017. Baseline characteristics were examined with independent samples t-test and χ2 test. A binary logistic regression was used to predict change in depression outcome following CR. Results The analysis included 2715 CR participants with depression history. The determinants of Hospital Anxiety and Depression Scale (HADS) depression measurement post-CR were higher total number of comorbidities (OR 0.914, 95% CI 0.854 to 0.979), a higher HADS anxiety score (OR 0.883, 95% CI 0.851 to 0.917), physical inactivity (OR 0.707, 95% CI 0.514 to 0.971), not-smoking at baseline (OR 1.774, 95% CI 1.086 to 2.898) and male gender (OR 0.721, 95% CI 0.523 to 0.992). Conclusion Baseline characteristics of patients with comorbid depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity and male gender were predictors of their depression levels following CR. CR programmes need to be aware of comorbid depression and these related patient characteristics associated with better CR outcomes.
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Affiliation(s)
| | | | - Su Golder
- Health Sciences, University of York, York, UK
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Sever S, Golder S, Doherty P. Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation. BMC Cardiovasc Disord 2018; 18:230. [PMID: 30526515 PMCID: PMC6288923 DOI: 10.1186/s12872-018-0974-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/03/2018] [Indexed: 12/01/2022] Open
Abstract
Background The literature suggests that comorbid depression, defined in this paper as a history of depression prior to a cardiovascular event, has an impact on later onset depression as well as constituting increased risk of mortality and adverse cardiac events. However, which factors are associated with depression, specifically in patients with comorbid depression, is unclear. Therefore, this paper investigates the factors associated with depression in patients with comorbid depression attending cardiac rehabilitation (CR). Methods This observational study used routinely collected data from the British Heart Foundation National Audit of Cardiac Rehabilitation for the time period between April 2012 and March 2017. CR participants with comorbid depression were selected as the study population. An independent t-test and chi-square test were used to compare the association between acute depression symptoms and baseline characteristics in this population. Results A total of 2715 CR patients with comorbid depression were analysed. Characteristics associated with acute depressive symptoms in patients with comorbid depression were found to be: young age (MD: 2.71, 95% CI 1.91, 3.50), increased number of comorbidities (MD: -0.50, 95% CI -0.66, − 0.34), increased weight (MD: -1.94, 95% CI -3.35, − 0.52), high BMI (MD: -1.94, 95% CI -3.35, − 0.52), HADS anxiety (MD: -5.17, 95% CI -5.47, − 4.87), comorbid anxiety (52.4%, p < 0.001), physical inactivity (150 min moderate physical activity a week and 75 min vigorous exercise a week; 27.5%, p < 0.001; 5.6%, p < 0.001 respectively), smoking (12.7%, p < 0.001), and being less likely to be partnered (63.6%, p < 0.001). Conclusion The study demonstrated the association between a variety of clinical and socio-demographic factors and depression. The findings of the research indicated that, at CR baseline assessment, caution must be taken with patients with comorbid depression, specifically those with higher level depressive symptoms at the start of rehabilitation. Furthermore, their multi-comorbid condition must also be taken into account. Patients with higher depression symptoms and comorbid depression scored five points higher on the HADS anxiety scale in comparison to patients with lower level depression symptoms at the start of CR, which demonstrated that anxiety and depression are interrelated and present together.
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Affiliation(s)
- Serdar Sever
- Department of Health Sciences, Faculty of Science, University of York, York, UK.
| | - Su Golder
- Department of Health Sciences, Faculty of Science, University of York, York, UK
| | - Patrick Doherty
- Department of Health Sciences, Faculty of Science, University of York, York, UK
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Zhang J, Yin M, Huang J, Lv Z, Liang S, Miao X, Huang F, Zhao Y. Long noncoding RNA LINC00152 as a novel predictor of lymph node metastasis and survival in human cancer: a systematic review and meta-analysis. Clin Chim Acta 2018; 483:25-32. [DOI: 10.1016/j.cca.2018.03.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 12/30/2022]
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Machado MO, Veronese N, Sanches M, Stubbs B, Koyanagi A, Thompson T, Tzoulaki I, Solmi M, Vancampfort D, Schuch FB, Maes M, Fava GA, Ioannidis JPA, Carvalho AF. The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Med 2018; 16:112. [PMID: 30025524 PMCID: PMC6053830 DOI: 10.1186/s12916-018-1101-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Depression is a prevalent and disabling mental disorder that frequently co-occurs with a wide range of chronic conditions. Evidence has suggested that depression could be associated with excess all-cause mortality across different settings and populations, although the causality of these associations remains unclear. METHODS We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, PsycINFO, and Embase electronic databases were searched through January 20, 2018. Systematic reviews and meta-analyses that investigated associations of depression and all-cause and cause-specific mortality were selected for the review. The evidence was graded as convincing, highly suggestive, suggestive, or weak based on quantitative criteria that included an assessment of heterogeneity, 95% prediction intervals, small-study effects, and excess significance bias. RESULTS A total of 26 references providing 2 systematic reviews and data for 17 meta-analytic estimates met inclusion criteria (19 of them on all-cause mortality); data from 246 unique studies (N = 3,825,380) were synthesized. All 17 associations had P < 0.05 per random effects summary effects, but none of them met criteria for convincing evidence. Associations of depression and all-cause mortality in patients after acute myocardial infarction, in individuals with heart failure, in cancer patients as well as in samples from mixed settings met criteria for highly suggestive evidence. However, none of the associations remained supported by highly suggestive evidence in sensitivity analyses that considered studies employing structured diagnostic interviews. In addition, associations of depression and all-cause mortality in cancer and post-acute myocardial infarction samples were supported only by suggestive evidence when studies that tried to adjust for potential confounders were considered. CONCLUSIONS Even though associations between depression and mortality have nominally significant results in all assessed settings and populations, the evidence becomes weaker when focusing on studies that used structured interviews and those that tried to adjust for potential confounders. A causal effect of depression on all-cause and cause-specific mortality remains unproven, and thus interventions targeting depression are not expected to result in lower mortality rates at least based on current evidence from observational studies.
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Affiliation(s)
- Myrela O Machado
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, 60430-140, Brazil
| | - Nicola Veronese
- Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
- National Research Council, Neuroscience Institute, Aging Branch, 35128, Padova, Italy
| | - Marcos Sanches
- Biostatistical Consulting Unit, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Brendon Stubbs
- Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, AF, SE5 8, UK
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu/CIBERSAM, 08950, Barcelona, Spain
| | - Trevor Thompson
- Faculty of Education and Health, University of Greenwich, London, SE10 9LS, UK
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, W2 1PG, London, UK
- MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Marco Solmi
- Institute for Clinical Research and Education in Medicine (IREM), 35128, Padova, Italy
- Department of Neuroscience, University of Padova, 35100, Padova, Italy
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, 3001, Leuven, Belgium
- KU Leuven - University of Leuven, University Psychiatric Center KU Leuven, 3070, Leuven, Kortenberg, Belgium
| | - Felipe B Schuch
- Centro Universitário La Salle, Canoas, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Giovanni A Fava
- Department of Psychology, University of Bologna, viale Berti Pichat 5, 40127, Bologna, Italy
- Department of Psychiatry, Erie County Medical Center, 462 Grider Street, Buffalo, NY, 14215, USA
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Palo Alto, CA, 94305, USA
- Department of Health Research and Policy, Stanford University, Palo Alto, CA, 94305, USA
- Department of Statistics, Stanford University, Palo Alto, CA, 94305, USA
- Department of Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, 94305, USA
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction & Mental Health (CAMH), 33 Russel Street, room RS1050S, Toronto, ON, M5S 2S1, Canada.
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Cromhout PF, Moons P, Thygesen LC, Nashef S, Damgaard S, Berg SK. Time to expand risk evaluation systems for cardiac surgery? Looking beyond physiological parameters. Eur J Cardiovasc Nurs 2018; 17:760-766. [DOI: 10.1177/1474515118783835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Risk assessment in cardiac surgery traditionally consists of medical and physiological parameters. However, non-physiological factors have also been found to be predictive of poor outcomes following cardiac surgery. Therefore, the isolated focus on physiological parameters is questionable. This paper describes the emotional, behavioural, social and functional factors that have been established to play a role in outcomes following cardiac surgery. This forms a basis for future research, testing the value of these factors above and beyond the physiological parameters. By including such non-physiological factors, the accuracy of the existing risk scoring systems could potentially be improved.
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Affiliation(s)
- Pernille F Cromhout
- Department of Thoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardio-thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Selina Kikkenborg Berg
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark
- Department of Public Health, University of Copenhagen, Denmark
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Lin S, Zhang H, Ma A. The association between depression and coronary artery calcification: A meta-analysis of observational studies. J Affect Disord 2018; 232:276-282. [PMID: 29500955 DOI: 10.1016/j.jad.2018.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/29/2018] [Accepted: 02/15/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular diseases and depression are responsible for a great global burden of disease; however, the association between depression and coronary artery calcification (CAC) remain controversial and no quantitative meta-analysis exists. Thus, we performed a meta-analysis aimed to evaluate the association between depression and CAC. METHODS We performed a systematic search strategy using PubMed, Web of science, Embase, China National Knowledge Infrastructure and Cochrane library for relevant observational studies investigating depression and CAC from inception until April 2017. The pooled odds ratios (ORs) with 95% confidence intervals (95%CIs) and subgroup analyses were calculated using a random effects model. RESULTS After screening 411 non-duplicated articles, a total of 15 studies involving 32,884 were included. Our analyses demonstrated a positive association between diagnosed depression and CAC (OR = 1.15; 95% CI: 1.04-1.28; I2 = 80.6), and a non-significant association between depressive symptoms and CAC (OR = 1.02; 95% CI: 0.97-1.07; I2 = 73.5%). In subgroup analysis for cohort studies, the positive association between diagnosed depression and CAC was enhanced (OR = 2.20; 95% CI: 1.33-3.64; I2 = 0). CONCLUSIONS Our study indicated that diagnosed depression was associated with higher odds of CAC. Systematic screening for CAC may be useful to identify clinically depressed patients at higher risk of future cardiovascular diseases.
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Affiliation(s)
- Song Lin
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Huaqi Zhang
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China
| | - Aiguo Ma
- The College of Public Health, Qingdao University, 38 Dengzhou Road, Qingdao, Shandong 266021, China.
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Preoperative factors associated with worsening in health-related quality of life following coronary artery bypass grafting in the Randomized On/Off Bypass (ROOBY) trial. Am Heart J 2018; 198:33-38. [PMID: 29653645 DOI: 10.1016/j.ahj.2017.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/17/2017] [Indexed: 11/21/2022]
Abstract
For advanced coronary disease, coronary artery bypass graft (CABG) surgery generally improves patients' symptoms and long-term survival. Unfortunately, some patients experience worse health-related quality of life (HRQL) after CABG. The objective of this study is to report the frequency and risk factors associated with 1-year post-CABG HRQL deterioration. METHODS From 2002 to 2007, 2203 "Randomized On/Off Bypass" (ROOBY) trial patients randomly received either off-pump or on-pump CABG at 18 VA medical centers. Subjects completed both baseline and 1-year Seattle Angina Questionnaire (SAQ) and the Veterans Rand 36 (VR-36) questionnaires to assess HRQL. Using previously published criteria, the rates of clinically significant changes were determined for the SAQ [angina frequency (AF), physical limitation (PL), and quality of life (QoL)] and VR36 [mental component score (MCS) and physical component score (PCS)] subscales. Multivariate regression models were then used to identify pre-CABG patient characteristics associated with worsened 1-year HRQL status for each subscale. RESULTS Over 80% of patients had an improvement or no change in SAQ and VR-36 subscale scores 1 year after CABG. The HRQL scale-specific deterioration rates were 4.5% SAQ-AF, 16.8% SAQ-PL, 4.9% SAQ-QoL, 19.4% VR36-MCS, and 13.5% VR36-PCS. Predictors of 1-year HRQL deterioration were diabetes and smoking for the SAQ-AF; diabetes, chronic obstructive pulmonary disease (COPD), and peripheral vascular disease (PVD) for SAQ-PL; COPD and depression for the SAQ-QoL; diabetes for VR36-PCS, and history of stroke and depression for VR36-MCS. The baseline score was an independent predictor for worsening in all the subscales studied. CONCLUSIONS Among VA patients, less than 20% experienced worse HRQL 1 year after CABG. For patients with low symptom burden at baseline, diabetes, smoking, depression, PVD, COPD, and a prior stroke, clinicians should be more cautious in pre-CABG counseling as to their anticipated HRQL improvements.
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Tao LY, Huang MY, Saroj-Thapa, Wang JN, Wu SZ, He F, Huang KY, Xue YJ, Lingwei-Jin, Liao LM, Tang JF, Ji KT. Effects of macrophage migration inhibitory factor on cardiac reperfusion injury in mice with depression induced by constant-darkness. J Affect Disord 2018; 229:403-409. [PMID: 29331700 DOI: 10.1016/j.jad.2017.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 12/31/2022]
Abstract
RATIONALE Depression is associated with coronary artery disease and increases adverse outcomes and mortality in patients with acute myocardial infarction, but the underlying pathophysiological mechanisms remain unclear. OBJECTIVE To evaluate the effect of macrophage migration inhibitory factor (MIF) on cardiac ischemia-reperfusion (I/R) injury in mice with constant darkness-induced depression. METHODS AND RESULTS Twenty C57BL/6 mice (8 weeks old, male) were randomly divided into 2 groups: one group was housed in a 12h light/dark cycle environment (LD) and the other in a constant darkness environment (DD). After 3 weeks, constant darkness-exposed (DD) mice displayed depression-like behavior as indicated by increased immobility in the forced swim test (FST) and lower sucrose preference rate. Western blotting revealed cardiac MIF expression was significantly lower in the DD mice than that in the LD mice. Next, 84 mice were randomly divided into 4 groups: LD sham group, LD I/R group, DD sham group, and DD I/R group. Following ischemia and reperfusion, mice in the DD I/R group had a larger infarct area and lower heart function index than mice in the LD I/R group (P < 0.05 for both). The cardiac pAMPK and pACC expression levels of the DD I/R group were also lower in the DD I/R group (P < 0.05). CONCLUSION DD-induced depression might cause decreased expression of MIF in the heart, resulting in downregulation of MIF-AMPK signaling and a subsequent adverse outcome after a cardiac I/R injury.
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Affiliation(s)
- Lu-Yuan Tao
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Ming-Yuan Huang
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Saroj-Thapa
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jiao-Ni Wang
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Shao-Ze Wu
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Fei He
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Kai-Yu Huang
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Yang-Jing Xue
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Lingwei-Jin
- Department of Nephrology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Lian-Ming Liao
- Department of Laboratory Medicine, Fujian Medical University Union Hospital, Fuzhou, Fujian 350122, China
| | - Ji-Fei Tang
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
| | - Kang-Ting Ji
- Department of Cardiology, Second Affiliated and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
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Altered long non-coding RNAs predict worse outcome in osteosarcoma patients: evidence from a meta-analysis. Oncotarget 2018; 8:35234-35243. [PMID: 28415638 PMCID: PMC5471049 DOI: 10.18632/oncotarget.16470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/10/2017] [Indexed: 01/11/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) are emerging as promising prognostic biomarkers in an expanding list of malignant neoplasms. Here, we sought to investigate the strength of associations between lncRNA signatures and clinical outcomes in osteosarcoma. We conducted a systematic search of the online databases from inception to July 2016. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) for the primary endpoints of overall survival (OS), progression-free survival (PFS) or event-free survival (EFS) were extracted and meta-analyzed. Our results manifested that altered lncRNAs expression was markedly associated with worse OS (univariate analysis: HR = 3.20, 95% CI: 2.42-4.24, P = 0.000; multivariate analysis: HR = 2.66, 95% CI: 1.92-3.69, P = 0.000), PFS (HR = 2.05, 95% CI: 1.32-3.18, P = 0.001) and EFS (HR = 4.37, 95% CI: 1.64-11.66, P = 0.003) times among osteosarcoma patients. In the pooled analyses stratified by clinicopathological features, levels of lncRNAs were closely correlated with tumor size (pooled P = 0.001), tumor stage (pooled P = 0.003), and distant metastasis (pooled P = 0.002) in osteosarcoma. The results obtained in our work suggest that altered lncRNA signatures predict unfavorable clinical outcomes and are acceptable to be potential prognostic biomarkers in forecasting prognosis of osteosarcoma.
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Geulayov G, Novikov I, Dankner D, Dankner R. Symptoms of depression and anxiety and 11-year all-cause mortality in men and women undergoing coronary artery bypass graft (CABG) surgery. J Psychosom Res 2018; 105:106-114. [PMID: 29332626 DOI: 10.1016/j.jpsychores.2017.11.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the overall and the sex-specific association of preoperative and one-year post coronary artery bypass (CABG) surgery symptoms of depression and anxiety with 11-year all-cause mortality. METHODS A multicenter prospective study including 1125 patients who completed the Hospital Anxiety and Depression Scale (HADS) before an elective CABG surgery, of whom 850 completed the HADS again at one-year follow-up. Information on all-cause mortality was obtained through the Israeli Ministry of Internal Affairs Register. Multivariable adjusted Cox regression models quantified the association of symptoms of depression and anxiety with all-cause mortality. RESULTS Females comprised 22.7% of the cohort and were 5.5years older than males (70.0±9.3 and 64.4±10.3years, respectively). Controlling for sociodemographic and lifestyle factors, illness severity and post-surgery participation in cardiac rehabilitation, there was little evidence of an association between preoperative symptoms of depression and mortality in males [adjusted hazard ratio (aHRmales)=1.03, 95% CI 0.99-1.07, p=0.21] or females (aHRfemales=1.01, 95% CI 0.95-1.08, p=0.7). One-year postoperative symptoms of depression were associated with mortality in both males (aHRmales=1.05, 95% CI 1.01-1.10, p=0.03) and females (aHRfemales=1.07, 95% CI 1.02-1.13, p=0.013). Preoperative symptoms of anxiety were unrelated to mortality overall, but among females postoperative symptoms of anxiety predicted 11-year mortality (aHRfemales=1.07, 95% CI 1.00-1.14, p=0.049). There was no HADS by sex interaction (p for interaction=0.12-0.99). CONCLUSIONS Symptoms of depression one-year after surgery were positively related to mortality with little evidence for sex differences. These findings underscore the need for identification and treatment of psychiatric symptoms in patients undergoing CABG surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT00356863.
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Affiliation(s)
- Galit Geulayov
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Ilya Novikov
- Unit for Biostatistics, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Rachel Dankner
- Unit for Cardiovascular Epidemiology, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Division of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel.
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Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. J Psychosom Res 2018; 104:1-8. [PMID: 29275777 DOI: 10.1016/j.jpsychores.2017.10.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND As mortality from coronary heart disease (CHD) falls, years lived with disability increase. Depression and anxiety are known indicators of poor outcomes in CHD, but most research has measured distress symptoms at one time point, often following acute events. Here we consider the long-term trajectories of these symptoms in established CHD, and examine their association to distinct measures of disability and impact on costs. METHODS AND RESULTS 803 patients with diagnosis of CHD were recruited from primary care, and completed detailed assessments every 6months for 3years. Latent class growth analysis (LCGA) was used to identify 5 distinct symptom trajectories based on the Hospital Anxiety and Depression Questionnaire (HADS): 'stable low', 'chronic high', 'improving', 'worsening', and 'fluctuating'. The 'chronic high' group had highest association with reporting of chest pain (RRR 5.8, CI 2.9 to 11.7), smoking (2.9, 1.1 to 6.3), and poorer physical (0.88, 0.83-0.93) and mental (0.78, 0.73-0.84) quality of life. The 'chronic high' and 'worsening' trajectories had significantly higher health-care costs over the 'stable low' trajectory (107.2% and 95.5% increase, respectively). In addition, our trajectories were the only significant variable associated with increased health-care costs across the 3years. CONCLUSIONS Symptoms of depression and anxiety are highly prevalent in stable CHD patients, and their long-term trajectories are the single biggest driver of health care costs. Managing morbidity in these patients, in which depression and anxiety play a key role in, should become the primary focus of policy makers and future clinical trials.
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Affiliation(s)
- Jorge Palacios
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK.
| | | | - Anthony Mann
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Andre Tylee
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, UK; South London and Maudsley NHS Foundation Trust, UK
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Flaherty LB, Wood T, Cheng A, Khan AR. Pre-existing psychological depression confers increased risk of adverse cardiovascular outcomes following cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2017; 154:1578-1586.e1. [DOI: 10.1016/j.jtcvs.2017.06.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/02/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Abstract
The analytical paper summarized the results of recent studies of an association of depression, anxiety, and stress with coronary heart disease (CHD). Mental disorders are shown to be associated with increased risk of CHD and to worsen the course of coronary disease. Antidepressants and psychotherapy improve the control of mental disorders, quality of life, and, in some cases, have a positive impact on the course of coronary disease.
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Perioperative depression or anxiety and postoperative mortality in cardiac surgery: a systematic review and meta-analysis. Heart Vessels 2017; 32:1458-1468. [DOI: 10.1007/s00380-017-1022-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
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