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Ruksakulpiwat S, Thongking W, Kannan N, Wright E, Niyomyart A, Benjasirisan C, Chiaranai C, Smothers C, Aldossary HM, Still CH. Understanding the Relationship Between Comorbidities, Medication Nonadherence, Activities of Daily Living, and Heart Condition Status Among Older Adults in the United States: A Regression Analysis and Machine Learning Approach. J Cardiovasc Nurs 2024:00005082-990000000-00224. [PMID: 39330877 DOI: 10.1097/jcn.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
BACKGROUND Nonadherence to medication among patients with heart disease poses serious risks, including worsened heart failure and increased mortality rates. OBJECTIVE This study aims to explore the complex interplay between comorbidities, medication nonadherence, activities of daily living, and heart condition status in older American adults, using both traditional statistical methods and machine learning. METHODS Data from 326 older adults with heart conditions, drawn from the Health and Retirement Study, were analyzed. Descriptive statistics characterized demographic profiles and comorbidities, whereas logistic regression, multiple regression analyses, and decision tree models were used to address our research inquiries. In addition, a machine learning approach, specifically decision tree models, was integrated to enhance predictive accuracy. RESULTS Our analysis showed that factors like age, gender, hypertension, and stroke history were significantly linked to worsening heart conditions. Notably, depression emerged as a robust predictor of medication nonadherence. Further adjusted analyses underscored significant correlations between stroke and challenges in basic activities such as dressing, bathing, and eating. Depression correlated significantly with difficulties in dressing, bed mobility, and toileting, whereas lung disease was associated with bathing hindrances. Intriguingly, our decision tree model revealed that patients experiencing dressing challenges, but not toileting difficulties, were more prone to report no improvement in heart condition status over the preceding 2 years. CONCLUSIONS Blending traditional statistics with machine learning in this study reveals significant implications for crafting personalized interventions to improve patients' depression, leading to increased activities of daily living, medication adherence, reduced severity of comorbidities, and ultimately better management of heart conditions.
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Susinski S, Bouchard K, Stragapede E, Dozois S, Sterling E, Tulloch H. Psychological interventions targeting mental health and stress among females with cardiac disease: a scoping review. Can J Physiol Pharmacol 2024; 102:607-619. [PMID: 38587177 DOI: 10.1139/cjpp-2023-0416] [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] [Indexed: 04/09/2024]
Abstract
Interventions that target mental health symptoms and stress among those with established cardiac disease have included predominately male samples despite female patients reporting greater severity of these symptoms. The aim of this scoping review was to synthesize the published literature on psychological interventions for females with cardiac disease. We conducted a systematic search of peer-reviewed randomized clinical trials (RCTs) published in the English language from 2003 to 2023, in three databases: Medline (Ovid), PsycInfo (Ovid), and CINAHL (EBSCO). Articles that included female samples, a control or comparison group, implemented psychological interventions, and measured depression, anxiety, or stress as an outcome were included in the review. Nine articles describing eight RCTs of psychological interventions, with a total of 1587 female patients with cardiac disease, were included. Interventions were most successful at reducing stress (75% of studies measuring stress reported efficacy), while symptoms of depression and anxiety were less responsive to intervention (∼30% of studies targeting these symptoms reported improvements) in comparison to a control condition. This scoping review highlights that further advancement in knowledge is required to better address the needs of females with cardiac disease and distress, particularly depression and anxiety.
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Affiliation(s)
| | - Karen Bouchard
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Elisa Stragapede
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Sophie Dozois
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Evan Sterling
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Heather Tulloch
- University of Ottawa Heart Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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Pan Y, Chen Y, Wu S, Ying P, Zhang Z, Tan X, Zhu J. Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study. BMC Psychiatry 2024; 24:644. [PMID: 39350149 PMCID: PMC11443634 DOI: 10.1186/s12888-024-06117-z] [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: 02/05/2024] [Accepted: 09/25/2024] [Indexed: 10/04/2024] Open
Abstract
AIMS Depressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients. METHODS CHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models. RESULTS Of 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19-4.03, and adjusted HR = 2.70; 95%CI 1.23-5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms. CONCLUSION Depressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association. TRIAL REGISTRATION This research was registered at https://www.chictr.org.cn . Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139.
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Affiliation(s)
- Yewei Pan
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Yequn Chen
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Shenglin Wu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Pengxiang Ying
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
- Centre for Precision Health, Edith Cowan University, Perth, WA, 6027, Australia
| | - Zishan Zhang
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xuerui Tan
- Department of Cardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
- Clinical Research Center, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Jinxiu Zhu
- Institute of Clinical Electrocardiology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China.
- Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Shenzhen, Guangdong, 518100, China.
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Rosen RC, Miner M, Burnett AL, Blaha MJ, Ganz P, Goldstein I, Kim N, Kohler T, Lue T, McVary K, Mulhall J, Parish SJ, Sadeghi-Nejad H, Sadovsky R, Sharlip I, Kloner RA. Proceedings of PRINCETON IV: PDE5 inhibitors and cardiac health symposium. Sex Med Rev 2024; 12:681-709. [PMID: 38936840 DOI: 10.1093/sxmrev/qeae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION Prior consensus meetings have addressed the relationship between phosphodiesterase type 5 (PDE5) inhibition and cardiac health. Given significant accumulation of new data in the past decade, a fourth consensus conference on this topic was convened in Pasadena, California, on March 10 and 11, 2023. OBJECTIVES Our meeting aimed to update existing knowledge, assess current guidelines, and make recommendations for future research and practice in this area. METHODS An expert panel reviewed existing research and clinical practice guidelines. RESULTS Key findings and clinical recommendations are the following: First, erectile dysfunction (ED) is a risk marker and enhancer for cardiovascular (CV) disease. For men with ED and intermediate levels of CV risk, coronary artery calcium (CAC) computed tomography should be considered in addition to previous management algorithms. Second, sexual activity is generally safe for men with ED, although stress testing should still be considered for men with reduced exercise tolerance or ischemia. Third, the safety of PDE5 inhibitor use with concomitant medications was reviewed in depth, particularly concomitant use with nitrates or alpha-blockers. With rare exceptions, PDE5 inhibitors can be safely used in men being treated for hypertension, lower urinary tract symptoms and other common male disorders. Fourth, for men unresponsive to oral therapy or with absolute contraindications for PDE5 inhibitor administration, multiple treatment options can be selected. These were reviewed in depth with clinical recommendations. Fifth, evidence from retrospective studies points strongly toward cardioprotective effects of chronic PDE5-inhibitor use in men. Decreased rates of adverse cardiac outcomes in men taking PDE-5 inhibitors has been consistently reported from multiple studies. Sixth, recommendations were made regarding over-the-counter access and potential risks of dietary supplement adulteration. Seventh, although limited data exist in women, PDE5 inhibitors are generally safe and are being tested for use in multiple new indications. CONCLUSION Studies support the overall cardiovascular safety of the PDE5 inhibitors. New indications and applications were reviewed in depth.
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Affiliation(s)
- Raymond C Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, United States
| | - Martin Miner
- Men's Health Center, Miriam Hospital, 180 Corliss St. 2nd Floor, Providence, RI 02904, United States
| | - Arthur L Burnett
- Department of Urology, Ciccarone Center for Clinical Research, Johns Hopkins University, 600 N Wolfe St # B110, Baltimore, MD 21287, United States
| | - Michael J Blaha
- Department of Cardiology, Johns Hopkins Health Care & Surgery Center, Green Spring Station, Lutherville, 10755 Falls Road, Lutherville, MD 21093, United States
| | - Peter Ganz
- Department of Cardiology and Vascular Research, University of California, San Francisco, 1001 Potrero Ave # 107, San Francisco, CA 94110, United States
| | - Irwin Goldstein
- Institute for Sexual Medicine, 5555 Reservoir Dr # 300, San Diego, CA 92120, United States
| | - Noel Kim
- Institute for Sexual Medicine, 5555 Reservoir Drive, Suite 300, San Diego, CA 92120, United States
| | - Tobias Kohler
- Dept of Urology, Mayo Clinic, 200 First St. S.W., Rochester, Minnesota 55905, US, United States
| | - Tom Lue
- Department of Urology, University of California, San Francisco, School of Medicine, 400 Parnassus Ave #610, San Francisco, CA 94143, United States
| | - Kevin McVary
- Center for Male Health, Stritch School of Medicine, Loyola University, 6800 N Frontage Rd, Burr Ridge, IL 60527, United States
| | - John Mulhall
- Memorial Sloan Kettering Cancer Center, Sloan Kettering Hospital, 205 E 64th St, New York, NY 10065, United States
| | - Sharon J Parish
- Weill Cornell Medical College, 21 Bloomingdale Rd, White Plains, NY 10605, United States
| | - Hossein Sadeghi-Nejad
- Professor of Urology and Ob-Gyn, Department of Urology, Langone Grossman School of Medicine, New York University, 222 East 41st Street, 12th Floor, New York, NY 10017, United States
| | - Richard Sadovsky
- Dept of Family Medicine, Downstate Medical Center, 450 Clarkson Ave, Brooklyn, NY 11203, United States
| | - Ira Sharlip
- Department of Urology, University of California, San Francisco, School of Medicine, 400 Parnassus Ave #610, San Francisco, CA 94143, United States
| | - Robert A Kloner
- Chief Scientist and Director, Cardiovascular Research Institute, Huntington Medical Research Institutes, 686 S. Fair Oaks Ave., Pasadena, CA. 91105, United States
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Changchien TC, Yen YC, Lu YC. Mental Health and Quality of Life of Patients with Differentiated Thyroid Cancer Pre and Post Radioactive Iodine Treatment: A Prospective Study. J Clin Med 2024; 13:5472. [PMID: 39336959 PMCID: PMC11432333 DOI: 10.3390/jcm13185472] [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: 07/23/2024] [Revised: 08/26/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Although patients with differentiated thyroid cancer (DTC) have a good prognosis, their long-term clinical course can influence their mental health and their health-related quality of life (HRQoL). However, few studies have evaluated the psychological factors that influence subsequent HRQoL in this population, particularly during the initial treatment stage. Methods: In this 1-month cohort study, we evaluated depressive and anxiety symptoms and HRQoL of patients with DTC and examined possible predictors of further HRQoL impairment. Results: In total, 181 patients completed questionnaires where they self-rated their psychological status (the Chinese Health Questionnaire [CHQ], Taiwanese Depression Questionnaire [TDQ]) and HRQoL (the 36-item Short Form Health Survey [SF-36]) at baseline and 1 month after radioactive iodine (RAI) therapy. Compared with the general Taiwanese population, patients with DTC reported a worse HRQoL in all dimensions of the SF-36. Multivariate regression models indicated that anxiety and depressive symptoms were inversely correlated with some dimensions (physical functioning, bodily pain, and general health perceptions for the CHQ; role limitations due to physical problems and social functioning for the TDQ). However, psychiatric follow-up and treatment history were significantly associated with physical functioning and role limitations owing to the physical problem dimensions of HRQoL. Conclusions: In conclusion, although anxiety and depressive symptoms may negatively affect certain HRQoL domains, psychiatric follow-up can improve the physical dimensions.
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Affiliation(s)
- Te-Chang Changchien
- Department of Psychiatry, E-Da Hospital, Kaohsiung City 824, Taiwan
- School of Medicine, I-Shou University, Kaohsiung City 824, Taiwan
| | - Yung-Chieh Yen
- Department of Psychiatry, E-Da Hospital, Kaohsiung City 824, Taiwan
- School of Medicine, I-Shou University, Kaohsiung City 824, Taiwan
| | - Yung-Chuan Lu
- School of Medicine, I-Shou University, Kaohsiung City 824, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, Kaohsiung City 824, Taiwan
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Baradaran A, Ardakani MRK, Bateni FS, Asadian-Koohestani F, Vahedi M, Aein A, Shahmansouri N, Sadighi G. The effect of escitalopram in treating mild to moderate depressive disorder and improving the quality of life in patients undergoing coronary artery bypass grafting - a double-blind randomized clinical trial. Front Psychiatry 2024; 15:1342754. [PMID: 39006820 PMCID: PMC11240843 DOI: 10.3389/fpsyt.2024.1342754] [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: 11/22/2023] [Accepted: 05/31/2024] [Indexed: 07/16/2024] Open
Abstract
Introduction Chronic depression and anxiety can be a risk factor for coronary aArtery bypass grafting (CABG) and is an emerging factor after coronary artery disease when the patient is admitted to the hospital and after surgery. We aimed to assess the effect of Escitalopram in treating mild to moderate depressive disorder and improving the quality of life in patients undergoing CABG. Methods In this randomized clinical trial, 50 patients undergoing CABG referred to Tehran Heart Hospital from January 2021 to May 2021 and were suffering from mild to moderate depression were randomly assigned to one of the two groups of Escitalopram or placebo. The level of depression was assessed based on Beck's depression inventory and the quality-of-life status and its domains were assessed based on the SF-36 questionnaire in 2 groups. Measurements were obtained at baseline and at four and eight weeks after treatment. Chi-square, Fisher's exact, paired, and Wilcoxon tests or ANOVA were used as appropriate. Results There was no significant difference between the level of depression between the two study groups at baseline (P=0.312). There was no significant difference between the quality of life and its domains in the two study groups at baseline (P=0.607). However, the most important effect of Escitalopram was reducing depression scores in the intervention group at weeks 4 and 8 after treatment compared to the placebo group (P<0.001). The quality of life and its domains were significantly higher in the Escitalopram group eight weeks after treatment (P=0.004). The amount of drug side effects at 2 and 4 weeks after treatment had no significant difference between the groups (P>0.05). Conclusion Escitalopram was effective in treating mild to moderate depressive disorder and improving quality of life in patients undergoing CABG. Clinical trial registration https://irct.behdasht.gov.ir/, identifier IRCT20140126016374N2.
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Affiliation(s)
- Abdolvahab Baradaran
- Cardiovascular Department of Firouzabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Sadat Bateni
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mohsen Vahedi
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Afsaneh Aein
- Department of Health Promotion and Education, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Shahmansouri
- Psychosomatic research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Sadighi
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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7
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Wang Y, Xu X, Lv Q, Zhang X, Zhao Y, Zang X. Dose-Response Relationship Between Perceived Control and Depression in Patients With Chronic Heart Failure: A Multicenter and Cross-sectional Study. J Cardiovasc Nurs 2024:00005082-990000000-00199. [PMID: 38896538 DOI: 10.1097/jcn.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Little is known regarding the relationship between perceived control and depression in patients with chronic heart failure (CHF), particularly in terms of their dose-response relationship. OBJECTIVE The aim of this study was to explore this relationship based on linear and nonlinear hypotheses and potential subgroup differences in patients with CHF. METHODS A total of 308 patients with CHF were included in the study. Data on perceived control, depression, and relevant covariates, such as gender, age, New York Heart Association classification, and comorbidity burden, were collected. Logistic regression, Spearman correlation, and restricted cubic spline analysis were used for data analysis. RESULTS Compared with the patients in the first quartiles of perceived control scores (0-16), those in the other 3 quartiles had a lower risk of depression (odds ratios of 0.29, 0.21, and 0.20, respectively; P < .05). Furthermore, a negative correlation between perceived control and depression (r = -0.317, P < .01) was observed. The restricted cubic spline analysis revealed an "L-shaped" curve relationship between perceived control and the presence of depression (P for nonlinear < .01). Compared with patients with a perceived control within the 5th percentile (10 scores), as the perceived control increased, the risk of depression rapidly decreased from "1" until it reached a threshold (20 scores) and stabilized. This trend remained consistent across the subgroups grouped by gender, age, New York Heart Association classification, and comorbidity burden. CONCLUSIONS Interventions targeting perceived control may hold valuable implications for reducing the risk of depression in patients with CHF, particularly those who have not yet reached the threshold.
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Kodur N, Tang WHW. Non-cardiac comorbidities in heart failure: an update on diagnostic and management strategies. Minerva Med 2024; 115:337-353. [PMID: 38899946 DOI: 10.23736/s0026-4806.24.09070-0] [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: 06/21/2024]
Abstract
Managing non-cardiac comorbidities in heart failure (HF) requires a tailored approach that addresses each patient's specific conditions and needs. Regular communication and coordination among healthcare providers is crucial to providing the best possible care for these patients. Poorly controlled hypertension contributes to left ventricular remodeling and diastolic dysfunction, emphasizing the importance of optimal blood pressure control while avoiding adverse effects. Among HF patients with diabetes, SGLT2 inhibitors and mineralocorticoid receptor antagonists have shown promise in reducing HF-related morbidity and mortality. Chronic kidney disease exacerbates HF and vice versa, forming the vicious cardiorenal syndrome, so disease-modifying therapies should be maintained in HF patients with comorbid CKD, even with transient changes in kidney function. Anemia in HF patients may be multifactorial, and there is growing evidence for the benefit of intravenous iron supplementation in HF patients with iron deficiency with or without anemia. Obesity, although a risk factor for HF, paradoxically offers a better prognosis once HF is established, though developing treatment strategies may improve symptoms and cardiac performance. In HF patients with stroke and atrial fibrillation, anticoagulation therapy is recommended. Among HF patients with sleep-disordered breathing, continuous positive airway pressure may improve sleep quality. Chronic obstructive pulmonary disease often coexists with HF, and many patients can tolerate cardioselective beta-blockers. Cancer patients with comorbid HF require careful consideration of cardiotoxicity risks associated with cancer therapies. Depression is underdiagnosed in HF patients and significantly impacts prognosis. Cognitive impairment is prevalent in HF patients and impacts their self-care and overall quality of life.
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Affiliation(s)
- Nandan Kodur
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - W H Wilson Tang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA -
- Center for Microbiome and Human Health, Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Varghese SM, Patel S, Nandan A, Jose A, Ghosh S, Sah RK, Menon B, K V A, Chakravarty S. Unraveling the Role of the Blood-Brain Barrier in the Pathophysiology of Depression: Recent Advances and Future Perspectives. Mol Neurobiol 2024:10.1007/s12035-024-04205-5. [PMID: 38730081 DOI: 10.1007/s12035-024-04205-5] [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: 08/03/2023] [Accepted: 04/19/2024] [Indexed: 05/12/2024]
Abstract
Depression is a highly prevalent psychological disorder characterized by persistent dysphoria, psychomotor retardation, insomnia, anhedonia, suicidal ideation, and a remarkable decrease in overall well-being. Despite the prevalence of accessible antidepressant therapies, many individuals do not achieve substantial improvement. Understanding the multifactorial pathophysiology and the heterogeneous nature of the disorder could lead the way toward better outcomes. Recent findings have elucidated the substantial impact of compromised blood-brain barrier (BBB) integrity on the manifestation of depression. BBB functions as an indispensable defense mechanism, tightly overseeing the transport of molecules from the periphery to preserve the integrity of the brain parenchyma. The dysfunction of the BBB has been implicated in a multitude of neurological disorders, and its disruption and consequent brain alterations could potentially serve as important factors in the pathogenesis and progression of depression. In this review, we extensively examine the pathophysiological relevance of the BBB and delve into the specific modifications of its components that underlie the complexities of depression. A particular focus has been placed on examining the effects of peripheral inflammation on the BBB in depression and elucidating the intricate interactions between the gut, BBB, and brain. Furthermore, this review encompasses significant updates on the assessment of BBB integrity and permeability, providing a comprehensive overview of the topic. Finally, we outline the therapeutic relevance and strategies based on BBB in depression, including COVID-19-associated BBB disruption and neuropsychiatric implications. Understanding the comprehensive pathogenic cascade of depression is crucial for shaping the trajectory of future research endeavors.
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Affiliation(s)
- Shamili Mariya Varghese
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, Kerala, 682 041, India
| | - Shashikant Patel
- Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad, Telangana, 500007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Amritasree Nandan
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, Kerala, 682 041, India
| | - Anju Jose
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, Kerala, 682 041, India
| | - Soumya Ghosh
- Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad, Telangana, 500007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Ranjay Kumar Sah
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, Kerala, 682 041, India
| | - Bindu Menon
- Department of Psychiatry, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, Kerala, 682 041, India
| | - Athira K V
- Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, Kerala, 682 041, India.
| | - Sumana Chakravarty
- Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Uppal Road, Hyderabad, Telangana, 500007, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India.
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Fraser M, Barnes SG, Barsness C, Beavers C, Bither CJ, Boettger S, Hallman C, Keleman A, Leckliter L, McIlvennan CK, Ozemek C, Patel A, Pierson NW, Shakowski C, Thomas SC, Whitmire T, Anderson KM. Nursing care of the patient hospitalized with heart failure: A scientific statement from the American Association of Heart Failure Nurses. Heart Lung 2024; 64:e1-e16. [PMID: 38355358 DOI: 10.1016/j.hrtlng.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Meg Fraser
- University of Minnesota MHealth Physicians, Minneapolis, MN, USA.
| | | | | | - Craig Beavers
- University of Kentucky College of Pharmacy, Lexington, KY, USA
| | | | | | | | - Anne Keleman
- MedStar Washington Section of Palliative Care, Washington, DC, USA
| | | | | | - Cemal Ozemek
- University of Illinois at Chicago, Cardiac Rehabilitation, College of Applied Health Sciences, Chicago, IL, USA
| | - Amit Patel
- Ascension St. Vincent Medical Group Cardiology, Indianapolis, IN, USA
| | - Natalie W Pierson
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Bekelman DB, Feser W, Morgan B, Welsh CH, Parsons EC, Paden G, Baron A, Hattler B, McBryde C, Cheng A, Lange AV, Au DH. Nurse and Social Worker Palliative Telecare Team and Quality of Life in Patients With COPD, Heart Failure, or Interstitial Lung Disease: The ADAPT Randomized Clinical Trial. JAMA 2024; 331:212-223. [PMID: 38227034 PMCID: PMC10792473 DOI: 10.1001/jama.2023.24035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 11/01/2023] [Indexed: 01/17/2024]
Abstract
Importance Many patients with chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) endure poor quality of life despite conventional therapy. Palliative care approaches may benefit this population prior to end of life. Objective Determine the effect of a nurse and social worker palliative telecare team on quality of life in outpatients with COPD, HF, or ILD compared with usual care. Design, Setting, and Participants Single-blind, 2-group, multisite randomized clinical trial with accrual between October 27, 2016, and April 2, 2020, in 2 Veterans Administration health care systems (Colorado and Washington), and including community-based outpatient clinics. Outpatients with COPD, HF, or ILD at high risk of hospitalization or death who reported poor quality of life participated. Intervention The intervention involved 6 phone calls with a nurse to help with symptom management and 6 phone calls with a social worker to provide psychosocial care. The nurse and social worker met weekly with a study primary care and palliative care physician and as needed, a pulmonologist, and cardiologist. Usual care included an educational handout developed for the study that outlined self-care for COPD, ILD, or HF. Patients in both groups received care at the discretion of their clinicians, which could include care from nurses and social workers, and specialists in cardiology, pulmonology, palliative care, and mental health. Main Outcomes and Measures The primary outcome was difference in change in quality of life from baseline to 6 months between the intervention and usual care groups (FACT-G score range, 0-100, with higher scores indicating better quality of life, clinically meaningful change ≥4 points). Secondary quality-of-life outcomes at 6 months included disease-specific health status (Clinical COPD Questionnaire; Kansas City Cardiomyopathy Questionnaire-12), depression (Patient Health Questionnaire-8) and anxiety (Generalized Anxiety Disorder-7) symptoms. Results Among 306 randomized patients (mean [SD] age, 68.9 [7.7] years; 276 male [90.2%], 30 female [9.8%]; 245 White [80.1%]), 177 (57.8%) had COPD, 67 (21.9%) HF, 49 (16%) both COPD and HF, and 13 (4.2%) ILD. Baseline FACT-G scores were similar (intervention, 52.9; usual care, 52.7). FACT-G completion was 76% (intervention, 117 of 154; usual care, 116 of 152) at 6 months for both groups. Mean (SD) length of intervention was 115.1 (33.4) days and included a mean of 10.4 (3.3) intervention calls per patient. In the intervention group, 112 of 154 (73%) patients received the intervention as randomized. At 6 months, mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care group (difference, 4.6 points [95% CI, 1.8-7.4]; P = .001; standardized mean difference, 0.41). The intervention also improved COPD health status (standardized mean difference, 0.44; P = .04), HF health status (standardized mean difference, 0.41; P = .01), depression (standardized mean difference, -0.50; P < .001), and anxiety (standardized mean difference, -0.51; P < .001) at 6 months. Conclusions and Relevance For adults with COPD, HF, or ILD who were at high risk of death and had poor quality of life, a nurse and social worker palliative telecare team produced clinically meaningful improvements in quality of life at 6 months compared with usual care. Trial Registration ClinicalTrials.gov Identifier: NCT02713347.
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Affiliation(s)
- David B. Bekelman
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - William Feser
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Brianne Morgan
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
| | - Carolyn H. Welsh
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Elizabeth C. Parsons
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
| | - Grady Paden
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Anna Baron
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Biostatistics and Informatics, Colorado School of Public Health, Anschutz Medical Campus, Aurora
| | - Brack Hattler
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Connor McBryde
- Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - Andrew Cheng
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle
| | - Allison V. Lange
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora
| | - David H. Au
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care Systems, Aurora, Colorado
- Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle
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Stallman HM, Lushington K, Varcoe TJ. Feasibility of a brief, in-patient coping and sleep intervention to reduce potentially preventable readmission of cardiac patients to hospital. Contemp Clin Trials Commun 2023; 36:101230. [PMID: 38034841 PMCID: PMC10684365 DOI: 10.1016/j.conctc.2023.101230] [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: 08/03/2023] [Revised: 10/16/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
Background Psychological distress is prevalent amongst hospital in-patient and may predispose patients to potentially preventable readmissions after discharge. A particularly vulnerable group are patients with cardiac disorders. This study tested the feasibility of a brief cognitive behavioural therapy consisting of an in-hospital coping session and a post-discharge healthy sleep session. Methods Standardised questionnaire were used to assess sleep, coping/distress and wellbeing at baseline (pre-intervention) and one-month post-discharge (post-intervention). Treatment fidelity and acceptability were assessed at follow-up. Participants included 72 inpatients admitted with a cardiac disorder or reported to have a cardiac problem whilst in hospital from a single Australian public hospital. Results Most (83 %) participants found the intervention helpful/very helpful. At baseline prior to admission, almost half of participants (46 %) reported poor wellbeing, 19 % high levels of distress and poor coping, and 47 % sleeping less than 7 h per night. Following the intervention, 45 % of participants with poor wellbeing at baseline had reliable change in wellbeing at follow-up. Conversely, only 22 % of patients with high levels of coping/distress at baseline demonstrated improved coping/distress at follow-up suggesting smaller gains. On average a large 43 min gain in sleep duration was observed post-treatment in patients with poor sleep at baseline. Fourteen percent of participants were readmitted to hospital within 34-days of discharge. Conclusions The coping and sleep intervention was well received with positive outcomes in patients especially those reporting high levels of distress for sleep and to lesser extent coping and wellbeing. Future studies to assess the efficacy of the brief intervention at reducing hospital readmissions are needed.
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Affiliation(s)
- Helen M. Stallman
- South Australian Medical and Health Research Institute, Adelaide, South Australia, 5000, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, South Australia, Australia
| | - Kurt Lushington
- Justice and Society, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - Tamara J. Varcoe
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, South Australia, Australia
- Justice and Society, University of South Australia, Adelaide, South Australia, 5000, Australia
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13
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Zhang L, Li G, Liu M. A meta-analysis on the association between SSRIs and blood pressure in patients with CVD and depression. J Affect Disord 2023; 340:181-188. [PMID: 37557986 DOI: 10.1016/j.jad.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 07/01/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE This meta-analysis aimed to explore the association between selective serotonine reuptake inhibitors (SSRIs) and blood pressure in patients with cardiovascular disease (CVD) and depression. METHOD This study was registered on PROSPERO (CRD42022368655) and conducted in accordance with PRISMA 2020. The databases included PubMed, Web of Science, and EMBASE. The inclusion date was from the inception date through Oct. 26, 2022.Review Manager version 5.3 and Stata version 12.0 were used for data analysis. RESULTS This meta-analysis included six studies, and a total number of 149 patients with CVD and depression . In the group analysis, SSRIs treatment had no effect on the systolic blood pressure (SBP) (MD = 1.01, 95%CI:-2.88, 4.90, P = 0.61) and diastolic blood pressure (DBP) (MD = 0.64, 95%CI:-1.03, 2.31, P = 0.45). In the subgroup analysis, SSRIs treatment had no effect on SBP for patients with hypertension (MD = -8.02, 95%CI:-16.84, 0.81, P = 0.08), and patients with other CVD (MD = 3.18, 95%CI:-1.15, 7.52, P = 0.15). For patients with hypertension, SSRIs treatment significantly lowered DBP (MD = -5.75, 95%CI:-10.84, -0.67, P = 0.03). But SSRIs treatment had no impact on DBP for patients with other CVD (MD = 1.41, 95%CI:-0.36, 3.18, P = 0.12). Subgroup analysis of the treatment period and the country had no significant impact on SBP and DBP. In the sensitivity analysis, there was no significant change after omitting one study in both SBP and DBP group analysis. Egger's test showed no publication bias of SBP (P = 0.183) and DBP group analysis (P = 0.392). CONCLUSION SSRIs help to lower DBP in hypertensive patients with depression. The potential pathophysiological mechanisms may lie in serotonin function, sympathetic activation and genetic heterogeneity. Further clinic and experimental researches need to be conducted on SSRIs and blood pressure.
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Affiliation(s)
- Lijun Zhang
- Department of Psycho-cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Guo Li
- Department of Psycho-cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Meiyan Liu
- Department of Psycho-cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
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14
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Leo DG, Islam U, Lotto RR, Lotto A, Lane DA. Psychological interventions for depression in adolescent and adult congenital heart disease. Cochrane Database Syst Rev 2023; 10:CD004372. [PMID: 37787122 PMCID: PMC10546482 DOI: 10.1002/14651858.cd004372.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
BACKGROUND Despite improvements in medical care, the quality of life of adults and adolescents with congenital heart disease remains strongly affected by their condition, often leading to depression. Psychotherapy, cognitive behavioural therapy, and other talking therapies may be effective in treating depression in both adults and young adults with congenital heart disease. The aim of this review was to assess the effects of treatments, such as psychotherapy, cognitive behavioural therapies, and talking therapies for treating depression in this population. OBJECTIVES To evaluate the effects (both harms and benefits) of psychological interventions for reducing symptoms of depression in adolescents (aged 10 to 17 years) and adults with congenital heart disease. Psychological interventions include cognitive behavioural therapy, psychotherapy, or 'talking/counselling' therapy for depression. SEARCH METHODS We updated searches from the 2013 Cochrane Review by searching CENTRAL, four other databases, and Conference Proceedings Citation Index to 7 March 2023, and two clinical trial registers to February 2021. We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychological interventions to no intervention in the congenital heart disease population, aged 10 years and older, with depression. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts, and independently assessed full-text reports for inclusion. Further information was sought from the authors if needed. Data were extracted in duplicate. We used standard Cochrane methods. Our primary outcome was a change in depression. Our secondary outcomes were: acceptability of treatment, quality of life, hospital re-admission, non-fatal cardiovascular events, cardiovascular behavioural risk factor, health economics, cardiovascular mortality, all-cause mortality. We used GRADE to assess the certainty of evidence for our primary outcome only. MAIN RESULTS We identified three new RCTs (480 participants). Participants were adults with congenital heart disease. Included studies varied in intervention length (90 minutes to 3 months) and follow-up (3 to 12 months), with depression assessed post-intervention and at follow-up. Risk of bias assessment identified an overall low risk of bias for the main outcome of depression. Psychological interventions (talking/counselling therapy) may reduce depression more than usual care at both three-month (mean difference (MD) -1.07, 95% confidence interval (CI) -1.84 to -0.30; P = 0.006; I2 = 0%; 2 RCTs, 156 participants; low-certainty evidence), and 12-month follow-up (MD -1.02, 95% CI -1.92 to -0.13; P = 0.02; I2 = 0%; 2 RCTs, 287 participants; low-certainty evidence). There was insufficient evidence to draw conclusions about the impact of psychological interventions on quality of life. None of the included studies reported on our other outcomes of interest. Due to the low number of studies included, we did not undertake any subgroup analyses. One study awaits classification. AUTHORS' CONCLUSIONS Psychological interventions may reduce depression in adults with congenital heart disease compared to usual care. However, the certainty of the evidence is low. Further research is needed to establish the role of psychological interventions in this population, defining the optimal duration, method of administration, and number of sessions required to obtain the greatest benefit.
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Affiliation(s)
- Donato Giuseppe Leo
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Umar Islam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Robyn R Lotto
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Attilio Lotto
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool, UK
- Department of Paediatric Cardiac Surgery, Alder Hey Children's Hospital, Liverpool, UK
| | - Deirdre A Lane
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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15
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Roy R, Mayer MM, Dzekem BS, Laiteerapong N. Screening for Emotional Distress in Patients with Cardiovascular Disease. Curr Cardiol Rep 2023; 25:1165-1174. [PMID: 37610597 DOI: 10.1007/s11886-023-01936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW In this article, we discuss the relationship between emotional distress and common cardiovascular disease condition, including coronary artery disease, atrial fibrillation, congestive heart failure, mechanical circulatory support, and heart transplant. We review screening measures that have been studied and used in clinical practice for each condition, as well as priorities for future research. RECENT FINDINGS Studies consistently demonstrate failing to identify and treat emotional distress in patients with cardiovascular disease is associated with adverse outcomes. However, routine emotional distress screening is not formally recommended for all cardiovascular disease conditions and is limited to depression screening in select patient populations. Future research should focus on evaluating the validity and reliability of standardized screening measures across the scope of emotional distress in patients with or at risk for cardiovascular disease. Other areas of future research include implementation of evidence-based pharmaceutical treatments and integrated behavioral health approaches and interventions.
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Affiliation(s)
- Rukmini Roy
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Michael M Mayer
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Bonaventure S Dzekem
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA
| | - Neda Laiteerapong
- Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Avenue, MC 3051, Chicago, IL 60637, USA.
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16
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Berk M, Köhler-Forsberg O, Turner M, Penninx BWJH, Wrobel A, Firth J, Loughman A, Reavley NJ, McGrath JJ, Momen NC, Plana-Ripoll O, O'Neil A, Siskind D, Williams LJ, Carvalho AF, Schmaal L, Walker AJ, Dean O, Walder K, Berk L, Dodd S, Yung AR, Marx W. Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management. World Psychiatry 2023; 22:366-387. [PMID: 37713568 PMCID: PMC10503929 DOI: 10.1002/wps.21110] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
Populations with common physical diseases - such as cardiovascular diseases, cancer and neurodegenerative disorders - experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug-drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic-pituitary-adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio-environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.
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Affiliation(s)
- Michael Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Megan Turner
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Brenda W J H Penninx
- Department of Psychiatry and Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anna Wrobel
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Loughman
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Nicola J Reavley
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - John J McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Dan Siskind
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Andre F Carvalho
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lianne Schmaal
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Orygen, Parkville, VIC, Australia
| | - Adam J Walker
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Olivia Dean
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ken Walder
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Lesley Berk
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Seetal Dodd
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Wolfgang Marx
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, Geelong, VIC, Australia
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Freedland KE, Skala JA, Carney RM, Steinmeyer BC, Rich MW. Treatment of depression and inadequate self-care in patients with heart failure: One-year outcomes of a randomized controlled trial. Gen Hosp Psychiatry 2023; 84:82-88. [PMID: 37406374 DOI: 10.1016/j.genhosppsych.2023.06.001] [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: 04/19/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Both depression and inadequate self-care are common in patients with heart failure. This secondary analysis examines the one-year outcomes of a randomized controlled trial of a sequential approach to treating these problems. METHODS Patients with heart failure and major depression were randomly assigned to usual care (n = 70) or to cognitive behavior therapy (n = 69). All patients received a heart failure self-care intervention starting 8 weeks after randomization. Patient-reported outcomes were assessed at Weeks 8, 16, 32, and 52. Data on hospital admissions and deaths were also obtained. RESULTS One year after randomization, Beck Depression Inventory (BDI-II) scores were - 4.9 (95% C.I., -8.9 to -0.9; p < .05) points lower in the cognitive therapy than the usual care arm, and Kansas City Cardiomyopathy scores were 8.3 (95% C.I., 1.9 to 14.7; p < .05) points higher. There were no differences on the Self-Care of Heart Failure Index or in hospitalizations or deaths. CONCLUSIONS The superiority of cognitive behavior therapy relative to usual care for major depression in patients with heart failure persisted for at least one year. Cognitive behavior therapy did not increase patients' ability to benefit from a heart failure self-care intervention, but it did improve HF-related quality of life during the follow-up period. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02997865.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America.
| | - Judith A Skala
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America
| | - Robert M Carney
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America
| | - Brian C Steinmeyer
- Department of Psychiatry, 4320 Forest Park Avenue, Suite 301, St. Louis, MO 63108, United States of America
| | - Michael W Rich
- Cardiovascular Division of the Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
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18
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Shan Y, Chen J, Zhou S, Wen G. Nursing Interventions and Care Strategies for Patients with Coronary Heart Disease: A Comprehensive Review. Galen Med J 2023; 12:1-13. [PMID: 38774841 PMCID: PMC11108677 DOI: 10.31661/gmj.v12i0.2994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 05/24/2024] Open
Abstract
Cardiovascular diseases are a major cause of death worldwide, and coronary heart disease (CHD) is a prevalent cardiovascular condition and a significant health burden for the population. In this disease, insufficient blood flow to the heart due to plaque accumulation in the coronary arteries causes chest pain, heart attack, and even death. So, it is vital to identify risk factors, prevention, appropriate treatment, and rehabilitation. Nurses play an indispensable role in managing and caring for patients with CHD. Indeed, they possess a deep understanding of the disease and its complexities, enabling them to provide comprehensive care to patients. Nurses monitor vital signs, administer medications, and perform diagnostic tests, ensuring patients receive timely and appropriate interventions. They also educate patients and their families about CHD, emphasizing lifestyle modifications, medication adherence, and self-care practices. Moreover, nurses offer emotional support, guiding patients through the physical and psychological challenges associated with CHD. Their expertise, compassion, and dedication significantly improve patient outcomes and overall quality of life. Nurses are responsible for assessing, diagnosing, and counseling patients on how to manage their disease, making them the front line of defense in preventing and addressing this serious condition. In the current study, we reviewed the literature to consider the best practices and emerging trends in nursing interventions and care strategies for patients with CHD.
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Affiliation(s)
- Yangyan Shan
- Department of Hemodialysis Room, Funan County Hospital of Traditional Chinese
Medicine, Funan, Anhui 236300, China
| | - Jun Chen
- Department of Hemodialysis Room, Funan County Hospital of Traditional Chinese
Medicine, Funan, Anhui 236300, China
| | - Siwen Zhou
- Department of Hemodialysis Room, Funan County Hospital of Traditional Chinese
Medicine, Funan, Anhui 236300, China
| | - Guangxue Wen
- Department of Nephrology, Funan County Hospital of Traditional Chinese Medicine,
Funan, Anhui 236300, China
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19
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Zhamaliyeva LM, Zhamankulova DG, Abenova NA, Koshmaganbetova GK. Educational Intervention Effects on Depression and Anxiety in Patients after Myocardial Infarction: A Randomized Controlled Trial. J Cardiovasc Dev Dis 2023; 10:267. [PMID: 37504523 PMCID: PMC10380402 DOI: 10.3390/jcdd10070267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/07/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
Depression and anxiety in cardiovascular disease worsen the prognosis of patients. Treatments for these disorders often provide limited improvement. The present study aimed to test, for the first time, the impact of educational technology on anxiety and depressive symptoms in patients participating in a cardiac rehabilitation program. A 12-month randomized controlled trial was conducted, in which 207 patients were randomly assigned to either the experimental (n = 76) or control (n = 69) groups. The intervention involved a structured patient education program provided by medical students who had undergone specially designed training in cardiac rehabilitation. The primary outcomes were death, hospitalization, heart failure, and recurrent myocardial infarction. The study also assessed anxiety and depression. A year later, the experimental group showed a statistically significant decrease in anxiety and depression on the HADS scale, with reductions of 2.0 and 1.9 points, respectively (p < 0.05). The control group showed reductions of 1.5 and 1.2 points (p < 0.05). The difference in the Hamilton Rating Scale for Depression between the groups at 12 months was -1.29 in favor of the main group (95% CI, -0.7 to -1.88), and the standardized mean difference was 0.36 (95% CI, 0.03 to 0.69). No treatment-related adverse events were observed. The results suggest that educational interventions can have a positive impact on mental health. The study's strengths include a structured intervention, randomization, and long-term follow-up. The limitations include the lack of blinding of study participants and a relatively small sample size.
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Affiliation(s)
- Lazzat M Zhamaliyeva
- Department of Family Medicine, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Damira G Zhamankulova
- Department of Internal Diseases, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Nurgul A Abenova
- Department of General Practice 1, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
| | - Gulbakit K Koshmaganbetova
- Department of Master's and Doctoral Studies, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan
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20
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Costa T, Bagnall A, Murray S, Bailey K, MacGowan G, Ng WF, McKinnon I, Watson S, McAllister-Williams RH. Role of autonomic dysregulation in quality of life and functional impairment in implantable cardioverter defibrillator patients. J Psychosom Res 2023; 171:111390. [PMID: 37270908 DOI: 10.1016/j.jpsychores.2023.111390] [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] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Tiago Costa
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom.
| | - Alan Bagnall
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Stephen Murray
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Kristian Bailey
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom
| | - Guy MacGowan
- Newcastle Cardiovascular Trials and Research, Newcastle upon Tyne Hospitals NHS Foundation Trust, Cardiovascular Research, Room 122F, Education Centre, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Department of Cardiology, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Catherine Cookson Building, Newcastle upon Tyne NE2 4HH, United Kingdom; NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Iain McKinnon
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom; Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Stuart Watson
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom
| | - R Hamish McAllister-Williams
- Translational and Clinical Research Institute, Faculty of Medical Sciences, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, United Kingdom; Northern Centre for Mood Disorders, Wolfson Research Centre, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, St. Nicholas Hospital, Jubilee Road, Gosforth, Newcastle upon Tyne NE3 3XT, United Kingdom
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21
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Lichter K, Klüpfel C, Stonawski S, Hommers L, Blickle M, Burschka C, Das F, Heißler M, Hellmuth A, Helmel J, Kranemann L, Lechner K, Lehrieder D, Sauter A, Schiele MA, Vijayakumar V, von Broen M, Weiß C, Morbach C, Störk S, Gelbrich G, Heuschmann PU, Higuchi T, Buck A, Homola GA, Pham M, Menke A, Domschke K, Kittel-Schneider S, Deckert J. Deep phenotyping as a contribution to personalized depression therapy: the GEParD and DaCFail protocols. J Neural Transm (Vienna) 2023; 130:707-722. [PMID: 36959471 PMCID: PMC10121520 DOI: 10.1007/s00702-023-02615-8] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/27/2023] [Indexed: 03/25/2023]
Abstract
Depressive patients suffer from a complex of symptoms of varying intensity compromising their mood, emotions, self-concept, neurocognition, and somatic function. Due to a mosaic of aetiologies involved in developing depression, such as somatic, neurobiological, (epi-)genetic factors, or adverse life events, patients often experience recurrent depressive episodes. About 20-30% of these patients develop difficult-to-treat depression. Here, we describe the design of the GEParD (Genetics and Epigenetics of Pharmaco- and Psychotherapy in acute and recurrent Depression) cohort and the DaCFail (Depression-associated Cardiac Failure) case-control protocol. Both protocols intended to investigate the incremental utility of multimodal biomarkers including cardiovascular and (epi-)genetic markers, functional brain and heart imaging when evaluating the response to antidepressive therapy using comprehensive psychometry. From 2012 to 2020, 346 depressed patients (mean age 45 years) were recruited to the prospective, observational GEParD cohort protocol. Between 2016 and 2020, the DaCFail case-control protocol was initiated integrating four study subgroups to focus on heart-brain interactions and stress systems in patients > 50 years with depression and heart failure, respectively. For DaCFail, 120 depressed patients (mean age 60 years, group 1 + 2), of which 115 also completed GEParD, and 95 non-depressed controls (mean age 66 years) were recruited. The latter comprised 47 patients with heart failure (group 3) and 48 healthy subjects (group 4) of a population-based control group derived from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study. Our hypothesis-driven, exploratory study design may serve as an exemplary roadmap for a standardized, reproducible investigation of personalized antidepressant therapy in an inpatient setting with focus on heart comorbidities in future multicentre studies.
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Affiliation(s)
- Katharina Lichter
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Catherina Klüpfel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | - Saskia Stonawski
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | - Leif Hommers
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Interdisciplinary Center for Clinical Research, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | - Manuel Blickle
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
| | - Carolin Burschka
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Felix Das
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Marlene Heißler
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Anna Hellmuth
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Jaqueline Helmel
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Leonie Kranemann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Karin Lechner
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Dominik Lehrieder
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Amelie Sauter
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hauptstr. 5, 79104, Freiburg, Germany
| | - Vithusha Vijayakumar
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Michael von Broen
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Carolin Weiß
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Caroline Morbach
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Medicine I, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Stefan Störk
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Medicine I, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Götz Gelbrich
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- Clinical Trial Center, University Hospital of Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- Clinical Trial Center, University Hospital of Würzburg, Würzburg, Germany
| | - Takahiro Higuchi
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center (CHFC), University Hospital of Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - György A Homola
- Department of Neuroradiology, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Mirko Pham
- Department of Neuroradiology, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andreas Menke
- Department of Psychosomatic Medicine and Psychotherapy, Medical Park Chiemseeblick, Rathausstr. 25, 83233, Bernau am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Nußbaumstr. 7, 80336, Munich, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hauptstr. 5, 79104, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Margarete-Höppel-Platz 1, 97080, Würzburg, Germany.
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22
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Islam KF, Awal A, Mazumder H, Munni UR, Majumder K, Afroz K, Tabassum MN, Hossain MM. Social cognitive theory-based health promotion in primary care practice: A scoping review. Heliyon 2023; 9:e14889. [PMID: 37025832 PMCID: PMC10070720 DOI: 10.1016/j.heliyon.2023.e14889] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Background Using a theoretical perspective to guide research design and implementation can result in a coherent preventative intervention model. Among theoretical frameworks, Bandura's Social Cognitive Theory (SCT) is particularly useful for studies focused on behavior change in health promotion research. Objective This scoping review explored and summarized the current evidence on health promotion interventions that integrated constructs of Social Cognitive Theory and the outcome of those interventions in primary care settings. Method ology: We conducted this scoping review using the PRISMA scoping review guidelines; we reviewed articles from five electronic databases and additional sources that were peer-reviewed journal articles reporting interventions applying SCT constructs and synthesized the outcomes following the interventions. Results Among 849 retrieved from multiple sources, 39 articles met our eligibility criteria. Most studies (n = 19) were conducted in the United States. Twenty-six studies followed a randomized control trial design. Most studies (n = 26) recruited participants utilizing the primary care network. All 39 studies mentioned "self-efficacy" as the most utilized construct of SCT to determine how behavior change operates, followed by "observational learning" through role models. Twenty-three studies integrated individual (face-to-face) or peered group-based counseling-training programs; eight interventions used telephonic health coaching by a specialist; eight studies used audio-visual mediums. All included studies reported positive health outcomes following the intervention, including increased self-reported moderate-to-vigorous physical activity, increased Knowledge of dietary intake, high-risk behaviors such as STIs transmission, adapting to a healthy lifestyle, and adherence to post-transplant medication. Conclusion Current evidence suggests that SCT-based interventions positively impact health outcomes and intervention effectiveness. The results of this study indicate the importance of incorporating and assessing several conceptual structures of behavioral theories when planning any primary care health promotion practice.
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23
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Vencloviene J, Beresnevaite M, Cerkauskaite S, Lopatiene K, Grizas V, Benetis R. The effects of weather on depressive symptoms in patients after cardiac surgery. PSYCHOL HEALTH MED 2023; 28:682-692. [PMID: 36203385 DOI: 10.1080/13548506.2022.2132411] [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: 10/10/2022]
Abstract
Patients with cardiovascular disease have depression more often than the general population does. The aim of the study was to detect the associations between the psychological state and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The prospective study was performed during 2008-2012 in Kaunas, Lithuania. The psychological state of 233 patients was assessed by using the Symptom Checklist-90-Revised instrument. The assessment was carried out at 1.5 months, 1 year, and 2 years after the surgery. A sample of 531 measurements of psychological states was used. To investigate the relationships between psychological scores and daily weather variables, a mixed linear model was used adjusting for sex, the type of surgery, age, the marital status, the presence of arterial hypertension, diabetes, major depressive disorders, dysthymic disorders, agoraphobia, smoking before surgery, and myocardial infarction in the anamnesis. The mean somatisation score and air temperature on the second day prior to the survey were found to have a negative correlation in the multivariate model. Lower mean scores of anxiety and depression were linked to hotter days (air temperature >16.25°C on the second day) that did not occur in July or August. During colder days (air temperature <0.35°C), a higher mean score of anxiety and phobic anxiety was observed. A higher mean score of somatizations, depression, and anxiety was seen on the second day after the day with wind speed ≤2.85 kt and on the day after the day with relative humidity <66%. Both a decrease and an increase in daily atmospheric pressure were associated with a higher depression score. Our results confirm that among patients after open heart surgery, psychosomatic complaints are related to some weather changes. The obtained results can help to determine the complexity of weather patterns linked to poorer psychological health.
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Affiliation(s)
- Jone Vencloviene
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.,Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Sonata Cerkauskaite
- Department of Environmental Sciences, Vytautas Magnus University, Kaunas, Lithuania.,Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Lopatiene
- Department of Orthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytautas Grizas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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24
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Gallego P. Addressing comorbidities in simple congenital heart disease: a critical step to achieve optimal long-term outcomes. Eur Heart J 2023; 44:749-751. [PMID: 36638775 DOI: 10.1093/eurheartj/ehac819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto BioMedicina, CIBERCV, Avenida Manuel Siurot s/n, Sevilla 41013, Spain.,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD Heart)
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25
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Adekkanattu P, Olfson M, Susser LC, Patra B, Vekaria V, Coombes BJ, Lepow L, Fennessy B, Charney A, Ryu E, Miller KD, Pan L, Yangchen T, Talati A, Wickramaratne P, Weissman M, Mann J, Biernacka JM, Pathak J. Comorbidity and healthcare utilization in patients with treatment resistant depression: A large-scale retrospective cohort analysis using electronic health records. J Affect Disord 2023; 324:102-113. [PMID: 36529406 PMCID: PMC10327872 DOI: 10.1016/j.jad.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Medical comorbidity and healthcare utilization in patients with treatment resistant depression (TRD) is usually reported in convenience samples, making estimates unreliable. There is only limited large-scale clinical research on comorbidities and healthcare utilization in TRD patients. METHODS Electronic Health Record data from over 3.3 million patients from the INSIGHT Clinical Research Network in New York City was used to define TRD as initiation of a third antidepressant regimen in a 12-month period among patients diagnosed with major depressive disorder (MDD). Age and sex matched TRD and non-TRD MDD patients were compared for anxiety disorder, 27 comorbid medical conditions, and healthcare utilization. RESULTS Out of 30,218 individuals diagnosed with MDD, 15.2 % of patients met the criteria for TRD (n = 4605). Compared to MDD patients without TRD, the TRD patients had higher rates of anxiety disorder and physical comorbidities. They also had higher odds of ischemic heart disease (OR = 1.38), stroke/transient ischemic attack (OR = 1.57), chronic kidney diseases (OR = 1.53), arthritis (OR = 1.52), hip/pelvic fractures (OR = 2.14), and cancers (OR = 1.41). As compared to non-TRD MDD, TRD patients had higher rates of emergency room visits, and inpatient stays. In relation to patients without MDD, both TRD and non-TRD MDD patients had significantly higher levels of anxiety disorder and physical comorbidities. LIMITATIONS The INSIGHT-CRN data lack information on depression severity and medication adherence. CONCLUSIONS TRD patients compared to non-TRD MDD patients have a substantially higher prevalence of various psychiatric and medical comorbidities and higher health care utilization. These findings highlight the challenges of developing interventions and care coordination strategies to meet the complex clinical needs of TRD patients.
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Affiliation(s)
| | - Mark Olfson
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | | | | | | | | | - Lauren Lepow
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Fennessy
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Lifang Pan
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Tenzin Yangchen
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Ardesheer Talati
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Priya Wickramaratne
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Myrna Weissman
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - John Mann
- Columbia University and New York State Psychiatric Institute, New York, NY, USA
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26
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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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27
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Manolis TA, Manolis AA, Melita H, Manolis AS. Neuropsychiatric disorders in patients with heart failure: not to be ignored. Heart Fail Rev 2022:10.1007/s10741-022-10290-2. [DOI: 10.1007/s10741-022-10290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
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28
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Nochaiwong S, Ruengorn C, Awiphan R, Chai-Adisaksopha C, Tantraworasin A, Phosuya C, Kanjanarat P, Chongruksut W, Sood MM, Thavorn K. Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis. Ann Med 2022; 54:80-97. [PMID: 34955074 PMCID: PMC8725830 DOI: 10.1080/07853890.2021.2017474] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Serotonin reuptake inhibitor (SRI) antidepressants are implicated in increasing the risk of bleeding among users; however, the comparative increase in bleeding risk with concurrent antithrombotic therapy (anticoagulant or antiplatelet) remains unclear. As such, we performed a systematic review and meta-analysis of all available evidence to evaluate the effects of SRI and the risk of bleeding complications among patients receiving antithrombotic therapy. METHODS We searched Medline, Embase, PubMed, PsycINFO, Cochrane Library, Web of Science, Scopus, CINAHL, and grey literature (Google Scholar and preprint reports) up to 26 November, 2020, with no language restrictions (updated on 31 July 2021). The primary outcome of interest was major bleeding. Secondary outcomes included intracranial haemorrhage, gastrointestinal bleeding, and any bleeding events. We used a random-effects model meta-analysis to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS We did not identify any randomised studies but found 32 non-randomized studies (cohort or case-control) with 1,848,285 patients that fulfilled the study selection criteria and were included in the meta-analysis. Among individuals receiving anticoagulants (13 studies), SRI users experienced a statistically higher risk of major bleeding compared to non-SRI users: pooled OR was 1.39 (95% CI, 1.23-1.58; p < .001; moderate heterogeneity). Among individuals receiving antiplatelet therapy (2 studies), SRI users were associated with an increased risk of major bleeding: pooled OR was 1.45 (95% CI, 1.17-1.80; p = .001; low heterogeneity). For secondary outcomes, the use of SRI among individuals treated with antithrombotic therapy revealed a higher risk of gastrointestinal bleeding or any bleeding events, whereas only anticoagulant use was illustrated an increased risk of intracranial haemorrhage. CONCLUSIONS The use of SRI antidepressants among patients treated with antithrombotic therapy (either anticoagulant or antiplatelet) is associated with a higher risk of bleeding complications, suggesting that caution is warranted in co-prescription. PROSPERO REGISTRATION CRD42018083917KEY MESSAGESIn this meta-analysis of 32 non-randomized studies, SRI users were associated with the risk of bleeding complications compared to non-SRI users, with concurrent antithrombotic use (either anticoagulant or antiplatelet).The risk was consistently elevated across types of bleeding events (major bleeding, gastrointestinal bleeding, or any bleeding events), whereas only anticoagulant use was associated with intracranial haemorrhage.To promote the rational use of medicines, our findings suggest that the risk-benefit ratio must account for the clear efficacy of SRI against safety concerns in terms of bleeding risks.
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Affiliation(s)
- Surapon Nochaiwong
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Ratanaporn Awiphan
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Chatree Chai-Adisaksopha
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Tantraworasin
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chabaphai Phosuya
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Penkarn Kanjanarat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Wilaiwan Chongruksut
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Manish M Sood
- Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Canada.,Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Kednapa Thavorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Bellon J, Quinlan C, Taylor B, Nemecek D, Borden E, Needs P. Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US. JAMA Netw Open 2022; 5:e2244644. [PMID: 36472875 PMCID: PMC9856223 DOI: 10.1001/jamanetworkopen.2022.44644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Outpatient behavioral health treatment (OPBHT) is an effective treatment for behavioral health conditions (BHCs) that may also be associated with improved medical health outcomes, but evidence regarding the cost-effectiveness of OPBHT across a large population has not been established. OBJECTIVE To investigate whether individuals newly diagnosed with a BHC who used OPBHT incurred lower medical and pharmacy costs over 15 and 27 months of follow-up compared with those not using OPBHT. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of commercially insured individuals in the US was conducted using administrative insurance claims data for individuals newly diagnosed with 1 or more BHCs between January 1, 2017, and December 31, 2018. Data were examined using a 12-month period before BHC diagnosis and 15- and 27-month follow-up periods. Participants included individuals aged 1 to 64 years who received any OPBHT with or without behavioral medication or who did not receive OPBHT or behavioral medication in the 15 months following diagnosis. Data were analyzed from May to October 2021. EXPOSURES Receipt of OPBHT both as a dichotomous variable and categorized by number of OPBHT visits. MAIN OUTCOMES AND MEASURES The main outcome was the association between OPBHT treatment and 15- and 27-month medical and pharmacy costs, assessed using a generalized linear regression model with γ distribution, controlling for potential confounders. RESULTS The study population included 203 401 individuals, of whom most were male (52%), White, non-Hispanic (75%), and 18 to 64 years of age (67%); 22% had at least 1 chronic medical condition in addition to a BHC. Having 1 or more OPBHT visits was associated with lower adjusted mean per-member, per-month medical and pharmacy costs across follow-up over 15 months (no OPBHT: $686 [95% CI, $619-$760]; ≥1 OPBHT: $571 [95% CI, $515-$632]; P < .001) and 27 months (no OPBHT: $464 [95% CI, $393-$549]; ≥1 OPBHT: $391 [95% CI, $331-$462]; P < .001). Furthermore, almost all doses of OPBHT across the 15 months following diagnosis were associated with lower costs compared with no OPBHT. CONCLUSIONS AND RELEVANCE In this cohort study, medical cost savings were associated with OPBHT among patients newly diagnosed with a BHC in a large, commercially insured population. The findings suggest that promoting and optimizing OPBHT may be associated with reduced overall medical spending among patients with BHCs.
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Affiliation(s)
| | | | | | | | - Eva Borden
- Evernorth Health, Inc, St Louis, Missouri
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30
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Reuter K, Genao K, Callanan EM, Cannone DE, Giardina EG, Rollman BL, Singer J, Slutzky AR, Ye S, Duran AT, Moise N. Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy. Circ Cardiovasc Qual Outcomes 2022; 15:e009338. [PMID: 36378766 PMCID: PMC9909565 DOI: 10.1161/circoutcomes.122.009338] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Depression leads to poor health outcomes in patients with coronary heart disease (CHD). Despite guidelines recommending screening and treatment of depressed patients with CHD, few patients receive optimal care. We applied behavioral and implementation science methods to (1) identify generalizable, multilevel barriers to depression screening and treatment in patients with CHD and (2) develop a theory-informed, multilevel implementation strategy for promoting guideline adoption. METHODS We conducted a narrative review of barriers to depression screening and treatment in patients with CHD (ie, medications, exercise, cardiac rehabilitation, or therapy) comprising data from 748 study participants. Informed by the behavior change wheel framework and Expert Recommendations for Implementing Change, we defined multilevel target behaviors, characterized determinants (capability, opportunity, motivation), and mapped barriers to feasible, acceptable, and equitable intervention functions and behavior change techniques to develop a multilevel implementation strategy, targeting health care systems/providers and patients. RESULTS We identified implementation barriers at the system/provider level (eg, Capability: knowledge; Opportunity: workflow integration; Motivation: ownership) and patient level (eg, Capability: knowledge; Opportunity: mobility; Motivation: symptom denial). Acceptable, feasible, and equitable intervention functions included education, persuasion, environmental restructuring, and enablement. Expert Recommendations for Implementing Change strategies included learning collaborative, audit, feedback, and educational materials. The final multicomponent strategy (iHeart DepCare) for promoting depression screening/treatment included problem-solving meetings with clinic staff (system); educational/motivational videos, electronic health record reminders/decisional support (provider); and a shared decision-making (electronic shared decision-making) tool with several functions for patients, for example, patient activation, patient treatment selection support. CONCLUSIONS We applied implementation and behavioral science methods to identify implementation barriers and to develop a multilevel implementation strategy for increasing uptake of depression screening and treatment in patients with CHD as a use case. The multilevel implementation strategy will be evaluated in a future hybrid II effectiveness-implementation trial.
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Affiliation(s)
- Katja Reuter
- Department of Medicine, SUNY Upstate Medical University, New York, USA
| | - Kirali Genao
- Columbia University Irving Medical Center, New York, USA
| | | | | | - Elsa-Grace Giardina
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Bruce L. Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jessica Singer
- Columbia University Irving Medical Center, New York, USA
| | - Amy R. Slutzky
- Health Sciences Library, SUNY Upstate Medical University, New York, USA
| | - Siqin Ye
- Columbia University Irving Medical Center, New York, USA
| | | | - Nathalie Moise
- Columbia University Irving Medical Center, New York, USA
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31
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Gutlapalli SD, Pu J, Zaidi MF, Patel M, Atluri LM, Gonzalez NA, Sakhamuri N, Athiyaman S, Randhi B, Penumetcha SS. The Significance of Sleep Disorders in Post-myocardial Infarction Depression. Cureus 2022; 14:e30899. [DOI: 10.7759/cureus.30899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
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Shen R, Zhao N, Wang J, Guo P, Shen S, Liu D, Zou T. Association between level of depression and coronary heart disease, stroke risk and all-cause and cardiovascular mortality: Data from the 2005-2018 National Health and Nutrition Examination Survey. Front Cardiovasc Med 2022; 9:954563. [PMID: 36386369 PMCID: PMC9643716 DOI: 10.3389/fcvm.2022.954563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/30/2022] [Indexed: 08/24/2023] Open
Abstract
Research on the association between level of depression and coronary heart disease (CHD), stroke risk, and all-cause and cardiovascular mortality is lacking in large-scale or population-based studies incorporating cardiovascular disease (CVD) endpoints. We aim to assess the relationship between the level of a person's depression and their risk of CHD, stroke, and all-cause and cardiovascular mortality. Utilizing data from the United States National Health and Nutrition Examination Survey (NHANES), multicycle cross-sectional design and mortality linkage studies were conducted. The study sample included 30918 participants aged 20-85 years old during the 2005-2018 period. Depression was assessed using the nine-item Patient Health Questionnaire (PHQ-9), with scores of 5, 10, 15, and 20 being the cut-off points for mild, moderate, moderately severe, and severe depression, respectively. A series of weighted logistic regression analyses and Cox proportional hazards models were utilized to examine the relationship between the level of depression with the risk of CHD, stroke, all-cause, and cardiovascular mortality. Trend analyses were conducted by entering the level of depression as a continuous variable and rerunning the corresponding regression models. Weighted logistic regression models consistently indicated a statistically significant association between the level of depression and increased risk of CHD and stroke, and those linear trend tests were statistically significant (P for trend < 0.001). Furthermore, weighted Cox regression analyses consistently indicated that participants who had a more severe degree of depression were at a higher risk of all-cause death, and trend analyses suggested similar results (P for trend < 0.001). Another weighted Cox regression analysis also consistently indicated that except for severe depression, the hazard of cardiovascular death was increased with each additional level increase of depression. Our study confirmed that the level of depression was strongly associated with CHD, stroke, and all-cause and cardiovascular mortality, even after accounting for other factors that could impact risk, including variables of age, gender, ethnicity, income, education, body mass index (BMI), marital, and smoking status.
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Affiliation(s)
- Ruihuan Shen
- Department of Cardiology, National Center of Gerontology, Peking Union Medical College, Beijing Hospital, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ning Zhao
- Department of Gastrointestinal Surgery, Department of General Surgery, National Center of Gerontology, Peking Union Medical College, Beijing Hospital, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Wang
- Department of Cardiology, National Center of Gerontology, Beijing Hospital, Institute of Geriatric Medicine, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Peiyao Guo
- Department of Cardiology, National Center of Gerontology, Beijing Hospital, Institute of Geriatric Medicine, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Shuhui Shen
- Department of Cardiology, National Center of Gerontology, Peking Union Medical College, Beijing Hospital, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Donghao Liu
- Department of Cardiology, National Center of Gerontology, Beijing Hospital, Institute of Geriatric Medicine, Peking University Fifth School of Clinical Medicine, Beijing, China
| | - Tong Zou
- Department of Cardiology, National Center of Gerontology, Peking Union Medical College, Beijing Hospital, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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R Thompson D, F Ski C, M Clark A, M Dalal H, S Taylor R. Why Do so Few People with Heart Failure Receive Cardiac Rehabilitation? Card Fail Rev 2022; 8:e28. [PMID: 36303590 PMCID: PMC9585646 DOI: 10.15420/cfr.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022] Open
Abstract
Many people with heart failure do not receive cardiac rehabilitation despite a strong evidence base attesting to its effectiveness, and national and international guideline recommendations. A more holistic approach to heart failure rehabilitation is proposed as an alternative to the predominant focus on exercise, emphasising the important role of education and psychosocial support, and acknowledging that this depends on patient need, choice and preference. An individualised, needs-led approach, exploiting the latest digital technologies when appropriate, may help fill existing gaps, improve access, uptake and completion, and ensure optimal health and wellbeing for people with heart failure and their families. Exercise, education, lifestyle change and psychosocial support should, as core elements, unless contraindicated due to medical reasons, be offered routinely to people with heart failure, but tailored to individual circumstances, such as with regard to age and frailty, and possibly for recipients of cardiac implantable electronic devices or left ventricular assist devices.
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Affiliation(s)
- David R Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Alexander M Clark
- School of Health Disciplines, Athabasca University, Edmonton, Canada
| | - Hasnain M Dalal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Rodney S Taylor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Gutlapalli SD, Lavu VK, Mohamed RA, Huang R, Potla S, Bhalla S, Al Qabandi Y, Nandula SA, Boddepalli CS, Hamid P. The Risk of Fatal Arrhythmias in Post-Myocardial Infarction Depression in Association With Venlafaxine. Cureus 2022; 14:e29107. [PMID: 36258960 PMCID: PMC9572810 DOI: 10.7759/cureus.29107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Venlafaxine is a second line anti-depressant and the most commonly used in the treatment of selective serotonin reuptake inhibitor nonresponders in major depression; due to its effects on the noradrenergic and serotonergic systems as a serotonin and norepinephrine reuptake inhibitor, there has been considerable apprehension regarding its use in patients with cardiovascular diseases, particularly post-myocardial infarction depression, some of the feared adverse effects include QT prolongation, arrhythmias including torsades de pointes and sudden cardiac death. We tried to resolve the facts regarding the risks associated with venlafaxine use in cardiac patients. We have reviewed all the relevant information up to May 2022 regarding the risks of venlafaxine use in cardiovascular disease, particularly with a focus on post-myocardial infarction depression, and gathered around 350 articles in our research and narrowed it down to 49 articles. The database used was PubMed and the keywords used were venlafaxine, arrhythmia, major depression, post-myocardial infarction, and ventricular tachycardia. We carefully screened all relevant articles and found articles supporting and refuting the effects of venlafaxine in increasing cardiovascular morbidity and mortality. We have concluded that there is a significant variability due to confounding factors affecting individual cases. Overall there is no increased arrhythmia risk in comparison with other anti-depressants except in high-risk cases such as with pre-existing cardiovascular disease, certain genotypes, and other co-morbidities. Any patient with a high risk of arrhythmias due to any etiology should receive a screening electrocardiogram before venlafaxine prescription for baseline QT interval and periodically while on therapy to check for changes. We encourage further research, including randomized clinical trials and post-marketing surveillance regarding the use of venlafaxine in high-risk cases such as patients with multiple co-morbidities, elderly patients, or patients with certain genotypes.
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35
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Fatigue in Heart Failure. J Cardiovasc Nurs 2022. [DOI: 10.1097/jcn.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Gutlapalli SD, Prakash K, Swarnakari KM, Bai M, Manoharan MP, Raja R, Jamil A, Csendes D, Desai A, Desai DM, Alfonso M. The Risk of Fatal Arrhythmias Associated With Sertraline in Patients With Post-myocardial Infarction Depression. Cureus 2022; 14:e28946. [PMID: 36237772 PMCID: PMC9547663 DOI: 10.7759/cureus.28946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022] Open
Abstract
Sertraline is a first-line antidepressant and the most commonly used in the treatment of selective serotonin reuptake inhibitor (SSRI) in major depression. It is preferred due to its central and peripheral actions on the serotonergic system in patients with mental health issues as well as cardiovascular disease, particularly post-myocardial infarction depression. Some of the feared adverse effects include QT prolongation, arrhythmias including Torsades de pointed, and sudden cardiac death, which are associated with older antidepressants and are rarely seen with SSRIs, including sertraline. We tried to understand the risks associated with sertraline use in cardiac patients. We reviewed all the relevant information from inception up to July 2022 regarding the risks of sertraline use in cardiovascular diseases, particularly with a focus on post-myocardial infarction depression, and gathered around 500 articles in our research and narrowed it down to 37 relevant articles. The database used was PubMed and the keywords used are sertraline, arrhythmia, major depression, post-myocardial infarction, and ventricular tachycardia. We carefully screened all relevant articles and found articles supporting and refuting the effects of sertraline in increasing cardiovascular morbidity and mortality. We concluded that there is a significant variability due to confounding factors affecting individual cases. Overall, sertraline has no increased risk in comparison with other antidepressants and a comparatively preferable safety profile to other SSRIs like citalopram in general cases. Any patient with a high risk of arrhythmias due to any etiology should receive a screening ECG before sertraline prescription for baseline QT interval and genotyping for any serotonin transporter/receptor variations. Patients should also be periodically monitored for drug-drug interactions while on therapy. We encourage further research, including randomized clinical trials and post-marketing surveillance regarding the use of sertraline in high-risk cases.
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Rome D, Sales A, Leeds R, Usseglio J, Cornelius T, Monk C, Smolderen KG, Moise N. A Narrative Review of the Association Between Depression and Heart Disease Among Women: Prevalence, Mechanisms of Action, and Treatment. Curr Atheroscler Rep 2022; 24:709-720. [PMID: 35751731 PMCID: PMC9398966 DOI: 10.1007/s11883-022-01048-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Sex and gender differences exist with regard to the association between depression and cardiovascular disease (CVD). This narrative review describes the prevalence, mechanisms of action, and management of depression and CVD among women, with a particular focus on coronary heart disease (CHD). RECENT FINDINGS Women versus men with incident and established CHD have a greater prevalence of depression. Comorbid depression and CHD in women may be associated with greater mortality, and treatment inertia. Proposed mechanisms unique to the association among women of depression and CHD include psychosocial, cardiometabolic, behavioral, inflammatory, hormonal, and autonomic factors. The literature supports a stronger association between CHD and the prevalence of depression in women compared to men. It remains unclear whether depression treatment influences cardiovascular outcomes, or if treatment effects differ by sex and/or gender. Further research is needed to establish underlying mechanisms as diagnostic and therapeutic targets.
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Affiliation(s)
- Danielle Rome
- Department of Medicine, Columbia University Irving Medical Center/New York Presbyterian, New York, NY, USA
| | | | - Rebecca Leeds
- Center for Family and Community Medicine, Columbia University Irving Medical Center/New York Presbyterian, New York, NY, USA
| | - John Usseglio
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Catherine Monk
- Departments of OB/GYN and Psychiatry, School of Physicians and Surgeons, Columbia University Vagelos, New York, NY, USA
| | - Kim G Smolderen
- Departments of Internal Medicine and Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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Pedersen CG, Nielsen CV, Lynggaard V, Zwisler AD, Maribo T. The patient education strategy "learning and coping" improves adherence to cardiac rehabilitation in primary healthcare settings: a pragmatic cluster-controlled trial. BMC Cardiovasc Disord 2022; 22:364. [PMID: 35941553 PMCID: PMC9361528 DOI: 10.1186/s12872-022-02774-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adherence and completion of programmes in educational and physical exercise sessions is essential in cardiac rehabilitation (CR) to obtain the known benefits on morbidity, mortality, risk factors, lifestyle, and quality of life. The patient education strategy “Learning and Coping” (LC) has been reported to positively impact adherence and completion in a hospital setting. It is unknown if LC has impact on adherence in primary healthcare settings, and whether LC improves self-management. The aim of this pragmatic primary healthcare-based study was to examine whether patients attending CR based on LC had a better adherence to patient education and physical exercise, higher program completion rate, and better self-management compared to patients attending CR based on a consultation program Empowerment, Motivation and Medical Adherence (EMMA).
Method A pragmatic cluster-controlled trial of two types of patient education LC and EMMA including ten primary healthcare settings and 514 patients (LC, n = 266; EMMA, n = 248) diagnosed with ischaemic heart disease discharged from hospital and referred to CR between August 1, 2018 and July 31, 2019. Adherence was defined as participation in ≥ 75% of provided sessions. Completion was defined as patients attended the final interview at the end of the 12-weeks programme. Patient Activation Measure (PAM) was used to obtain information on a person's knowledge, skills and confidence for self-management. PAM questionnaire was completed at baseline and 12-weeks follow-up. Multiple and Linear regression analyses adjusted for potential confounder variables and cluster effect were performed. Result Patients who followed CR based on LC had a higher adherence rate to educational and physical exercise sessions compared to patients who followed CR based on EMMA (p < 0.01). High-level of completion was found at the end of CR with no statistically significant between clusters (78.9% vs. 78.2%, p > 0.05). At 12-weeks, there was no statistical differences in PAM-score between clusters (p > 0.05). Conclusion This study indicates that the LC positively impacts adherence in CR compared to EMMA. We found non-significant difference in completing CR and in patient self-management between the two types of patient education. Future studies are needed to investigate if the higher adherence rate achieved by LC in primary healthcare settings translates into better health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02774-8.
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Affiliation(s)
- Charlotte Gjørup Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark. .,DEFACTUM, Central Denmark Region, Aarhus, Denmark. .,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | - Ann Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Thomas Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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van den Berk Clark C, Kansara V, Fedorova M, Ju T, Renirie T, Lee J, Kao J, Opada ET, Scherrer JF. How does PTSD treatment affect cardiovascular, diabetes and metabolic disease risk factors and outcomes? A systematic review. J Psychosom Res 2022; 157:110793. [PMID: 35339907 PMCID: PMC9149090 DOI: 10.1016/j.jpsychores.2022.110793] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Prior research indicates PTSD is associated with cardiovascular and metabolic disease. A number of different treatments for PTSD can be effective in reducing PTSD symptoms. The aim of this study is to systematically review studies which determine whether treatment for PTSD is associated with better cardiovascular and metabolic outcomes. METHOD Five different databases were searched in a systematic manner, and 11 relevant studies were recovered and analyzed. FINDINGS Treatments associated with PTSD improvement and found to be effective in improving cardiovascular or metabolic outcomes among individuals with PTSD include cognitive behavioral therapy (heart rate variability and blood pressure), prolonged exposure (heart rate and heart rate variability) and SSRIs (blood pressure). CONCLUSIONS Multiple PTSD treatment modalities were associated with improved cardiovascular health and reduced risk of cardiovascular-related mortality. Given the small sample sizes, lack of follow-up studies and the extensive use of military populations in studies on PTSD and chronic diseases, these results should be interpreted with caution. More studies are needed that assess and verify whether PTSD treatments mitigate the risk for metabolic, diabetic and cardiovascular disease.
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Affiliation(s)
- Carissa van den Berk Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America.
| | - Vruta Kansara
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Margarita Fedorova
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Tiffany Ju
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Tess Renirie
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Jaewon Lee
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Jesse Kao
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Emmanuel T Opada
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
| | - Jeffrey F Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO. 63104, United States of America
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Wilhelm EAB, Davis LL, Sharpe L, Waters S. Assess and address: Screening and management of depression in patients with chronic heart failure. J Am Assoc Nurse Pract 2022; 34:769-779. [PMID: 35383649 DOI: 10.1097/jxx.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF. LOCAL PROBLEM Depression screening was not being systematically implemented in an outpatient cardiology clinic. METHODS To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms. INTERVENTION A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan. RESULTS Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan. CONCLUSIONS We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.
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Affiliation(s)
| | - Leslie L Davis
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina
| | - Leslie Sharpe
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina
| | - Sarah Waters
- Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Huffman JC, Harnedy LE, Massey CN, Carrillo A, Feig EH, Chung WJ, Celano CM. A phone and text message intervention to improve physical activity in midlife: initial feasibility testing. Health Psychol Behav Med 2022; 10:291-315. [PMID: 35295924 PMCID: PMC8920368 DOI: 10.1080/21642850.2022.2049796] [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: 11/23/2021] [Accepted: 03/01/2022] [Indexed: 10/29/2022] Open
Abstract
Background Physical activity during midlife (ages 45-64) plays a major role in the prevention of chronic and serious medical conditions. Unfortunately, many midlife adults struggle to be physically active in the setting of low levels of psychological well-being and the management of multiple confluent sources of stress. Effective, scalable, midlife-specific interventions are needed to promote physical activity and prevent the development of chronic medical conditions. Objectives In an initial proof-of-concept trial, we assessed the feasibility and acceptability of a new, midlife-adapted, phone- and text message-based intervention using positive psychology (PP) skill-building and motivational interviewing (MI) techniques. We secondarily analyzed post-intervention changes in accelerometer-measured physical activity and self-reported outcomes. Methods The PP-MI intervention included six weekly phone sessions with a study trainer, with completion of PP activities and physical activity goals between calls, and in the subsequent six weeks briefer phone check-ins were conducted. Text messages over the 12-week intervention period were utilized to support participants and identify barriers to goal completion. Feasibility (session completion rates) and acceptability (participant ratings of intervention ease and utility) were assessed via descriptive statistics, and pre-post improvements in psychological, functional, and physical activity outcomes at 12 weeks were examined via mixed effects regression models. Results Twelve midlife adults with low baseline physical activity enrolled in the single-arm trial. Overall, 76.8% of all possible sessions were completed by participants, and mean ratings of weekly phone sessions were 8.9/10 (SD 1.6), exceeding our a priori thresholds for feasibility and acceptability. Participants demonstrated generally medium to large effect size magnitude improvements in accelerometer-measured physical activity, psychological outcomes, and function. Conclusions A novel, midlife-specific phone- and text-based PP-MI intervention was feasible and had promising effects on physical activity and other clinically relevant outcomes, supporting next-step testing of this program via a randomized controlled trial.
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Affiliation(s)
- Jeff C. Huffman
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren E. Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christina N. Massey
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Alba Carrillo
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Instituto Polibienestar, University of Valencia, Valencia, Spain
| | - Emily H. Feig
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Wei-Jean Chung
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M. Celano
- Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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42
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Brain-heart communication in health and diseases. Brain Res Bull 2022; 183:27-37. [PMID: 35217133 DOI: 10.1016/j.brainresbull.2022.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/19/2022]
Abstract
Tight connections between the brain and heart have attracted a considerable amount of attention. This review focuses on the anatomical (extrinsic cardiac autonomic nervous system and intrinsic cardiac autonomic nervous system) and functional (neuroendocrine-heart axis and neuroimmune-heart axis) connections between the brain and heart, the linkage between central nervous system diseases and cardiovascular diseases, the harm of sympathetic hyperactivity to the heart, and current neuromodulation therapies. Depression is a comorbidity of cardiovascular diseases, and the two are causally related. This review summarizes the mechanisms and treatment of depression and cardiovascular diseases, providing theoretical evidence for basic research and clinical studies to improve treatment options.
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Garcia RG, Goldstein JM. Nonpharmacologic Therapeutics Targeting Sex Differences in the Comorbidity of Depression and Cardiovascular Disease. Psychiatr Ann 2022. [DOI: 10.3928/00485713-20211222-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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44
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Shan Q, Xinxin S, Zhijuan X, Rongjing D, Minjie Z. Effects of Cognitive Behavior Therapy on Depression, Illness Perception, and Quality of Life in Atrial Fibrillation Patients. Front Psychiatry 2022; 13:830363. [PMID: 35599772 PMCID: PMC9120611 DOI: 10.3389/fpsyt.2022.830363] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AF Patients with depression resulted in a markedly reduced quality of life. The purpose of this study was to evaluate the efficacy of cognitive behavior therapy (CBT) on the health-related quality of life (HRQoL). METHODS It was A longitudinal randomized controlled trial with a pre and 12-weeks post-test. Ninety persons were randomly assigned to either a CBT group (CBT) (n = 45) or a treatment as usual (TAU) group (n = 45). The outcome were changes in the HRQoL [12-item Short Form Health Survey, SF12, divided into two domains: the physical component summary (PCS) and the mental component summary (MCS)], changes in psychological distress [Hamilton Depression Rating Scale (HAM-D) and Patient Health Questionnaire-9 (PHQ-9)], and Illness Perception [Brief Illness Perception Questionnaire (BIPQ)]. RESULTS There were statistically significant differences in score reduction for PHQ-9 (t = 3.186, P = 0.002), HAMD (t = 2.611, P = 0.011), BIPQ (t = 7.660, P < 0.001), and MCS (t = 4.301, P < 0.001) between CBT group and TAU group. CONCLUSIONS CBT improved HRQoL, Illness Perception and reduced Depressive symptoms in atrial fibrillation.
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Affiliation(s)
- Qu Shan
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
| | - Shi Xinxin
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
| | - Xie Zhijuan
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
| | - Ding Rongjing
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Zheng Minjie
- Department of Psychiatry, Peking University People's Hospital, Beijing, China
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PSYChosomatic Medicine in ONcologIc and Cardiac Disease (PSYCHONIC) Study-A Retrospective and Prospective Observational Research Protocol. J Clin Med 2021; 10:jcm10245786. [PMID: 34945081 PMCID: PMC8709231 DOI: 10.3390/jcm10245786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Psychosocial factors play an important role in non-communicable diseases (NCDs). This observational study is primarily aimed at assessing the relationship of psychological characteristics of patients with the outcomes of different NCDs, and to assess short-term psychotherapy (STP) efficacy in the real world. Methods: One hundred and forty patients with recent acute myocardial infarction, Takotsubo syndrome, or non-metastatic breast cancer and a control group of 140 age and sex-matched healthy subjects, will be enrolled. All subjects will be administered psychometric tests, quality of life tests, a specific body perception questionnaire, a dream questionnaire, and a projective test, the Six Drawing test at baseline and follow-up. All subjects with medical conditions will be asked to freely choose between an ontopsychological STP along with standard medical therapy and, whenever indicated, rehabilitation therapy or medical therapy plus rehabilitation alone. The study endpoints will be to evaluate: the relationship of the psychological characteristics of enrolled subjects with the outcomes of different NCDs, predictors of the choice of psychotherapy, and the efficacy of ontopsychological intervention on psychological and medical outcomes. Conclusion: This study will generate data on distinctive psychological characteristics of patients suffering from different CDs and their relationship with medical outcomes, as well as explore the efficacy of ontopsychological STP in these patients in the real world. (Number of registration: NCT03437642).
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Mazza M, Marano G, Gonsalez del Castillo A, Chieffo D, Albano G, Biondi-Zoccai G, Galiuto L, Sani G, Romagnoli E. Interpersonal violence: Serious sequelae for heart disease in women. World J Cardiol 2021; 13:438-445. [PMID: 34621488 PMCID: PMC8462046 DOI: 10.4330/wjc.v13.i9.438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/10/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Experiencing various forms of violence in either childhood or adulthood has been associated with cardiovascular disease, both shortly after the event and during follow-up, particularly in women. The coronavirus disease 2019 pandemic has heightened the risk of domestic violence with serious sequelae for mental and cardiovascular health in women, possibly due to several contributing factors, ranging from lockdown, stay at home regulations, job losses, anxiety, and stress. Accordingly, it remains paramount to enforce proactive preventive strategies, at both the family and individual level, maintain a high level of attention to recognize all forms of violence or abuse, and guarantee a multidisciplinary team approach for victims of interpersonal or domestic violence in order to address physical, sexual, and emotional domains and offer a personalized care.
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Affiliation(s)
- Marianna Mazza
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Marano
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Angela Gonsalez del Castillo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Chieffo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriella Albano
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina 04100, Italy
- Mediterranea Cardiocentro, Napoli 80122, Italy
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriele Sani
- Department of Neurosciences, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
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Thyagaturu HS, Thangjui S, Shah K, Naik RV, Bondi G. Association of Major Depressive Disorder on Heart Failure With Reduced and Preserved Ejection Fraction: Analysis of National Readmission Database 2018. Cureus 2021; 13:e15107. [PMID: 34026388 PMCID: PMC8133512 DOI: 10.7759/cureus.15107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The effect of major depressive disorder (MDD) on heart failure types is unclear. We aimed to assess the association of depression in heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) readmissions using the Nationwide Readmission Database (NRD) 2018. Methods We identified hospitalizations with a primary discharge diagnosis of HFrEF and HFpEF by appropriate ICD-10-CM codes. We acquired mortality and readmission data with and without MDD at 30 days. We used multivariate logistic regression analysis to estimate the adjusted odds ratio (aOR). Results Among 102,997 patients admitted with heart failure as a primary diagnosis, 11% had MDD. We found a similar prevalence of HFpEF with MDD compared to HFrEF at 13.9% and 10%, respectively. Both HFrEF and HFpEF patients with MDD had similar combined outcomes of 30-day mortality and rehospitalization compared to patients without MDD with aOR 0.94 (95% CI: 0.85-1.04) and 0.93 (95% CI: 0.81-1.07), respectively. Both types of HF with MDD were associated with lesser mortality. Conclusion MDD was associated with similar combined 30-day mortality and readmissions for both HFrEF and HFpEF. However, MDD was associated with decreased 30-day mortality in both groups of heart failure (HF) patients. Further studies with robust medications and treatment data are needed to verify the results of our study.
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Affiliation(s)
| | | | - Kashyap Shah
- Internal Medicine, Saint Luke's University Hospital, Bethlehem, USA
| | - Riddhima V Naik
- Internal Medicine, Bassett Healthcare Network, Cooperstown, USA
| | - Gayatri Bondi
- Internal Medicine, Bassett Healthcare Network, Cooperstown, USA
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Zambrano J, Celano CM, Januzzi JL, Massey CN, Chung WJ, Millstein RA, Huffman JC. Psychiatric and Psychological Interventions for Depression in Patients With Heart Disease: A Scoping Review. J Am Heart Assoc 2020; 9:e018686. [PMID: 33164638 PMCID: PMC7763728 DOI: 10.1161/jaha.120.018686] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Depression in patients with cardiovascular disease is independently associated with progression of heart disease, major adverse cardiac events, and mortality. A wide variety of depression treatment strategies have been studied in randomized controlled trials as the field works to identify optimal depression treatments in this population. A contemporary scoping review of the literature can help to consolidate and synthesize the growing and disparate literature on depression treatment trials in people with cardiovascular disease. We conducted a scoping review utilizing a systematic search of the literature via 4 databases (PubMed, PsycINFO, EMBASE, and Google Scholar) from database inception to March 2020. We identified 42 relevant randomized controlled trials of depression treatment interventions in patients with cardiac disease (n=9181 patients with coronary artery disease, n=1981 patients with heart failure). Selective serotonin reuptake inhibitors appear to be safe in patients with cardiac disease and to have beneficial effects on depression (and some suggestion of cardiac benefit) in patients with coronary artery disease, with less evidence of their efficacy in heart failure. In contrast, psychotherapy appears to be effective for depression in coronary artery disease and heart failure, but with less evidence of cardiac benefit. Newer multimodal depression care management approaches that utilize flexible approaches to patients' care have been less studied but appear promising across cardiac patient groups. Selective serotonin reuptake inhibitors may be preferred in the treatment of patients with coronary artery disease, psychotherapy may be preferred in heart failure, and more flexible depression care management approaches have shown promise by potentially using both approaches based on patient needs.
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Affiliation(s)
- Juliana Zambrano
- Department of Psychiatry Massachusetts General Hospital Boston MA
| | - Christopher M Celano
- Department of Psychiatry Massachusetts General Hospital Boston MA.,Harvard Medical School Boston MA
| | - James L Januzzi
- Department of Psychiatry Massachusetts General Hospital Boston MA.,Division of Cardiology Massachusetts General Hospital Boston MA
| | - Christina N Massey
- Department of Psychiatry Massachusetts General Hospital Boston MA.,Harvard Medical School Boston MA
| | - Wei-Jean Chung
- Department of Psychiatry Massachusetts General Hospital Boston MA.,Harvard Medical School Boston MA
| | - Rachel A Millstein
- Department of Psychiatry Massachusetts General Hospital Boston MA.,Harvard Medical School Boston MA
| | - Jeff C Huffman
- Department of Psychiatry Massachusetts General Hospital Boston MA.,Harvard Medical School Boston MA
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