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Hausvater A, Spruill TM, Xia Y, Smilowitz NR, Arabadjian M, Shah B, Park K, Giesler C, Marzo K, Thomas D, Wei J, Trost J, Mehta PK, Har B, Bainey KR, Zhong H, Hochman JS, Reynolds HR. Psychosocial Factors of Women Presenting With Myocardial Infarction With or Without Obstructive Coronary Arteries. J Am Coll Cardiol 2023; 82:1649-1658. [PMID: 37852694 PMCID: PMC11010594 DOI: 10.1016/j.jacc.2023.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Women with myocardial infarction (MI) are more likely to have elevated stress levels and depression than men with MI. OBJECTIVES We investigated psychosocial factors in women with myocardial infarction with nonobstructive coronary arteries (MINOCA) and those with MI and obstructive coronary artery disease (CAD). METHODS Women with MI enrolled in a multicenter study and completed measures of perceived stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-2) at the time of MI (baseline) and 2 months later. Stress, depression, and changes over time were compared between MI subtypes. RESULTS We included 172 MINOCA and 314 MI-CAD patients. Women with MINOCA were younger (age 59.4 years vs 64.2 years; P < 0.001) and more diverse than those with MI-CAD. Women with MINOCA were less likely to have high stress (Perceived Stress Scale-4 ≥6) at the time of MI (51.0% vs 63.0%; P = 0.021) and at 2 months post-MI (32.5% vs 46.3%; P = 0.019) than women with MI-CAD. There was no difference in elevated depressive symptoms (Patient Health Questionnaire-2 ≥2) at the time of MI (36% vs 43%; P = 0.229) or at 2 months post-MI (39% vs 40%; P = 0.999). No differences in the rate of 2-month decline in stress and depression scores were observed between groups. CONCLUSIONS Stress and depression are common among women at the time of and 2 months after MI. MINOCA patients were less likely to report high stress compared with MI-CAD patients, but the frequency of elevated depressive symptoms did not differ between the 2 groups. Stress and depressive symptoms decreased in both MI-CAD and MINOCA patients over time.
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Affiliation(s)
- Anaïs Hausvater
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.
| | - Tanya M Spruill
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA; Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Nathaniel R Smilowitz
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; VA NY Harbor Health Care System, Department of Medicine, Section of Cardiology, New York, New York, USA
| | - Milla Arabadjian
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA; Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA; Center for Population and Health Services Research Department of Foundations of Medicine NYU Long Island School of Medicine, Mineola, New York, USA
| | - Binita Shah
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA; VA NY Harbor Health Care System, Department of Medicine, Section of Cardiology, New York, New York, USA
| | - Ki Park
- University of Florida, Division of Cardiovascular Medicine, Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | | | - Kevin Marzo
- New York University Winthrop Hospital, New York University Long Island School of Medicine, Mineola, New York, USA
| | - Dwithiya Thomas
- St Luke's University Healthcare, Bethlehem, Pennsylvania, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jeffrey Trost
- Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Puja K Mehta
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bryan Har
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kevin R Bainey
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Hua Zhong
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Judith S Hochman
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Harmony R Reynolds
- Sarah Ross Soter Center for Women's Cardiovascular Research, NYU Grossman School of Medicine, New York, New York, USA; Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
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Pedersen SS, Skovbakke SJ, Skov O, Carlbring P, Burg MM, Habibović M, Ahm R. Internet-Delivered, Therapist-Assisted Treatment for Anxiety and Depression in Patients with Cardiovascular Disease: Evidence-Base and Challenges. Curr Cardiol Rep 2023; 25:443-453. [PMID: 37119450 DOI: 10.1007/s11886-023-01867-w] [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] [Accepted: 03/20/2023] [Indexed: 05/01/2023]
Abstract
PURPOSE OF REVIEW This review focuses on the efficacy of internet-based psychological interventions for patients with cardiovascular disease (CVD) and comorbid anxiety and depression. Anxiety and depression comprise barriers for treatment adherence and are associated with poorer patient-reported and clinical outcomes, and greater health care costs. RECENT FINDINGS Internet-based, therapist-assisted interventions targeting anxiety and depression can be as efficacious as face-to-face therapy and may have some advantages, as patients can do it from their own laptop/smartphone at home at a time of their convenience, which may facilitate a better integration in their lives. To enhance the field of internet-based therapy for patients with CVD, we need to involve patients in the development of interventions, focus on developing standards for adherence and assessment of fidelity, and assess and augment health literacy in patients to safeguard equality in health care.
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Affiliation(s)
- S S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark.
- Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | - S J Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - O Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
| | - P Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - M M Burg
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, USA
| | - M Habibović
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - R Ahm
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230, Odense M, Denmark
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Olsson EMG, Norlund F, Rondung E, Humphries SM, Held C, Lyngå P, Spaak J, Sundin Ö, Sundelin R, Leissner P, Kövamees L, Tornvall P. The e-mental health treatment in Stockholm myocardial infarction with non-obstructive coronaries or Takotsubo syndrome study (E-SMINC): a study protocol for a randomised controlled trial. Trials 2022; 23:597. [PMID: 35883115 PMCID: PMC9315084 DOI: 10.1186/s13063-022-06530-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the aftermath of a myocardial infarction with non-obstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS), patients commonly express high levels of stress and anxiety. Current treatment alternatives rarely address these issues. METHODS The study is a randomised controlled trial, where 90 patients with a discharge diagnosis of MINOCA or TS who also report symptoms of stress or anxiety will be randomised 2-6 weeks after their cardiac event. The treatment consists of 10 weeks of Internet-based cognitive behaviour therapy (CBT) and starts immediately after randomisation for the treatment group. The control group receives usual care. Main outcomes are symptoms of anxiety measured with the Hospital Anxiety and Depression scale, anxiety subscale, and perceived stress measured with the Perceived Stress Scale, 14-item version, 10 weeks after randomisation. Secondary measures include cardiac specific anxiety, symptoms of post-traumatic stress, quality of life, cortisol measured in hair and physiological stress responses (heart rate variability, blood pressure and saliva cortisol) during a stress procedure. Ten weeks after randomisation, the control group will also receive treatment. Long-term follow-up in the self-report measures mentioned above will be conducted 20 and 50 weeks after randomisation where the total group's development over time is followed, and the groups receiving intervention early versus late compared. DISCUSSION At present, there are no randomised studies evaluating psychological treatment for patients with MINOCA or TS. There is an urgent need for treatment alternatives aiming at relieving stress and anxiety considering the high mental stress and anxiety levels observed in MINOCA and TS, leading to decreased quality of life. CBT aiming at reducing mental stress has been shown to be effective regarding prognosis in patients with coronary artery disease. The current protocol describes a randomised open-label controlled trial evaluating an Internet-based CBT program for reduction of stress and anxiety in patients with increased mental stress and/or anxiety with a discharge diagnosis of either MINOCA or TS. TRIAL REGISTRATION ClinicalTrials.gov NCT04178434 . Registered on 26 November 2019.
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Affiliation(s)
- Erik M G Olsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Fredrika Norlund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Sophia M Humphries
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Patrik Lyngå
- Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Jonas Spaak
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Örjan Sundin
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Runa Sundelin
- Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Philip Leissner
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lena Kövamees
- Swedish Heart and Lung Association, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Karolinska Institutet and Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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