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Pedersen SS, Skov O. Two for the price of one: does treating depression in cardiac patients using internet-based cognitive behavioural therapy also reduce anxiety symptoms? Eur J Cardiovasc Nurs 2024; 23:e46-e47. [PMID: 38175653 DOI: 10.1093/eurjcn/zvad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
- Department of Cardiology, Odense University Hospital, J.B. Winsløwsvej 4, 5000 Odense C, Denmark
| | - Ole Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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2
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Verdicchio CV, Hollings M, Freene N. Understanding what factors underpin change in walking distance in patients with depression following completion of cardiac rehabilitation: commentary. Eur J Cardiovasc Nurs 2024:zvae078. [PMID: 38805179 DOI: 10.1093/eurjcn/zvae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Christian V Verdicchio
- Heart Support Australia, Canberra, ACT, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia
| | - Matthew Hollings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole Freene
- Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT 2617, Australia
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3
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Mindham R, Van Heetvelde M, Pedersen SS. How your patient is really feeling: the emotional hinterland of a cardiac diagnosis. Eur Heart J 2024; 45:748-750. [PMID: 38190305 DOI: 10.1093/eurheartj/ehad840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Affiliation(s)
- Richard Mindham
- European Society of Cardiology Patient Forum, Sophia Antipolis 06903, France
| | | | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Dinsmore JS, Schmidt CL, Messner PK, Loth AR, Meiers SJ. Enhancement of Preoperative Mental Health Assessment Through Clinical Nurse Specialist Project Leadership. CLIN NURSE SPEC 2024; 38:80-90. [PMID: 38364068 DOI: 10.1097/nur.0000000000000801] [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: 02/18/2024]
Abstract
PURPOSE/OBJECTIVES The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery. DESCRIPTION OF PROJECT The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates. OUTCOME Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion. CONCLUSION Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.
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Affiliation(s)
- Jill S Dinsmore
- Author Affiliations: Clinical Nurse Specialists (Dinsmore and Messner), Department of Nursing, and Clinical Nurse Specialist Provider (Schmidt), Pain Clinic, Mayo Clinic, Rochester, Minnesota; Associate Professor (Loth), and Professor (Meiers), Department of Graduate Nursing, Winona State University, Rochester, Minnesota; and Jane W. and James E. Moore Nursing Research Professor (Meiers), College of Nursing and Health Sciences, University of Wisconsin Eau Claire
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5
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Helmark C, Harrison A, Pedersen SS, Doherty P. Screening for - and prevalence of - anxiety and depression in cardiac rehabilitation in the post-COVID era. An observational study. Int J Cardiol 2023; 393:131379. [PMID: 37734491 DOI: 10.1016/j.ijcard.2023.131379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Approximately 20-30% of patients with a cardiac disease suffer from anxiety and/or depression, leading to poor health outcomes. To identify this subgroup, clinical guidelines recommend screening for anxiety and depression in cardiac rehabilitation (CR). It is unknown how screening practice is delivered post-COVID. METHODS This observational study used data from the National Audit of Cardiac Rehabilitation from April 2018-March 2022. Descriptive statistics were used to assess screening rates and prevalence, while a multivariate logistic regression model was performed to analyse determinants for screening for anxiety and depression among patients participating in cardiac rehabilitation. RESULTS The population consisted of 245,705 patients, where 128,643 (52.4%) were screened and 117,062 (47.6%) were not. Patients attending CR during first year of COVID-19 were less likely to be screened. Patients with female gender, living alone, non-white ethnicity, living in the most deprived areas, current smoking, and physical inactivity were less likely to be screened, while patients who were revascularized, having an objective physical fitness test, and attending a certified CR center were more likely to be screened. For patients attending CR during COVID-19, the prevalence of anxiety and depression decreased significantly. For anxiety the prevalence dropped from 34.4% to 15.8%, for depression the prevalence dropped from 33.5% to 16.5%. CONCLUSION CR service provision was negatively impacted during COVID-19, leading to much lower screening for anxiety and depression in the CR setting. Prevalence of anxiety and depression decreased during COVID-19 for this population, possibly because psychologically affected patients refrained from attending CR.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark.
| | - Alex Harrison
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
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6
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Gu J, Tong X, Meng S, Xu S, Huang J. Remote cardiac rehabilitation program during the COVID-19 pandemic for patients with stable coronary artery disease after percutaneous coronary intervention: a prospective cohort study. BMC Sports Sci Med Rehabil 2023; 15:79. [PMID: 37415247 DOI: 10.1186/s13102-023-00688-2] [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: 01/30/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The coronavirus disease-19 (COVID-19) pandemic restricts rapid implementation of in-person delivery of cardiac rehabilitation (CR) at the center for coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI), thus enabling a cohort comparison of in-person vs. remote CR program. This study aims to investigate outcomes of exercise capacity, health-related quality of life (HRQL), mental health, and family burden of stable CAD patients undergoing PCI in low-to-moderate risk after different delivery models of CR program. METHODS The study included a cohort of stable CAD patients undergoing PCI who had experienced two naturally occurring modes of CR program after hospital discharge at two time periods, January 2019 to December 2019 (in-person CR program) and May 2020 to May 2021 (remote CR program). The exercise capacity was assessed by means of 6-min walk test (6MWT), maximal oxygen uptake (VO2max) and the respiratory anaerobic threshold (VO2AT) before discharge, at the end of the 8-week and 12-week in-person or remote CR program after discharge. RESULTS No adverse events occurred during the CR period. CAD patients had a longer distance walked in 6 min with a higher VO2max after 8-week and 12-week CR program whether in-person or remote model (p < 0.05). The distance walked in 6 min was longer and the maximal oxygen uptake (VO2max) was higher at the end of the 12-week in-person or remote CR program than 8-week in-person or remote CR program (p < 0.05). The respiratory anaerobic threshold (VO2AT) of CAD patients was decreased after 8-week CR program whether in-person or remote model (p < 0.05). CAD patients receiving remote CR program exhibited higher HRQL scores in domains of vitality (p = 0.048), role emotional (p = 0.039), mental health (p = 0.014), and the summary score of the mental composite (p = 0.048) compared to in-person CR program after 8 weeks. The anxiety and depression scores of CAD patients undergoing PCI were decreased after 8-week CR program whether in-person or remote model (p < 0.05). The CAD patients receiving remote delivery showed lower anxiety and depression scores compared to those receiving in-person delivery at the end of the 8-week CR program (p < 0.05). It was found that the family burden scores of CAD patients undergoing PCI were reduced after 8-week and 12-week CR program whether in-person or remote model (p < 0.05). The CAD patients receiving remote CR program showed lower family burden scores than those receiving in-person CR program after whether 8 weeks or 12 weeks (p < 0.05). CONCLUSION These data indicate that a properly designed and monitored remote delivery represents a feasible and safe model for low-to-moderate-risk, stable CAD patients undergoing PCI inaccessible to in-person CR during the COVID-19 pandemic.
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Affiliation(s)
- Junjie Gu
- Department of Cardiology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Xiaoshan Tong
- Department of Cardiology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Shasha Meng
- Department of Cardiology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Shuhui Xu
- Department of Cardiology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, Zhejiang, China
| | - Jinyan Huang
- Operation Room, Hangzhou Women's Hospital, Hangzhou, 310016, Zhejiang, China.
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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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8
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Pedersen SS, Skov O, Ahm R. Are we getting closer to treating heart and mind together and bridging the gap for individual patients attending cardiac rehabilitation? Eur Heart J 2023; 44:997-999. [PMID: 36649936 DOI: 10.1093/eurheartj/ehac820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense 5230, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ole Skov
- Department of Psychology, University of Southern Denmark, Odense 5230, Denmark
| | - Robert Ahm
- Department of Psychology, University of Southern Denmark, Odense 5230, Denmark
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Kruse M, Laudicella M, Olsen KR, Zwisler ADO, Helmark C, Pedersen SS. Effects of screening for anxiety and depression in patients with ischaemic heart disease - a nationwide Danish register study. Scand J Public Health 2023; 51:149-156. [PMID: 35114856 DOI: 10.1177/14034948221074972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To investigate the effect of screening for anxiety and depression (AD) in patients with ischaemic heart disease (IHD) on the likelihood of receiving treatment for AD. METHODS We used a nationwide dataset of all Danish patients with an incident IHD diagnosis in the period 2015-2018 (N = 80,701) of which 20,461 (25%) were exposed to screening for AD as part of cardiac rehabilitation. A binary composite indicator for the use of any AD treatment (prescriptions of AD drugs, general practitioner (GP) counselling or referral to a psychologist), was modelled as the dependent variable. The probability of receiving AD treatment was estimated using linear probability and instrumental variable regression models. RESULTS Exposure to AD screening was lower for patients with low income (change in probability -0.67, 95% CI -0.76; -0.59), low education (change in probability -0.16, 95% CI -0.20; -0.13), and a high comorbidity burden (change in probability -0.09, 95% CI -0.10; -0.07). Screened patients had a lower conditional probability of AD treatment (change in probability -0.0061, p < 0.001) than non-screened patients. The patient's GP also had an impact on the probability of being referred for AD treatment. Using an instrumental variable approach did not affect the results. CONCLUSIONS
Screening for AD was subject to selection at the patient level; patients at lower risk of AD had a higher probability of being screened. Hence, extending systematic screening to cover a larger population may not achieve a noticeable increase in the uptake of AD treatment if it is not supported by appropriate measures to reduce reverse selection into screening.
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Affiliation(s)
- Marie Kruse
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mauro Laudicella
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kim Rose Olsen
- DaCHE, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ann Dorthe O Zwisler
- Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Denmark; University of Southern Denmark, Odense Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Denmark
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10
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Thompson DR, Pedersen SS. Psychosocial assessment and psychological interventions following a cardiac event. Heart 2023; 109:405-410. [PMID: 36593099 DOI: 10.1136/heartjnl-2022-321607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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11
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Psychological distress is independently related to new coronary events at 8 years' follow-up in elderly primary care patients with hypertension. J Psychosom Res 2022; 160:110980. [PMID: 35779439 DOI: 10.1016/j.jpsychores.2022.110980] [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: 02/18/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Occurrence of psychological distress in hypertensive patients could have a negative synergistic effect on future cardiovascular events (CVEs). The aim of this study was to determine the association between anxiety or depressive symptoms in elderly hypertensive primary care patients and the development of new CVEs and all-cause mortality. METHODS A prospective cohort study was conducted in five Dutch general practices between June 2010 and January 2012. Patients with primary care managed hypertension, aged 60-85 years, were included and completed the GAD-7 and PHQ-9, measuring anxiety and depressive symptoms respectively. The incidence of new CVEs (coronary event, cerebrovascular disease, atrial fibrillation and heart failure) and all-cause mortality at 8 years' follow-up was recorded by data extraction of the digital information systems. RESULTS Among the 555 included participants (mean age 70 ± 6.6 years; 56% female), 29 (5.2%) had a new coronary event, 42 (7.6%) a cerebrovascular disease, 57 (10.3%) atrial fibrillation, 22 (4%) heart failure and 68 (12.3%) died. Elevated anxiety and depression scores increased the risk of a coronary event independently and significantly by 12% (HR 1.12; 95% CI [1.04-1.22], p = 0.005) and 18% (HR 1.18; 95% CI [1.08-1.28], p < 0.0001), respectively, adjusted for relevant (Framingham) baseline covariates. No associations were found with regard to other CVEs and all-cause mortality. CONCLUSION In a random sample of elderly primary care hypertension patients there was a significant association between psychological distress and the occurrence of new coronary events after 8 years' follow-up but not with other CVEs and all-cause mortality.
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Mourad G, Lundgren J, Andersson G, Husberg M, Johansson P. Cost-effectiveness of internet-delivered cognitive behavioural therapy in patients with cardiovascular disease and depressive symptoms: secondary analysis of an RCT. BMJ Open 2022; 12:e059939. [PMID: 35410939 PMCID: PMC9002253 DOI: 10.1136/bmjopen-2021-059939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Cost-effectiveness evaluations of psychological interventions, such as internet-delivered cognitive behavioural therapy (iCBT) programmes, in patients with cardiovascular disease (CVD) are rare. We recently reported moderate to large effect sizes on depressive symptoms in CVD outpatients following a 9-week iCBT programme compared with an online discussion forum (ODF), in favour of iCBT. In this paper, we evaluate the cost-effectiveness of this intervention. METHODS Cost-effectiveness analysis of a randomised controlled trial. The EQ-5D-3L was used to calculate quality-adjusted life-years (QALYs). Data on healthcare costs were retrieved from healthcare registries. RESULTS At 12-month follow-up, the QALY was significantly higher in iCBT compared with the ODF group (0.713 vs 0.598, p=0.007). The mean difference of 0.115 corresponds with 42 extra days in best imaginable health status in favour of the iCBT group over the course of 1 year. Incremental cost-effectiveness ratio (ICER) for iCBT versus ODF was €18 865 per QALY saved. The cost-effectiveness plane indicated that iCBT is a cheaper and more effective intervention in 24.5% of the cases, and in 75% a costlier and more effective intervention than ODF. Only in about 0.5% of the cases, there was an indication of a costlier, but less effective intervention compared with ODF. CONCLUSIONS The ICER of €18 865 was lower than the cost-effectiveness threshold range of €23 400-€35 100 as proposed by the NICE guidelines, suggesting that the iCBT treatment of depressive symptoms in patients with CVD is cost-effective. TRIAL REGISTRATION NUMBER NCT02778074; Post-results.
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Affiliation(s)
- Ghassan Mourad
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Magnus Husberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Linköping University, Linköping, Sweden
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Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. Int J Cardiol 2022; 348:1-8. [PMID: 34902504 PMCID: PMC8779638 DOI: 10.1016/j.ijcard.2021.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.
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Clair L, Anderson H, Anderson C, Ekuma O, Prior HJ. Cardiovascular disease and the risk of dementia: a survival analysis using administrative data from Manitoba. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:455-464. [PMID: 35025100 PMCID: PMC9043061 DOI: 10.17269/s41997-021-00589-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/15/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Recent research has shown that cardiovascular disease (CVD) raises the risk of dementia and other forms of cognitive decline. Generally, these studies are unable to model the time of diagnosis of CVD in their analyses and treat CVD as a time-fixed variable. Our objective was to assess the risk of being diagnosed with dementia for individuals diagnosed with CVD when CVD is time-dependent. METHODS We performed a retrospective cohort study using administrative health datasets from the Manitoba Population Research Data Repository in Canada. We constructed a longitudinal dataset to track individuals enrolled in the Manitoba Health Insurance Registry between April 1, 1997 and March 31, 2015. The study population consisted of 496,192 individuals 30 years of age or older who were not diagnosed with CVD or dementia prior to April 1, 1997. Diagnoses of CVD and dementia were based on diagnosis codes from medical claims and hospitalizations and the use of prescription medications. Hazard ratios were then computed using adjusted Cox-proportional hazards analyses. RESULTS Among the CVD subgroups considered, atrial fibrillation, ischemic heart disease, and stroke increased the risk of developing dementia, with stroke doubling one's risk of being diagnosed with the disease (hazard ratio: 1.95; 95% confidence interval: 1.9, 2.01). Age, lower socioeconomic status, and worsening comorbidities also increased the risk of being diagnosed with dementia. CONCLUSION A diagnosis of CVD is associated with an increased risk of a future diagnosis of dementia. Promoting good cardiovascular health may serve as an effective measure for preventing dementia.
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Affiliation(s)
- Luc Clair
- Department of Economics, University of Winnipeg, 515 Portage, Avenue, Winnipeg, MB R3B 2E9 Canada ,Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB Canada
| | - Hope Anderson
- Canadian Centre for Agri-Food Research in Health and Medicine, Winnipeg, MB Canada ,College of Pharmacy, University of Manitoba, Winnipeg, MB Canada
| | - Christopher Anderson
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, MB Canada ,Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Health Sciences Centre, Winnipeg, MB Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB Canada
| | - Heather J. Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB Canada
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Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients. Sci Rep 2021; 11:3760. [PMID: 33580174 PMCID: PMC7881008 DOI: 10.1038/s41598-021-83231-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/25/2021] [Indexed: 01/30/2023] Open
Abstract
Exploring new models of medical care requires evaluating the impact of new care strategies not only on physiological parameters but also on the quality of life of the patient. On the other hand the presence of anxiety together with depression requires further consideration when planning appropriate management strategies. The aim of this study was to examine the effectiveness of a home-based cardiac rehabilitation program incorporating an e-Health technology on health-related quality of life associated with symptoms of anxiety and depression in moderate-risk patients. A multicenter, randomized controlled clinical trial was designed to compare a traditional hospital based cardiac rehabilitation program (n = 38, 35 male) with a mixed home surveillance program where patients exercised at home with a remote electrocardiographic monitoring device (n = 33, 31 male). The Short Form-36 (SF-36) Health Survey and the Goldberg questionnaire were used to evaluate quality of life and the presence of symptoms of anxiety and depression respectively. The results of this study show that the type of cardiac rehabilitation program did not influence the improvement in quality of life (p = 0.854), but the presence of symptoms of anxiety and depression did (p = 0.001). Although both programs achieved a decrease in anxiety and depression symptoms and improved functional capacity (p ≤ 0.001), a significant interaction effect was found between the group with or without anxiety and depression symptoms and the type of program in the bodily pain dimension (p = 0.021). Trial registration: Retrospectively registered NCT02796404 (10/06/2016) in clinialtrials.gov.
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Pedersen SS, Andersen CM, Ahm R, Skovbakke SJ, Kok R, Helmark C, Wiil UK, Schmidt T, Olsen KR, Hjelmborg J, Zwisler AD, Frostholm L. Efficacy and cost-effectiveness of a therapist-assisted web-based intervention for depression and anxiety in patients with ischemic heart disease attending cardiac rehabilitation [eMindYourHeart trial]: a randomised controlled trial protocol. BMC Cardiovasc Disord 2021; 21:20. [PMID: 33413109 PMCID: PMC7788554 DOI: 10.1186/s12872-020-01801-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/25/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND One in five patients with ischaemic heart disease (IHD) develop comorbid depression or anxiety. Depression is associated with risk of non-adherence to cardiac rehabilitation (CR) and dropout, inadequate risk factor management, poor quality of life (QoL), increased healthcare costs and premature death. In 2020, IHD and depression are expected to be among the top contributors to the disease-burden worldwide. Hence, it is paramount to treat both the underlying somatic disease as well as depression and anxiety. eMindYourHeart will evaluate the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention targeting depression and anxiety in patients with IHD, which may help fill this gap in clinical care. METHODS eMindYourHeart is a multi-center, two-armed, unblinded randomised controlled trial that will compare a therapist-assisted eHealth intervention to treatment as usual in 188 CR patients with IHD and comorbid depression or anxiety. The primary outcome of the trial is symptoms of depression, measured with the Hospital Anxiety and Depression Scale (HADS) at 3 months. Secondary outcomes evaluated at 3, 6, and 12 months include symptoms of depression and anxiety (HADS), perceived stress, health complaints, QoL (HeartQoL), trial dropout (number of patients dropped out in either arm at 3 months) and cost-effectiveness. DISCUSSION To our knowledge, this is the first trial to evaluate both the efficacy and cost-effectiveness of a therapist-assisted eHealth intervention in patients with IHD and comorbid psychological distress as part of CR. Integrating screening for and treatment of depression and anxiety into standard CR may decrease dropout and facilitate better risk factor management, as it is presented as "one package" to patients, and they can access the eMindYourHeart program in their own time and at their own convenience. The trial holds a strong potential for improving the quality of care for an increasing population of patients with IHD and comorbid depression, anxiety or both, with likely benefits to patients, families, and society at large due to potential reductions in direct and indirect costs, if proven successful. Trial registration The trial was prospectively registered on https://clinicaltrials.gov/ct2/show/NCT04172974 on November 21, 2019 with registration number [NCT04172974].
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Affiliation(s)
- Susanne S. Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Christina M. Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Robert Ahm
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Søren J. Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Robin Kok
- Department of Psychology, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
| | - Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Uffe K. Wiil
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Thomas Schmidt
- The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | - Kim Rose Olsen
- Danish Center for Health Economics (DaCHE), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Jacob Hjelmborg
- Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Zwisler
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- Danish Knowledge Center for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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Ko DT, Khan AM, Kotrri G, Austin PC, Wijeysundera HC, Koh M, Chu A, Jackevicius CA, Lawler PR, Tu JV. Eligibility, Clinical Outcomes, and Budget Impact of PCSK9 Inhibitor Adoption: The CANHEART PCSK9 Study. J Am Heart Assoc 2019; 7:e010007. [PMID: 30571382 PMCID: PMC6404170 DOI: 10.1161/jaha.118.010007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background The FOURIER (Further Cardiovascular Outcomes Research With PCSK9i [Proprotein Convertase Subtilisin‐Kexin Type 9 Inhibitors] in Subjects With Elevated Risk) trial found a reduction in cardiovascular events in patients with atherosclerotic cardiovascular disease (ASCVD). Our objective was to estimate the eligibility, clinical outcomes, and budget impact of adopting PCSK9i in a large healthcare system. Methods and Results Ontario, Canada, residents alive in 2011, aged 40 to 85 years, were eligible for inclusion. PCSK9i eligibility was determined on the basis of FOURIER trial definition. Hazard ratios observed in the FOURIER trial were applied to assess the number of events that could be avoided. Budget impact was calculated as the difference between projected costs of treatment adoption and events avoided if PCSK9i were used. Of the 2.4 million included individuals, 5.3% had a history of ASCVD. We estimated that 2.7% of the general population and 51.9% of the patients with ASCVD would be eligible for PCSK9i. Adoption of PCSK9i in all eligible patients with ASCVD was projected to reduce primary events rates by 1.8% after 3 years. Despite cost reduction of $44 million in events, PCSK9i adoption would have a net budget impact of $1.5 billion over 3 years. Potential benefits of PCSK9i varied widely across subgroups, with the largest absolute risk reduction estimated to be 4.3% at 3 years in peripheral artery disease. In this subgroup of 5601 patients, the budget impact of treatment adoption was $116 million. Conclusions We estimated that ≈1 in 2 patients with ASCVD would be eligible for PCSK9i. The budget impact of adopting PCSK9i for all patients with ASCVD is substantial. Selective adoption to high‐risk patients will lessen the overall budgetary impact of PCSK9i treatment. See Editorial by Nasir
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Affiliation(s)
- Dennis T Ko
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,2 Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Anam M Khan
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Gynter Kotrri
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Peter C Austin
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Harindra C Wijeysundera
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,2 Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.,3 University of Toronto Ontario Canada
| | - Maria Koh
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Anna Chu
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada
| | - Cynthia A Jackevicius
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,3 University of Toronto Ontario Canada.,4 University Health Network Toronto Ontario Canada.,5 Western University of Health Sciences Pomona CA
| | - Patrick R Lawler
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,4 University Health Network Toronto Ontario Canada
| | - Jack V Tu
- 1 Institute for Clinical Evaluative Sciences Toronto Ontario Canada.,2 Schulich Heart Centre Sunnybrook Health Sciences Centre Toronto Ontario Canada.,3 University of Toronto Ontario Canada
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Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures: A National Readmissions Database Study. Anesthesiology 2019; 128:880-890. [PMID: 29470180 DOI: 10.1097/aln.0000000000002136] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. METHODS A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. RESULTS Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. CONCLUSIONS Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery. VISUAL ABSTRACT An online visual overview is available for this article at http://links.lww.com/ALN/B704.
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19
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Broers ER, Lodder P, Spek VR, Widdershoven JW, Pedersen SS, Habibović M. Healthcare utilization in patients with first-time implantable cardioverter defibrillators (data from the WEBCARE study). Pacing Clin Electrophysiol 2019; 42:439-446. [PMID: 30779208 PMCID: PMC6850604 DOI: 10.1111/pace.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/07/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Knowledge of the level of healthcare utilization (HCU) and the predictors of high HCU use in patients with an implantable cardioverter defibrillator (ICD) is lacking. We examined the level of HCU and predictors associated with increased HCU in first-time ICD patients, using a prospective study design. METHODS ICD patients (N = 201) completed a set of questionnaires at baseline and 3, 6, and 12 months after inclusion. A hierarchical multiple linear regression with three models was performed to examine predictors of HCU. RESULTS HCU was highest between baseline and 3 months postimplantation and gradually decreased during 12 months follow-up. During the first year postimplantation, only depression (β = 0.342, P = 0.002) was a significant predictor. Between baseline and 3 months follow-up, younger age (β = -0.220, P < 0.01), New York Heart Association class III/IV (β = 0.705, P = 0.01), and secondary indication (β = 0.148, P = 0.05) were independent predictors for increased HCU. Between 3 and 6 months follow-up, younger age (β = -0.151, P = 0.05) and depression (β = 0.370, P < 0.001) predicted increased HCU. Between 6 and 12 months only depression (β = 0.355, P = 0.001) remained a significant predictor. CONCLUSIONS Depression was an important predictor of increased HCU in ICD patients in the first year postimplantation, particularly after 3 months postimplantation. Identifying patients who need additional care and provide this on time might better meet patients' needs and lower future HCU.
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Affiliation(s)
- Eva R. Broers
- Department of CardiologySt. Elisabeth‐TweeSteden HospitalTilburgThe Netherlands
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Paul Lodder
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Viola R.M. Spek
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Jos W.M.G. Widdershoven
- Department of CardiologySt. Elisabeth‐TweeSteden HospitalTilburgThe Netherlands
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
| | - Susanne S. Pedersen
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Mirela Habibović
- Department of CardiologySt. Elisabeth‐TweeSteden HospitalTilburgThe Netherlands
- Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
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20
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Pedersen SS, Andersen CM. Minding the heart: Why are we still not closer to treating depression and anxiety in clinical cardiology practice? Eur J Prev Cardiol 2017; 25:244-246. [DOI: 10.1177/2047487317744367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Denmark
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