Chest pain, depression and anxiety in coronary heart disease: Consequence or cause? A prospective clinical study in primary care

Comparing depression, anxiety, and quality of life in individuals with cardiac and non-cardiac chest pain

Background

Psychological factors are often overlooked as potential contributors to cardiovascular disease. This study aimed to investigate the relationship between depression, anxiety, and quality of life with chest pain origin.

Method

This cross-sectional study was performed from 2019 to 2020 and included participants from multiple medical centers across Shahrekord, Iran. Participants were recruited through advertisements in medical centers. Participants were divided into three groups: healthy control (n = 67), chest pain with cardiac origin (CCP) (n = 70), and chest pain with non-cardiac origin (NCCP) (n = 73). Data were collected using the Beck's Anxiety scale, Beck's Depression scale, and Short-Form Health Survey questionnaires. The chi-square, exact test, t-test, Kruskal-Wallis, and logistic regression models were used for statistical analysis. All analysis was performed using SPSS 26.

Results

The mean scores of depression and anxiety in the NCCP group (depression = 17.03 ± 11.93, anxiety = 17.18 ± 11.37) were significantly higher than those in the CCP (depression = 9.73 ± 5.76, anxiety = 8.77 ± 5.96) and healthy (depression = 7.00 ± 7.61, anxiety = 6.18 ± 7.63) groups (p < 0.05). The mean score of quality of life in the NCCP group (54.87 ± 12.66) was significantly lower than that in the CCP (76.31 ± 12.49) and healthy (80.94 ± 15.78) groups (p < 0.05). Patients with NCCP had higher odds of having depression (adjusted OR = 4.39, 95% CI: 1.25, 15.35) and lower odds for having mental quality of life scores than the CCP and health groups, respectively (adjusted OR = 0.90, 95% CI: 0.87, 0.94).

Conclusion

Our findings suggest that collaboration between psychiatrists and other specialists may be necessary to improve patients' health conditions and quality of life.

Hybrid visualization-based framework for depressive state detection and characterization of atypical patients

INTRODUCTION

Depression is a global concern, with a significant number of people affected worldwide, particularly in low- and middle-income countries. The rising prevalence of depression emphasizes the importance of early detection and understanding the origins of such conditions.

OBJECTIVE

This paper proposes a framework for detecting depression using a hybrid visualization approach that combines local and global interpretation. This approach aims to assist in model adaptation, provide insights into patient characteristics, and evaluate prediction model suitability in a different environment.

METHODS

This study utilizes R programming language with the Caret, ggplot2, Plotly, and Dalex libraries for model training, visualization, and interpretation. Data from the NHANES repository was used for secondary data analysis. The NHANES repository is a comprehensive source for examining health and nutrition of individuals in the United States, and covers demographic, dietary, medication use, lifestyle choices, reproductive and mental health data. Penalized logistic regression models were built using NHANES 2015-2018 data, while NHANES 2019-March 2020 data was used for evaluation at the global-specific and local level interpretation.

RESULTS

The prediction model that supports this framework achieved an average AUC score of 0.748 (95% CI: 0.743-0.752), with minimal variability in sensitivity and specificity.

CONCLUSION

The built-in prediction model highlights chest pain, the ratio of family income to poverty, and smoking status as crucial features for predicting depressive states in both the original and local environments.

Sexual Satisfaction and Quality of Life in Cardiovascular Patients: The Mediating Role of Anxiety

BACKGROUND

Cardiovascular diseases represent one of the most important problems for public health. Research indicates that elderly patients consider sexual satisfaction as a fundamental aspect of their quality of life and a better sexual function is related to higher general wellbeing.

OBJECTIVE

The main objective of this study was to investigate the mediating role of anxiety and depression in the relationship between quality of life and sexual satisfaction in cardiovascular (CVD) patients.

METHODS

The sample comprised 128 adult patients, males and females, hospitalized in a Cardiology Rehabilitation clinical center. To collect data, the following were used: a demographic information sheet, the left ventricular ejection fraction (EF) to evaluate cardiac function, cardiovascular diagnosis type, the HADS scale to evaluate anxiety and depression states, a test for sexual satisfaction evaluation (SAS) and the SF-36 survey to measure quality of life.

RESULTS

The results indicated that only SF-36 physical health is indirectly related to SAS through its relationship with anxiety.

CONCLUSION

A mediating model was proposed to explore the underlying association between sexual satisfaction and quality of life. We recommend investigating perceived general health and sexuality as clinical indicators for therapeutic decisions and risk evaluation for the management of cardiovascular diseases.

Depression increased risk of coronary heart disease: A meta-analysis of prospective cohort studies

Background

Depression, as an independent risk factor, can lead to a substantially increased risk of coronary heart disease (CHD). The overall body of evidence involving depression and CHD is not consistent. Therefore, we performed an update meta-analysis to evaluate the association between depression and the risk of patients with CHD.

Methods

Studies were identified through a comprehensive literature search of the PubMed, Embase, and the Cochrane Library database from its inception to 28 September 2021 for titles/abstracts with restricted to English language articles. The literature was screened according to the inclusion and exclusion criteria. Along with data extraction, we evaluated the quality of eligible studies using the Newcastle-Ottawa Scale (NOS). The primary outcome was fatal or non-fatal CHD. We calculated relative risk (RR) with 95% confidence intervals (CIs) using a random-effects models. The protocol was registered in the PROSPERO registration (registration number CRD42021271259).

Results

From 9,151 records, we included 26 prospective cohort studies published from 1998 to 2018, consisting of 402,597 patients. Either in depression-exposured group or non-depression-exposured group, the mean age of all participants ranged from 18 to 99 years. Moreover, the NOS scores of these studies are eventually indicated that the quality of these eligible studies was reliable. In general, the pooled results showed that patients with depression had a higher risk of CHD compared to patients without depression (RR = 1.21, 95% CI: 1.14–1.29). Additionally, the funnel plot appeared to be asymmetry, indicating there existing publication bias for the pooled results between depression and CHD. A sensitivity analysis was used to assess the stability of the relationship between depression and CHD that indicating the results robust (RR = 1.15, 95% CI: 1.09–1.21).

Conclusion

Depression may increase risk of CHD. Future studies on the share pathogenic mechanisms of both depression and CHD may develop novel therapies.

The prognostic impact of symptom clusters in patients with heart failure: A systematic review and meta-analysis

AIM

To determine the impact of symptom clusters on clinical outcomes among heart failure patients.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Peer-reviewed articles were searched from 12 English and Chinese language databases from inception to August 2021.

REVIEW METHODS

Narrative syntheses were first conducted to integrate symptom clusters reported in the identified studies. This was followed by meta-analysis to synthesize the evidence on the association or predictive effects of symptom clusters on clinical outcomes.

RESULTS

Twelve studies were identified. Among studies which identified highly correlated symptoms as in a cluster, meta-analysis indicated that severe congestive (r = .45, 95% CI = 0.38-0.52), weary (r = .41, 95% CI = 0.33-0.50), ischaemic (r = .29, 95% CI = 0.04-0.51) and stress-related (r = .62, 95% CI = 0.31-0.81) symptom clusters were correlated with a poorer health-related quality of life. As for studies used latent class to identified patient cohorts of similar symptom pattern, high symptom cohorts (hazard ratio = 1.86, 95% CI = 1.39-2.48) and incongruent physical and psycho-cognitive symptom cohorts was associated with a significantly higher risk (hazard ratio = 2.10, 95% CI = 1.44-3.07) of combined event rate relative to low symptom presentation.

CONCLUSIONS

This review has identified the impact of symptom clusters on clinical outcomes in heart failure patients. In addition to the classical physical symptoms highlighted in the clinical management guidelines, our findings suggested the important predictive role of psycho-cognitive and weary symptoms in determining the clinical outcomes of HF patients.

IMPACT

This review concluded the promising prospect of symptom clusters in shaping clinical outcomes of heart failure. The findings highlighted the importance of integrating care to minimize the disease impact on psycho-cognitive function and weary symptoms among this clinical cohort. The review also inform the direction on how to advance the knowledge on symptom clusters among this clinical cohort.

Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature

BACKGROUND

The term "data science" encompasses several methods, many of which are considered cutting edge and are being used to influence care processes across the world. Nursing is an applied science and a key discipline in health care systems in both clinical and administrative areas, making the profession increasingly influenced by the latest advances in data science. The greater informatics community should be aware of current trends regarding the intersection of nursing and data science, as developments in nursing practice have cross-professional implications.

OBJECTIVES

This study aimed to summarize the latest (calendar year 2020) research and applications of nursing-relevant patient outcomes and clinical processes in the data science literature.

METHODS

We conducted a rapid review of the literature to identify relevant research published during the year 2020. We explored the following 16 topics: (1) artificial intelligence/machine learning credibility and acceptance, (2) burnout, (3) complex care (outpatient), (4) emergency department visits, (5) falls, (6) health care-acquired infections, (7) health care utilization and costs, (8) hospitalization, (9) in-hospital mortality, (10) length of stay, (11) pain, (12) patient safety, (13) pressure injuries, (14) readmissions, (15) staffing, and (16) unit culture.

RESULTS

Of 16,589 articles, 244 were included in the review. All topics were represented by literature published in 2020, ranging from 1 article to 59 articles. Numerous contemporary data science methods were represented in the literature including the use of machine learning, neural networks, and natural language processing.

CONCLUSION

This review provides an overview of the data science trends that were relevant to nursing practice in 2020. Examinations of such literature are important to monitor the status of data science's influence in nursing practice.

Persistent Symptoms and Health Needs of Women and Men With Non-Obstructed Coronary Arteries in the Years Following Coronary Angiography

Background: The prognosis of women and men with persistent anginal complaints and non-obstructed coronary arteries is impaired as compared with asymptomatic women and men. The increased healthcare burden in the hospital due to repeated coronary angiography in these women and men has been documented, yet little is known about the percentage of women and men who remain symptomatic and under care of the general practitioner in the years following a coronary angiographic outcome of non-obstructed coronary arteries. Methods: From the Utrecht Coronary Biobank study, including individuals who underwent a coronary angiography from 2011 to 2015 (N = 2,546, 27% women), we selected women and men with non-obstructed coronary arteries (N = 687, 39% women). This population was linked to the Julius General Practitioners Network (JGPN); a database with routine care data of general practitioners. For every individual with non-obstructed coronary arteries, we selected an asymptomatic non-referred age-, sex-, and general practitioner-matched individual from the JGPN. We compared the healthcare consumption of men and women with non-obstructed coronary arteries to these matched individuals. The McNemar's test was used for pairwise comparison, and sex differences were assessed using stratified analyses. Results: The prevalence of non-obstructed coronary arteries was higher in women as compared with men (39 vs. 23%). During a median follow-up of 7 years [IQR 6.4-8.0], 89% of the individuals with non-obstructed coronary arteries (91% women and 87% men) visited their general practitioner for one or more cardiovascular consultations. This was compared to 34% of the matched individuals (89 vs. 34%, p < 0.001). The consultations were most often for angina (equivalents) (57 vs. 11%, p < 0.001) and heart failure (10 vs. 2%, p = 0.015). In addition, they more often consulted the general practitioner for psychosocial complaints (31 vs. 15%, p = 0.005). Findings were similar for women and men. Conclusions: A coronary angiographic outcome of non-obstructed coronary arteries is more common in women than in men. In the years following the coronary angiography, the majority of the population remains symptomatic. Both women and men with non-obstructed coronary arteries had higher health needs for angina, heart failure, and psychosocial complaints than matched asymptomatic individuals.

An Integrative Pharmacology-Based Strategy to Uncover the Mechanism of Xiong-Pi-Fang in Treating Coronary Heart Disease with Depression

Objectives: This study aimed to explore the mechanism of Xiong-Pi-Fang (XPF) in the treatment of coronary heart disease (CHD) with depression by an integrative strategy combining serum pharmacochemistry, network pharmacology analysis, and experimental validation. Methods: An ultrahigh performance liquid chromatography-quadrupole-time-of-flight tandem mass spectrometry (UPLC-Q-TOF/MS) method was constructed to identify compounds in rat serum after oral administration of XPF, and a component-target network was established using Cytoscape, between the targets of XPF ingredients and CHD with depression. Furthermore, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed to deduce the mechanism of XPF in treating CHD with depression. Finally, in a chronic unpredictable mild stress (CUMS)-and isoproterenol (ISO)-induced rat model, TUNEL was used to detect the apoptosis index of the myocardium and hippocampus, ELISA and western blot were used to detect the predicted hub targets, namely AngII, 5-HT, cAMP, PKA, CREB, BDNF, Bcl-2, Bax, Cyt-c, and caspase-3. Results: We identified 51 compounds in rat serum after oral administration of XPF, which mainly included phenolic acids, saponins, and flavonoids. Network pharmacology analysis revealed that XPF may regulate targets, such as ACE2, HTR1A, HTR2A, AKT1, PKIA, CREB1, BDNF, BCL2, BAX, CASP3, cAMP signaling pathway, and cell apoptosis process in the treatment of CHD with depression. ELISA analysis showed that XPF decreased Ang-II content in the circulation and central nervous system, inhibited 5-HT levels in peripheral circulation, and increased 5-HT content in the central nervous system and cAMP content in the myocardia and hippocampus. Meanwhile, western blot analysis indicated that XPF could upregulate the expression levels of PKA, CREB, and BDNF both in the myocardia and hippocampus. TUNEL staining indicated that the apoptosis index of myocardial and hippocampal cells increased in CUMS-and ISO-induced CHD in rats under depression, and XPF could increase the expression of Bcl-2, inhibit the expression of Bax, Cyt-c, and caspase-3, and rectify the injury of the hippocampus and myocardium, which exerted antidepressant and antimyocardial ischemia effects. Conclusion: Our study proposed an integrated strategy, combining serum pharmacochemistry and network pharmacology to investigate the mechanisms of XPF in treating CHD with depression. The mechanism of XPF in treating CHD with depression may be related to the activation of the cAMP signaling pathway and the inhibition of the apoptosis.

Time-dependent depression and anxiety symptoms as risk factors for recurrent cardiac events: findings from the UPBEAT-UK study

BACKGROUND

Depression is a well-known risk factor for recurrent cardiac events (RCEs) but findings are less consistent for anxiety, not previously reported on using a time-dependent approach. We aimed to study the prognostic effect of anxiety and depression symptom levels on RCEs.

METHODS

Data (N = 595) were drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Hospital Anxiety and Depression Scale symptoms were grouped into: agitation (three items), anxiety (four items), and depression (seven items) subscales. We performed two types of multivariate analyses using Cox proportional hazard models with delayed entry: with baseline variables (long-term analysis), and with variables measured 12-to-18 months prior to the event (short-term time-dependent analysis), as RCE risk factors.

RESULTS

In the baseline analysis, both anxiety and depression, but not agitation, were separate RCE risk factors, with a moderating effect when considered jointly. In the short-term time-dependent analysis, elevated scores on the anxiety subscale were associated with increased RCE risk even when adjusted for depression [hazard ratio (95% confidence interval) 1.22 (1.05-1.41), p = 0.009]. Depression was no longer a significant predictor when adjusted for anxiety [1.05 (0.87-1.27), p = 0.61]. For anxiety, individual items associated with RCEs differed between the two approaches: item 5 'worrying thoughts' was the most significant long-term risk factor [1.52 (1.21-1.91), p = 0.0004] whereas item 13 'feelings of panic' was the most significant time-dependent short-term risk factor [1.52 (1.18-1.95), p = 0.001].

CONCLUSIONS

Anxiety is an important short-term preventable and potentially causal risk factor for RCEs, to be targeted in secondary cardiac disease prevention programmes.

Severity, Progress, and Related Factors of Mood Disorders in Patients with Coronary Artery Disease: A Retrospective Study

Patients with coronary artery disease (CAD) are more likely to experience depression and anxiety, which, in turn, are risk factors for CAD. The Beck depression inventory (BDI) and Beck anxiety inventory (BAI) were applied for mood evaluation during hospitalization and again 3 months after discharge in 118 patients with CAD, and cardiopulmonary exercise tests were conducted in the outpatient department. Of the patients diagnosed with CAD, 40 (33.9%) had depressive moods, and 51 (43.2%) had anxious moods. A family history of CAD, low Korean activity scale index (KASI), and use of beta-blockers were independent factors causing depressive mood, while lower left ventricular ejection fraction (LVEF) and low KASI score were independent factors causing anxious mood. A considerable number of patients (35.7% with depressive mood and 25.0% with anxious mood) still had emotional problems after 3 months of discharge. The change values of BDI were associated with lower LVEF and longer hospital stay, while those of BAI was associated with a longer hospital stay. Since some patients had depressive and anxious moods after three months of discharge, evaluating and treating them are essential.