Do the Gender and the Number of Comorbidities and the Use of Tertiary Prevention Play a Role in the Severity of Anxiety and Depression in Patients with Coronary Artery Disease? A POLASPIRE II Study

Background/Objectives: The need to conduct research on anxiety and depression in patients with coronary artery disease in connection with factors such as gender or implemented tertiary prevention is very important for drawing practical conclusions and, consequently, implementing new recommendations and procedures. The aim of the study was to attempt to answer the question whether gender and the number of comorbidities, as well as the application of tertiary prevention principles, play a role in the severity of anxiety and depression in the studied group of patients with coronary artery disease. Material: The study involved 765 patients from 11 Polish cardiology centers. The presented material is part of the multicenter POLASPIRE II study. Methods: All patients completed The Hospital Anxiety and Depression Scale (HADS) questionnaire, and a medical interview was conducted with them. Conclusions: Although the intensity of anxiety and depression in the studied group of patients was low, gender differentiated them, which, however, did not influence undertaking tertiary prevention activities. In the study group of patients, the number of comorbidities and cardiac incidents/procedures after the event qualifying for the study, as well as preventive actions undertaken, were not associated with the severity of anxiety and depression. In the studied group of patients with coronary heart disease, there was still a large group of people who did not take preventive measures. Therefore, there is a need for systematic education regarding the benefits of implementing them to prevent the progression of the disease and premature death.

Effects of Aromatherapy on Anxiety and Blood Pressure in Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Introduction: Patients with acute coronary syndrome (ACS) often experience high levels of anxiety, which can significantly impact their prognosis. However, evidence regarding anxiety reduction by aromatherapy in patients with ACS is lacking. This study aimed to investigate the effects of aromatherapy on anxiety in patients with ACS. Methods: The literature search was conducted using PubMed, CINAHL, Embase, Web of Science, Cochrane Library, and PsycINFO from their inception until February 21, 2024. Based on inclusion criteria, randomized controlled trials (RCTs) on aromatherapy in patients with ACS aged ≥ 18 years were included. The risk of bias in the included studies was assessed using the revised Cochrane risk-of-bias tool for RCTs. Results: A total of 14 studies were included in the final analysis. Aromatherapy significantly reduced anxiety among patients with ACS, with a large effect size (standardized mean difference [SMD] = -1.66, 95% confidence interval [CI]: -2.47 to -0.85). The effect on systolic blood pressure (SBP) was -0.65 (95% CI: -1.15 to -0.15), indicating a moderate effect size, whereas there was no significant effect on diastolic blood pressure. Inhalation therapy demonstrated a large effect size (SMD = -1.70, 95% CI: -2.33 to -1.08), whereas massage therapy did not show a significant effect on reducing anxiety. Discussion/Conclusions: The findings show that aromatherapy can effectively reduce anxiety and SBP in patients with ACS. In particular, inhalation therapy showed a significant effect on reducing anxiety levels. Applying aromatherapy in clinical settings to reduce anxiety among patients with ACS should be considered. However, the limited number of studies analyzed hinders a comprehensive evaluation of the effectiveness of massage therapy. Hence, further research is necessary to elucidate its potential role in reducing anxiety among patients with ACS.

Psychosocial and lifestyle impacts of spontaneous coronary artery dissection: A quantitative study

INTRODUCTION

Recent studies suggest that acute myocardial infarction due to spontaneous coronary artery dissection (SCAD) carries significant psychosocial burden. This survey-based quantitative study builds on our earlier qualitative investigation of the psychosocial impacts of SCAD in Australian SCAD survivors. The study aimed to document the prevalence and predictors of a broad range of psychosocial and lifestyle impacts of SCAD.

METHOD

Australian SCAD survivors currently enrolled in the Victor Chang Cardiac Research Institute genetics study were invited to participate in an online survey to assess the psychosocial impacts of SCAD. Participants completed a questionnaire, developed using findings from our earlier qualitative research, which assessed 48 psychosocial and five lifestyle impacts of SCAD. Participants also provided demographic and medical data and completed validated measures of anxiety and depression.

RESULTS

Of 433 SCAD survivors invited to participate, 310 (72%) completed the questionnaire. The most common psychosocial impacts were 'shock about having a heart attack' (experienced by 87% respondents), 'worry about having another SCAD' (81%), 'concern about triggering another SCAD' (77%), 'uncertainty about exercise and physical activity' (73%) and 'confusion about safe levels of activity and exertion' (73.0%) and 'being overly aware of bodily sensations' (73%). In terms of lifestyle impacts, the SCAD had impacted on work capacity for almost two thirds of participants, while one in ten had sought financial assistance. The key predictors of psychosocial impacts were being under 50, current financial strain, and trade-level education. The key predictors of lifestyle impacts were being over 50, SCAD recurrence, trade-level education, and current financial strain. All psychosocial impacts and some lifestyle impacts were associated with increased risk of anxiety and/or depression.

CONCLUSION AND IMPLICATIONS

This quantitative study extends our previous qualitative investigation by documenting the prevalence of each of 48 psychosocial and five lifestyle impacts identified in our earlier focus group research, and by providing risk factors for greater SCAD impacts. The findings suggest the need for supports to address initial experiences of shock, as well as fears and uncertainties regarding the future, including SCAD recurrence and exercise resumption. Support could be targeted to those with identified risk factors. Strategies to enable SCAD survivors to remain in or return to the paid workforce are also indicated.

Global prevalence of depression, anxiety, and stress in cardiac patients: A systematic review and meta-analysis

BACKGROUND

Cardiovascular disease is one of the most common chronic and life-threatening diseases. Due to the changes made in the normal living conditions of people after suffering from cardiovascular diseases, the appearance of symptoms of depression, anxiety, and stress is common among these patients. The results of the studies show the different prevalence of these disorders, so this study aimed to standardize the global prevalence of depression, anxiety, and stress in Cardiac patients by a systematic review and meta-analysis approach.

METHODS

The present systematic review and meta-analysis were conducted from 2000 to 2022. National and international databases were considered to retrieve related studies, including SID, Magiran, Scopus, Embase, PubMed, and Web of Science (WoS). Joanna Briggs Institute (JBI) checklist was used to evaluate studies qualitatively. Heterogeneity between studies was assessed by I2 index, and data analysis was performed in Comprehensive Meta-Analysis software.

RESULTS

After reviewing the retrieved studies, finally 68 studies on the prevalence of depression with a sample size of 110,219, 36 studies on the prevalence of anxiety with a sample size of 72,374 and 5 studies on the prevalence of stress with a sample size of 533 considered for the meta-analysis. Based on the results of the Meta-Analysis, the overall estimation of the prevalence of depression was 31.3 % (95 % confidence interval: 25.4/0.38 %), anxiety prevalence; 32.9 % (95 % confidence interval: 21.9-46.6 %) and stress prevalence was 57.7 % (95 % confidence interval: 45.3-3.3 %).

CONCLUSION

The result of the present study shows the high prevalence rate of depression, anxiety, and stress in cardiac patients. Therefore, it is recommended that health professionals and policymakers pay more attention to preventing and controlling these disorders.

Factors Associated with Anxiety Scores in Patients with Stable Angina Pectoris in Cardiology Outpatient Clinic of Universitas Sumatera Utara Hospital

Introduction: Stable angina pectoris is of great interest to health care workers because of the high levels of anxiety observed in patients following a coronary event. This study aims to investigate factors associated with anxiety scores in patients with stable angina pectoris.  Methods: This cross-sectional study was conducted from November to December 2020. Subjects were patients diagnosed with stable angina pectoris in the Cardiology outpatient clinic of Universitas Sumatera Utara Hospital. Signed the informed consent were subjected to history taking, and structured interviews then were asked to fill out the HADS questionnaire.  Results: A total of 200 study subjects were obtained. The majority of the subjects, 110 (55%) subjects, were women. Of all subjects, 105 (52.5%) subjects were married. The majority of study subjects were employed (61.5%), had >9 years education (88%), non-smokers (70.5%), had comorbidities (73.5%) and had a family history of the disease (64%). The median age was 53 years (min 50, max 55 years). The median value of the length of illness was seven years (min 1 year, max 12 years). The median value of body mass index was 24.16 (min 20.11, max 30.59).   Conclusion: Age, marital relationship, occupation, smoking status, comorbidities, family history of the disease, and body mass index were found to be associated with anxiety scores in patients with stable angina pectoris. 

Severity of psychological distress over five years differs as a function of sex and presence of coronary artery disease

BACKGROUND

Psychological distress is more prevalent and severe among patients with coronary artery disease (CAD) compared to healthy individuals. Little is known regarding its time course, and whether these differences extend to individuals with non-cardiovascular (CV) illnesses. This study examined the presence, severity, and time course of psychological distress in men and women with CAD and those of similarly aged individuals suffering from non-CV conditions.

METHODS

1229 individuals (61% men; mean_age = 60.4 ± 7.0 years) with stable CAD or non-CV illnesses reported on social support, hostility, stress, anxiety and depression at baseline as well as 4.8 ± 0.8 years later. Analyses involved mixed (Sex*CAD status*Time) repeated measures analyses (controlling for relevant covariates), as well as Chi-square and McNemar analyses.

RESULTS

Women with CAD reported more symptoms of depression compared to other participants at both evaluations (p's < 0.01), and reported more symptoms of anxiety and stress compared to others at T1 (p's < 0.05). At T2, perceived stress remained significantly greater among women with CAD compared to men (p's < 0.01), though differences in anxiety were no longer significant. Men reported more hostility than women (p = 0.001). CAD women fell within the clinical range for depression (p < 0.001), anxiety (p = 0.001), and stress (p = 0.030) more frequently compared to others at T1, and for depression (p = 0.009) and stress (p = 0.002) at T2.

CONCLUSIONS

The evolution of patient distress differed as a function of the measure examined, their sex, and/or CV status. While psychological distress was prevalent among these patients with diverse health conditions, women with CAD were particularly and chronically vulnerable.

Psychological factors of suspect coronary microvascular dysfunction in patients undergoing SPECT imaging

BACKGROUND

Patients with myocardial ischemia in the absence of obstructive coronary artery disease (CAD) often experience anginal complaints and are at risk of cardiac events. Stress-related psychological factors and acute negative emotions might play a role in these patients with suspect coronary microvascular dysfunction (CMD).

METHODS AND RESULTS

295 Patients (66.9 ± 8.7 years, 46% women) undergoing myocardial perfusion single-photon-emission computed tomography (MPI-SPECT), were divided as follows: (1) a non-ischemic reference group (n = 136); (2) patients without inducible ischemia, but with a history of CAD (n = 62); (3) ischemia and documented CAD (n = 52); and (4) ischemia and suspect CMD (n = 45). These four groups were compared with regard to psychological factors and acute emotions. Results revealed no differences between the groups in psychological factors (all P > .646, all effect sizes d < .015). State sadness was higher for patients with suspect CMD (16%) versus the other groups (P = .029). The groups did not differ in the association of psychological factors or emotions with anginal complaints (all P values > .448).

CONCLUSION

Suspect CMD was not associated with more negative psychological factors compared to other groups. State sadness was significantly higher for patients with suspect CMD, whereas no differences in state anxiety and other psychological factors were found.

Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex

AIMS

To explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.

METHODS & FINDINGS

A retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012-2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72-0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78-0.96 p = 0.007, OR 0.80 95%CI 0.69-0.92 p = 0.003 & OR 0.69 95CI% 0.61-0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50-0.61 p<0.001 & OR 0.63 95%CI 0.55-0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65-0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41-0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41-0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data.

CONCLUSION

Patients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care.

Anxiety and Depression Prevalence and Risk Factors Among Patients With Cardiovascular Diseases in Post-COVID-19 China

Objective: Data are limited on the psychological disorders of patients with cardiovascular disease during the post-COVID-19 period, although mental health status is associated with morbidity and mortality. We aimed to investigate the prevalence of anxiety and depression and risk factors among patients with cardiovascular disease in the post-pandemic period.

Method: A cross-sectional survey was conducted through opportunistic and snowball sampling in southeast China from 10 October to 24 November. Anxiety and depression were assessed on the hospital anxiety and depression scale (HADS).

Results: A total of 435 patients with hypertension (48.05%), atrial fibrillation (17.24%), coronary artery disease (14.48%), heart failure (9.89%) and other heart diseases (10.34%) completed the survey. Interestingly, most patients reported monthly income comparable to (90.11%) or even greater than (8.51%) pre-pandemic income. The occurrence of anxiety and depression was 11.72 and 9.20%, respectively. Marital status and treatment interruption during the pandemic were independent risk factors for both anxiety and depression. Moreover, current monthly income and access to telemedicine during the pandemic were independent risk factors for anxiety.

Conclusion: Patients with cardiovascular disease may experience anxiety and depression not only because of disease complications but also because of the effects of the pandemic. In facing the global challenge posed by the coronavirus, efforts should be made to improve patients' psychological well-being in the management of populations with cardiovascular disease.

Association of Anxiety and Depression in Patients Undergoing Cardiac Catheterization With Number of Major Coronary Artery Stenosis: A Cross-Sectional Study

Introduction

The relationship between the level of anxiety and depression among coronary artery disease (CAD) patients and coronary angiographic findings is ambiguously mentioned in studies. Past evidence shows that the relationship between anxiety and depression with coronary artery disease can be bidirectional. There is a paucity of literature on the association of levels of anxiety and depression with the number of coronary arteries involved in coronary artery disease.

Methods

This study was conducted in a tertiary care hospital to find the level of anxiety and depression in patients undergoing cardiac catheterization and their association with the numbers of the major coronary artery involved. Patients undergoing cardiac catheterization in the Department of Cardiovascular Science of a tertiary care hospital in India from May 2020 to December 2020 were considered for inclusion in the study. Coronary artery disease was diagnosed based on the combination of clinical, ECG, echocardiography, or biomarker parameters in various combinations. These patients were further subjected to coronary angiogram to know the extent of stenosis and the number of coronary vessels involved in the disease. The level of anxiety and depression was measured by using the Hospital Anxiety and Depression Scale (HADS) during the period of admission and at least 24 hours after diagnosis and at least 12 hours before cardiac catheterization. The data was entered into SPSS software version 22.0 (Armonk, NY: IBM Corp.) for statistical analysis. Chi-square test, Kolmogorov-Smirnov test, and Kruskal-Wallis test were used for the interpretation of data and find an association between severity of anxiety and depression with the number of major coronary vessels involved.

Results

Anxiety was seen in 83.3% of the patients with 31.5% having severe anxiety. Depression was found in 77.8% with 38.9% suffering from severe depression. The anxiety and depression scores of HADS were significantly higher in those with triple-vessel disease compared to the double-vessel or single-vessel disease.

Conclusion

Screening and management of anxiety and depression is an essential part of the care of patients with coronary artery disease. People with triple-vessel disease need the most attention and appropriate management of anxiety and depression.

Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept

BACKGROUND

Heart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation.

METHODS

A prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach.

RESULTS

Exercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found.

CONCLUSIONS

HFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.

Factors Associated with Anxiety and Depressive Symptoms in 2775 Patients with Arterial Hypertension and Coronary Heart Disease: Results from the COMETA Multicenter Study

Aim:

To identify associations of anxiety symptoms (AS) and depressive symptoms (DS) with other psychosocial and lifestyle risk factors in primary care patients with arterial hypertension (AH) and/or coronary heart disease (CHD).

Methods:

COMETA (Clinical-epidemiOlogical prograM of studying psychosocial risk factors in cardiological practice in patiEnts with arterial hyperTension and ischemic heArt disease) is a multicenter cross-sectional study performed in 30 big cities of Russia with two to five out-patient clinics per city randomly selected and two to five general practitioners (GPs) per an out-patient clinic. Each GP included 8–10 consecutive patients with AH and/or CHD. AS and DS were assessed by the Hospital Anxiety and Depression Scale.

Results:

325 GPs enrolled 2775 patients (mean age 66.7 years, 72% women) with AH (60.8%), CHD (2.6%), and AH plus CHD (36.6%). Moderate/severe (≥11 HADS) AS were found in 25.5% and DS in 16.3% patients. The strongest associations of AS and DS were revealed for high stress level (OR 5.79; 95% CI [4.18–8.03]), moderate stress level (OR 2.34; 95% CI [1.73–3.16]), low social support (OR 1.87; 95% CI [1.31–2.68]) and female gender (OR 1.78; 95% CI [1.41–2.25]). Low physical activity, unhealthy eating, unemployment and low income were also positively associated with both AS and DS (p < 0.003 for all).

Conclusion:

In out-patients with AH and CHD, AS and DS were strongly associated with higher levels of stress, low social support, unemployment, low family income and unhealthy lifestyle such as low physical activity, low fruit and vegetables intake and excessive salt consumption. Our findings indicate that patients with AH and CHD, who have anxiety and depressive symptoms need extra attention and monitoring in regard to stress and lifestyle risk factor control.

The association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease: A meta-analysis

This study aimed to investigate the association between cardiovascular drugs and depression/anxiety in patients with cardiovascular disease (CVD). This meta-analysis was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42020197839) and conducted in accordance with the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines. The PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were systematically searched to identify all available studies on this topic. Random-effects multivariate meta-regression was performed to investigate the sources of study heterogeneity. Review Manager version 5.3 and Stata 12.0 were used for data analyses. This meta-analysis included 54 studies with a total number of 212,640 patients. Overall, in patients with CVD, aspirin (odds ratio [OR]:0.91, 95% confidence interval [CI]:0.86-0.96, P = 0.02) was associated with a lower risk of depression, while calcium channel blockers (CCB) (OR:1.21, 95%CI:1.05-1.38, P = 0.008), diuretics (OR:1.34, 95%CI:1.14-1.58, P = 0.0005), and nitrate esters (OR:1.32, 95%CI:1.08-1.61, P = 0.006) were associated with a higher risk of depression, additionally, statin (OR:0.79, 95%CI:0.71-0.88, P < 0.0001) was associated with a lower risk of anxiety, but diuretics (OR:1.39, 95%CI:1.26-1.52, P < 0.00001) was associated with a higher risk of anxiety. Subgroup analysis presented that, in patients with hypertension, β-blockers were associated with a higher risk of depression (OR:1.45, 95%CI:1.26-1.67, P < 0.00001); in patients with coronary artery disease (CAD), statin (OR:0.77, 95%CI:0.59-0.99, P = 0.04), and aspirin (OR:0.85, 95%CI:0.75-0.97, P = 0.02) were associated with a lower risk of depression, while CCB (OR:1.32, 95%CI:1.15-1.51, P < 0.0001) and diuretics (OR:1.36, 95%CI:1.12-1.64, P = 0.002) were associated with a higher risk of depression, additionally, diuretics was associated with a higher risk of anxiety (OR:1.41, 95%CI:1.28-1.55, P < 0.00001); in patients with heart failure, nitrate esters (OR:1.93, 95%CI:1.19-3.13, P = 0.007), and diuretics (OR:1.58, 95%CI: 1.02-2.43, P = 0.04) were associated with a higher risk of depression. The use of cardiovascular drugs should be considered when evaluating depression or anxiety in patients with CVD to improve the care and treatment of these patients.

Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease: A meta-analysis

BACKGROUND

Recently, the efficacy of cognitive behavioral therapy (CBT)-based intervention on health outcomes in patients with coronary heart disease (CHD) has been recognized in randomized controlled trials (RCTs), but no comprehensive systematic review has been conducted. To address this research gap, our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients. It was hypothesized that CBT-based interventions are effective in: (1) Reducing depression, anxiety, and stress symptoms; (2) Reducing body mass index, blood pressure, and lipid levels; and (3) Improving quality of life, and exercise endurance.

AIM

To verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications.

METHODS

Relevant RCTs published in English were obtained by searching electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Proquest, with the retrieval time from inception to August 2020. The primary outcomes were psychological factors (depression, anxiety, and stress symptoms), physiological factors (body mass index, blood pressure, blood lipids). The secondary outcomes included quality of life and exercise endurance. We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies.

RESULTS

A total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis. The main analysis revealed that CBT-based intervention can reduce depression symptoms: -2.00 [95% confidence interval (CI): -2.83 to -1.16, P < 0.001]; anxiety symptoms: -2.07 (95%CI: -3.39 to -0.75, P = 0.002); stress symptoms: -3.33 (95%CI: -4.23 to -2.44, P < 0.001); body mass index: -0.47 (95%CI: -0.81 to -0.13, P = 0.006); and improve physical functioning: 3.36 (95%CI: 1.63 to 5.10, P = 0.000) and mental functioning: 6.91 (95%CI: 4.10 to 9.73, P < 0.001). Moreover, subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual, as opposed to group treatment, and psycho-education, behavioral and cognitive strategies were applied as the core treatment approaches.

CONCLUSION

CBT-based interventions are effective treatment strategies for CHD patients, significantly improving their symptoms of depression, anxiety and stress, body mass index, and health-related quality of life.

The Role of Mental Stress in Ischaemia with No Obstructive Coronary Artery Disease and Coronary Vasomotor Disorders

Ischaemic heart disease has been estimated to affect 126.5 million people globally. Approximately 70% of patients with angina and suspected myocardial ischaemia show no signs of obstructed coronary arteries after coronary angiography, but may still demonstrate ischaemia. Ischaemia with no obstructive coronary artery disease (INOCA) is increasingly acknowledged as a serious condition because of its association with poor quality of life and elevated risk for cardiovascular events. The negative effects of psychological stress on INOCA are gaining more attention. Psychological stress is associated with adverse cardiovascular outcomes such as mental stress-induced myocardial ischaemia. Psychological stress includes anxiety, depression, anger and personality disturbances. Coronary microvascular dysfunction and coronary arterial spasm are phenotypes of coronary vasomotor disorders that are triggered by psychological distress and depression, thereby increasing cardiovascular disease risk. Coronary vasomotor disorders are often co-existent in INOCA patients and might be considered as a contributing factor to mental stress-associated adverse cardiovascular outcomes. Additionally, psychological stress induces endothelial dysfunction more often in (young) women with INOCA than in men. Overall, many studies demonstrate an association between mental stress, coronary microvascular dysfunction and coronary vasospasm in patients with INOCA - especially women. Future research on stress-reducing therapies that target coronary vasomotor disorders in patients with INOCA is needed. This is particularly the case in young adolescents, in whom this type of ischaemic heart disease is increasing.

Symptoms of Depression and Anxiety in Patients With Type 2 Diabetes in a Canadian Outpatient Cardiac Rehabilitation Program

PURPOSE

The objective of this study was to determine whether type 2 diabetes status is associated with an increased likelihood of depressed mood and anxiety in patients attending cardiac rehabilitation (CR) and to explore predictors of depression and anxiety after CR completion in patients with diabetes.

METHODS

A retrospective analysis was conducted in patients who completed a 12-wk CR program between 2002 and 2016. Patients were classified as reporting normal-to-mild or moderate-to-severe symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS). Logistic regression models were used to compare predictors of depression and anxiety prior to CR enrollment and investigate predictors of post-CR HADS scores among a subset of patients with diabetes.

RESULTS

Data from 6746 patients (mean age 61 ± 11 yr, 18% female, 18% with diabetes) were analyzed. After controlling for known predictors of depression, patients with diabetes were not more likely to report moderate-to-severe levels of depression prior to or after completing CR. In patients with diabetes, younger age predicted moderate-to-severe depression post-CR (OR = 0.95: 95% CI, 0.93-0.98). Patients with diabetes were also more likely to report moderate-to-severe levels of anxiety after completing CR (OR = 1.45: 95% CI, 1.02-2.07). Younger age (OR = 0.93: 95% CI, 0.88-0.97) and smoking status (OR = 3.3: 95% CI, 1.15-7.06) predicted moderate-to-severe post-CR anxiety in patients with diabetes.

CONCLUSIONS

Patients with diabetes, particularly younger patients who currently smoke or recently quit, are more likely to report having anxiety following CR. These patients may therefore require additional management of anxiety symptoms during CR. Larger studies of CR patients with diabetes and more variable depression and anxiety levels are needed.

Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients

Exploring new models of medical care requires evaluating the impact of new care strategies not only on physiological parameters but also on the quality of life of the patient. On the other hand the presence of anxiety together with depression requires further consideration when planning appropriate management strategies. The aim of this study was to examine the effectiveness of a home-based cardiac rehabilitation program incorporating an e-Health technology on health-related quality of life associated with symptoms of anxiety and depression in moderate-risk patients. A multicenter, randomized controlled clinical trial was designed to compare a traditional hospital based cardiac rehabilitation program (n = 38, 35 male) with a mixed home surveillance program where patients exercised at home with a remote electrocardiographic monitoring device (n = 33, 31 male). The Short Form-36 (SF-36) Health Survey and the Goldberg questionnaire were used to evaluate quality of life and the presence of symptoms of anxiety and depression respectively. The results of this study show that the type of cardiac rehabilitation program did not influence the improvement in quality of life (p = 0.854), but the presence of symptoms of anxiety and depression did (p = 0.001). Although both programs achieved a decrease in anxiety and depression symptoms and improved functional capacity (p ≤ 0.001), a significant interaction effect was found between the group with or without anxiety and depression symptoms and the type of program in the bodily pain dimension (p = 0.021). Trial registration: Retrospectively registered NCT02796404 (10/06/2016) in clinialtrials.gov.

Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort

BACKGROUND

Depressive symptoms (DS) disproportionately affect women with cardiac disease; however, no analyses have been conducted that would allow for focused sex-specific interventions.

METHODS

Consecutively enrolled women (n = 663) were matched with men postcardiac revascularization at cardiac rehabilitation (CR) entry by primary diagnosis, age, and year of CR entry from database records (2006 to 2017). Multivariate analyses were conducted to determine predictors of DS (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and men and women separately.

RESULTS

In bivariate analysis, women were more likely than men to have DS (30.2% vs 19.3%; P < 0.001) in the matched cohort. A greater proportion of women than men had DS in all 10-year age categories (P < 0.05) except youngest (<50 years; 37% vs 30.4%; P = 0.7) and oldest (≥80; 12.3% vs 10.3%; P = 0.8). DS peaked in women aged 50 to 59 (42.5%) and men <50 years (30.4%). In all patients, independent predictors of DS were younger age, lower cardiorespiratory fitness (VO_2peak), being unemployed, greater comorbidities, smoking, anxiolytics, antidepressants, not being married, but not sex. Shared predictors in women-only and men-only analyses were younger age, lower VO_2peak, antidepressants, and being unemployed. Unique predictors for women were obesity, smoking, and delayed CR entry and, for men, hypertension, myocardial infarction, anxiolytics, and not being married.

CONCLUSIONS

Despite matching for age and diagnosis, women were more likely to have DS than men. However, sex was not a predictor of DS in multivariate analyses. This suggests that the profile of women predisposes them to greater DS. Obesity, smoking, and greater delayed CR entry were unique correlates for women and targets for intervention.

Long-term trajectories of anxiety and depression in patients with stable coronary heart disease and risk of subsequent cardiovascular events

BACKGROUND

Anxiety and depression seem to be under-recognized in their importance and are often not incorporated in subsequent prevention strategies in routine clinical care of coronary heart disease.

METHODS

The KAROLA cohort included coronary heart disease patients participating in an in-patient rehabilitation program (years 1999/2000) and followed after 1, 3, 6, 8, 10, 13, and 15 years. We identified anxiety and depression trajectories based on the hospital anxiety and depression scale subdomains using joint latent class mixture time-to-event models. We included cardiovascular (CV) events and non-CV mortality as competing endpoints.

RESULTS

We included 1,109 patients (15.4% female; mean age, 59.4 (standard deviation [SD] = 8.0) years) with baseline covariate data. Over a median follow-up of 14.8 years, participants experienced 324 subsequent CV events. We identified four anxiety and depression trajectory classes, a low-stable class (52.2% and 69.6% of patients for anxiety and depression, respectively), moderate-stable class (37.6% and 23.8%), increasing class (2.3% and 3.3%), and high-stable/high-decreasing class (7.9% and 3.3%). The hazard ratio (HR) for subsequent CV events for the increasing anxiety class was 2.13 (95% confidence interval [CI], 0.61; 7.45) compared with the low-stable class after covariate adjustment. Patients following the high-decreasing anxiety trajectory showed an HR of 1.72 (95% CI, 1.11; 2.68) and patients following the high-stable depression trajectory an HR of 2.47 (95% CI, 1.35; 4.54).

CONCLUSIONS

Chronic high anxiety and depression trajectory classes were associated with increased risk of subsequent CV events. Assessments of both symptoms of anxiety and depression during long-term routine medical care are recommended to identify patients who would benefit from appropriate interventions.

Longitudinal change and prognostic value of anxiety and depression in coronary heart disease patients

BACKGROUND

This study aimed to investigate the longitudinal changes and risk factors of anxiety and depression, as well as their values in predicting major adverse cardiovascular events (MACE) occurrence in coronary heart disease (CHD) patients.

METHODS

Every 3 months until 36 months (M36), 190 newly diagnosed CHD patients were consecutively recruited and followed up. Anxiety and depression were assessed using hospital anxiety and depression scale (HADS) at each follow-up timepoint. Meanwhile, MACE occurrence was recorded.

RESULTS

Anxiety occurrence sustainably increased from 42.6% at baseline to 51.1% at M36; meanwhile, depression occurrence also sustainably elevated from 33.3% at baseline to 43.7% at M36. Then, independent risk factors for anxiety and depression at baseline/1 year/2 years/3 years were assessed, which revealed that female, diabetes, and higher Gensini score independently predicted anxiety occurrence at each time point, while single/divorced/widowed status independently predicted anxiety occurrence at some specific time points; regarding depression, female, single/divorced/widowed status, diabetes and higher Gensini score independently predicted depression occurrence at each time point, whereas higher education duration, family history of CHD and age > 60 years only predicted depression at some individual time points. Interestingly, baseline/1-year depression were correlated with increased accumulating MACE occurrence, while no correlation of baseline/1-year /2-year/3-year anxiety or 2-year/3-year depression with accumulating MACE occurrence was found.

CONCLUSION

Anxiety and depression are common and progress sustainably with female, diabetes, and higher Gensini score as their independent risk factors; meanwhile, depression but not anxiety may predict increased accumulating MACE occurrence in CHD patients.

Effects of a transtheoretical model - based intervention and motivational interviewing on the management of depression in hospitalized patients with coronary heart disease: a randomized controlled trial

Background

Depression is a major risk factor for the morbidity and mortality of cardiovascular disease. A transtheoretical model-based intervention and motivational interviewing have been used to change health risk behaviors and have demonstrated positive effects. To our knowledge, no studies of patients with coronary heart disease (CHD) have used a transtheoretical model-based intervention and motivational interviewing as an intervention to provide dynamic education. Therefore, this study aimed to determine the effects of the transtheoretical model-based intervention and motivational interviewing on the management of depression in hospitalized patients with CHD.

Method

A randomized controlled trial was designed. A total of 110 participants were randomly divided into an intervention group (n = 55) and a control group (n = 55). The Hamilton Rating Scale for Depression and the Depression Prevention & Management Survey items (stages of change, perceived benefits, perceived barriers, process of change and self-efficacy) were used to collect data at all time points. Analysis of covariance, chi-square test and repeated measures analysis of variance were used to analyze the data.

Results

After the intervention, there were more positive changes in stages of change, higher scores for the cognitive and behavioral levels, the perceived benefits, and self-efficacy, and lower perceived barriers and depression in the intervention group than in the control group. Finally, there were statistically significant differences in the depression scores at different time points in the intervention group (F = 17.814, p = 0.000 < 0.01).

Conclusions

The study showed that a transtheoretical model-based intervention and motivational interviewing exert positive effects on the management of depression in hospitalized patients with CHD.

Trial registration

Clinicaltrials.gov, NCT03953924 (Date assigned: 16/5/2019). Retrospectively registered.

Depressive Symptoms in Women With Coronary Heart Disease: A Systematic Review of the Longitudinal Literature

BACKGROUND

Interpreting studies about women with coronary heart disease and depressive symptoms is challenging: women continue to be underrepresented in research; data are often not presented separately by sex; many studies do not examine depressive symptoms longitudinally, leaving our understanding incomplete; and the use of multiple depressive symptom assessment instruments makes comparisons between studies problematic.

PURPOSE

The authors of this systematic review examined 20 longitudinal descriptive studies on women with coronary heart disease and depressive symptoms, including prevalence of elevated symptoms, changes in symptoms over time, findings in women versus men, and findings based on assessment instruments.

CONCLUSIONS

The prevalence of elevated depressive symptoms in women was 35.75% at baseline (hospitalization). The Beck Depression Inventory II yielded the highest baseline prevalence (40.3%), slightly higher than the Depression Interview and Structured Hamilton Scale (36%). The Hospital Anxiety and Depression Scale and the Kellner questionnaire yielded much lower prevalence (21.45% and 23%, respectively). Higher prevalence was linked to inclusion of somatic symptoms on measurement instruments except in post-coronary bypass surgery patients. Symptoms trended toward improvement, particularly in the first 6 months, although a few studies measured beyond this time. Women demonstrated higher prevalence than men initially (35.75% vs 23.46%, respectively) and over 24 months (22.71% vs 19.82%, respectively).

CLINICAL IMPLICATIONS

Women experienced significantly more depressive symptoms than men initially and over time, although most women's symptoms improved. Measurement varies widely based on instrument and the inclusion/exclusion of somatic symptoms. More longitudinal studies beyond 6 months with prevalence data and analysis by sex/gender are needed.

Association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease

OBJECTIVE

To analyze the association between heart-focused anxiety, depressive symptoms, health behaviors and healthcare utilization in patients with coronary heart disease (CHD).

METHODS

N = 1007 patients with CHD were recruited in hospital and followed for one year in a two-site cohort study. Heart focused anxiety (Cardiac Anxiety Questionnaire [CAQ] with the three subscales fear, attention, and avoidance), depressive symptoms (depression module from the Patient Health Questionnaire [PHQ-9]), health behaviors and healthcare utilization (smoking status, alcohol consumption, physical activity, outpatient physician/psychotherapist visits) were assessed six months after the initial hospitalization. Multiple regression models were used for statistical analysis.

RESULTS

About one third of the sample exhibited clinically significant CAQ scores. Higher CAQ-avoidance scores were associated with current smoking (OR = 1.62; 95%CI: 1.33-1.98), reduced alcohol intake (OR = 0.83; 95%CI: 0.71-0.98), non-participation in a coronary exercise group (OR = 1.76; 95%CI: 1.42-2.17), less regular physical activity (OR = 2.69; 95%CI: 2.32-3.12), and more frequent contact to general practitioners (GPs; b = 0.07, SE: 0.03). CAQ-attention was associated with non-smoking (OR = 0.51; 95%CI: 0.37-0.70), exercise group participation (OR = 0.69; 95%CI: 0.51-0.94), more frequent regular physical activity (OR = 0.55; 95%CI: 0.44-0.68), and more frequent contact to specialists for internal medicine (b = 0.09, SE: 0.04). CAQ-fear was not associated with any of the health behavior or healthcare use measures. Depressive symptoms were associated with reduced regular physical activity (OR = 1.05; 95%CI: 1.02-1.08) and increased contact to mental care specialists (b = 0.03, SE: 0.01) and GPs (b = 0.02, SE: 0.01).

CONCLUSIONS

Heart-focused anxiety and depressive symptoms may impede secondary prevention in patients with CHD and increase outpatient healthcare utilization.

[Influence of gender on protective and vulnerability factors, adherence and quality of life in patients with cardiovascular disease]

OBJECTIVES

To examine gender differences on specific protective factors (PF: acceptance and resilience), vulnerability factors (VF: anger, depression, and anxiety; adherence to treatment and quality of life (QoL) in cardiovascular patients, as well as to study separately the relationships of these factors with adherence and QoL in females and males.

DESIGN

Observational and cross-sectional.

SETTING

Two Primary Care Centres in Gran Canaria.

PARTICIPANTS

One hundred and ninety-eight cardiovascular patients (91 males and 107 females) participated.

MAIN MEASUREMENTS

Acceptance was assessed by the ICQ scale; resilience by the CD-RISC; depression by the PHQ-9; anxiety by the HADS; Anger-In and Anger-Out by the STAXI-2; QoL by the SF-36; and adherence by a self-reported scale.

RESULTS

Females exhibited higher anxiety (95% CI: 6.3-7.9) and adherence to reducing smoking (95% CI: 9.4-10.0) and drinking (95% CI: 9.6-10.1), and lower Anger-Out (95% CI: 8.9-10.0), mental QoL (95% CI: 47.0-51.3) and adherence to medication (95% CI: 22.2-23.3) compared to males. Acceptance was associated with better adherence only in women. There were more VF related to worse adherence in males. Anxiety had a negative impact on adherence, and QoL was positively associated with PF, and negatively with VF in both groups.

CONCLUSIONS

Gender differences in QoL, some VF, and adherence are observed, in addition to the beneficial role of Acceptance in women.

Prevalence of and risk factors for anxiety after coronary heart disease: Systematic review and meta-analysis

BACKGROUND

As the most important component of cardiovascular disease, coronary heart disease (CHD) is closely related to psychological factors such as anxiety. Anxiety, whether present before or after the onset of illness, can lead to many serious consequences. The aim of this systematic review and meta-analysis was to assess the prevalence of and potential risk factors for anxiety after coronary heart disease (post-CHD anxiety).

METHOD

Systematic searches were performed in electronic databases including China National Knowledge Infrastructure (CNKI), Wanfang, Technology Journal database (VIP), PubMed, Web of Science, Embase and Medline.

RESULT

Thirteen studies were included. With regard to cross-sectional studies, the prevalence of post-CHD anxiety was P = .37, 95% CI (0.26-0.49). The overall analysis among cohort studies revealed that the prevalence of post-CHD anxiety was P = .50, 95% CI (0.05-0.95). Among the 11 potential risk factors, low education level [OR = 1.46, 95% CI (1.05-2.02)] and long duration of disease [OR = 2.05, 95% CI (1.05-4.00)] were statistically significant.

CONCLUSION

There is high heterogeneity between studies and many defects; thus, further research is required to support these results. Attention should be paid to post-CHD anxiety, and clinical caring should include psychological counselling and imparting disease-related knowledge to patients with a long disease duration and low educational background.

Mood disorders impaired quality of life but not the mortality or morbidity risk in stable coronary heart disease patients

Background: It was suggested that depression and anxiety might be associated with increased cardiovascular risk in both primary and secondary prevention. In stable coronary heart disease (CHD) patients, we aimed to assess prevalence of depression and anxiety, its relations to conventional risk profile and mortality or morbidity and to quality of life (QoL). Methods: We examined 969 patients, at least 6 months after myocardial infarction or coronary revascularisation. Depression or anxiety was assessed using a standard HADS (Hospital Anxiety and Depression Scale), while QoL by SF-36 (Short-Form-36 Questions) questionnaires. Follow-up was done to assess mortality in incidence of non-fatal cardiovascular event. Results: Both mood disorders were rather frequent; borderline depression or anxiety (HADS score 8-10) had 14.8 or 10.9% of patients, respectively; moderate-to-severe depression or anxiety (HADS score ≥11) had another 8.2 or 6.7% of patients. After adjustment for potential covariates impaired QoL (SF-36 score <40) was independently associated with depressive mood [odds ratio (OR) 6.08 (95%CI: 2.92-12.7) or anxiety [OR 8.66 (95%CI: 3.77-19.89)], as well as with combination of both disorders [OR 33.58 (95%CI: 15.5-72.6)]. Conventional risk characteristics remained virtually unrelated to mood disorders (with exception of angina pectoris). We found significantly higher incidence of major cardiovascular events in patients with anxious mood and marginally significant inferior survival in patients with depression, but any cardiovascular risk disappeared if adjusted for potential covariates (conventional risk factors, natriuretic peptides, angina pectoris.) Conclusions: Mood disorders severely affected QoL of stable CHD patients, but not their global cardiovascular risk.

Longitudinal relationship between B-type natriuretic peptide and anxiety in coronary heart disease patients with depression

OBJECTIVE

Patients with coronary heart disease (CHD) suffer from physical limitations, but also from psychological distress. Natriuretic peptides may be involved in the neurobiological processes that modulate psychological adaptation, as they are increased in heart disease and seem to have an anxiolytic-like function. Longitudinal data on this association are scarce.

METHODS

To assess the relationship between NT-proBNP and anxiety (Hospital Anxiety and Depression Scale (HADS)), we used secondary data from a multicenter trial from baseline to 24 months. Patients (N = 308, 80.8% male, mean age 60.1 years) had stable CHD and moderate levels of depression (HADS ≥8).

RESULTS

Multiple linear regression adjusted for age, sex, BMI, and physical functioning revealed NT-proBNP as a significant predictor for anxiety at baseline, 1, 6, 12, 18, and 24 months (all p < .05). Linear mixed model analysis with the six anxiety measures as level-1 variable and NT-proBNP as fixed factor revealed a significant time*NT-proBNP interaction (t(1535.99) = -2.669, p = .01) as well as a significant time*NT-proBNP*sex interaction (t(1535.99) = 3.277, p = .001), when NT-proBNP was dichotomized into lowest vs. the three highest quartiles.

CONCLUSION

Our results indicate a stable negative association of baseline NT-proBNP with anxiety over two years. In men and women, different pathways modulating this relationship appear to be in effect. Female patients with very low NT-proBNP levels, despite their cardiac disease, show persistently higher levels of anxiety compared to women with higher levels of NT-proBNP and compared to men. Trial name: A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD).

TRIAL REGISTRATION

www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576.

EVALUATION OF THE INTERNAL PICTURE OF HEALTH IN PATIENTS WITH ACUTE CORONARY SYNDROME IN PRESENTING WITHOUT ST-SEGMENT AFTER PERCUTANEOUS CORONARY INTERVENTIONS AND IN THE PROCESS OF REHABILITATION

Ischemic heart disease remains an actual problem of modern clinical and rehabilitation medicine. One of the forms of ischemic heart disease (IHD) is an acute coronary syndrome (ACS) in patients presenting without persistent ST-segment, the treatment of which involves the use of conservative treatment and reperfusion techniques. An integral part of the management of patients after acute coronary syndrome is rehabilitation and restoration with the search for methods of changing the attitude of the patient to his health. To improve the rehabilitation of patients it is important to assess the internal picture of health with the formation of the correct attitude of the patient to his health. Aim. To study the peculiarities of the components of the internal picture of health in patients with acute coronary syndrome in patients presenting without persistent ST-segment in the process of treatment and rehabilitation. Materials and methods. There were examined 135 patients with ACS presenting without persistent ST-segment, who were divided into the groups depending on the treatment performed; 60 patients with conservative treatment tactics and 75 patients with the performed PCI. The analysis of the internal picture of health was carried out with the help of methods: hospital scale for the detection of anxiety and depression (HADS); patient health questionnaire (PHQ-9); scale for measuring the level of reactive (situational) and personality anxiety of Spielberg-Hanin; SF-36; indicators of the Seattle Quality of Life Questionnaire for Patients with Angine Pectoris (Seattle Angina Questionnaire - SAQ). Results. The study of the internal picture of health in patients with ACS presenting without persistent ST-segment showed low levels of emotional, sensory, cognitive, value-motivational, behavioral components on the appropriate scales, which also depend on the method of treatment used. The revealed peculiarities of patients with ACS presenting without persistent ST-segment need to increase the knowledge of the patient about the disease and the importance of rehabilitation measures. Conclusions. In assessment of the internal picture of health in patients with ACS presenting without persistent ST-segment after transcutaneous coronary intervention and in the process of rehabilitation, it has been determined that the course of ischemic heart disease in patients with ACS presenting without persistent ST-segment, both during conservative treatment and in the course of PCI at the stages of rehabilitation, is accompanied by significant changes of the internal picture of health (IPH); the most significant changes in patients with ACS presenting without persistent ST-segment is the value-motivational and behavioral components of the internal picture of health. In order to increase the effectiveness of rehabilitation after ACS, it is advisable to apply programs that will significantly affect the positive changes in the rehabilitation of patients with ACS.

Determinants of depression in patients with comorbid depression following cardiac rehabilitation

Background

A prior history of depression, at the point patients start cardiac rehabilitation (CR), is associated with poor outcomes; however, little is known about which factors play a part in determining the extent of benefit following CR. Therefore, we aim to identify and evaluate determinants of CR depression outcomes in patients with comorbid depression.

Methods

An observational study of routine practice using the British Heart Foundation National Audit of Cardiac Rehabilitation data between April 2012 and March 2017. Baseline characteristics were examined with independent samples t-test and χ2 test. A binary logistic regression was used to predict change in depression outcome following CR.

Results

The analysis included 2715 CR participants with depression history. The determinants of Hospital Anxiety and Depression Scale (HADS) depression measurement post-CR were higher total number of comorbidities (OR 0.914, 95% CI 0.854 to 0.979), a higher HADS anxiety score (OR 0.883, 95% CI 0.851 to 0.917), physical inactivity (OR 0.707, 95% CI 0.514 to 0.971), not-smoking at baseline (OR 1.774, 95% CI 1.086 to 2.898) and male gender (OR 0.721, 95% CI 0.523 to 0.992).

Conclusion

Baseline characteristics of patients with comorbid depression such as higher anxiety, higher total number of comorbidities, smoking, physical inactivity and male gender were predictors of their depression levels following CR. CR programmes need to be aware of comorbid depression and these related patient characteristics associated with better CR outcomes.

Multi-state models of transitions in depression and anxiety symptom severity and cardiovascular events in patients with coronary heart disease

Objective

Patients with coronary heart disease (CHD) commonly suffer from depression and anxiety, yet transitions of symptom severity and cardiovascular events (CVE) over time are not well characterized.

Methods

We included 997 patients with stable CHD from a prospective cohort study. We estimated 5- and 10-year transition probabilities of depression and anxiety symptom severity levels and fatal- and non-fatal adverse CVE. Depression and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale 5 times over 13 years and categorized as no, mild, or moderate/severe symptoms. Using multi-state modeling, we calculated 5- and 10-year transition probabilities for depression and anxiety symptom severity and CVE and calculated transition intensity ratios for factors associated with symptom severity progression and regression.

Results

At 5 years, only approximately half of participants with moderate or severe symptom severity at baseline transitioned to no symptom severity. Patients with low physical activity (<1x/week or never) had a higher probability of worse symptom severity after 5 and 10 years and a higher probability of a CVE after 5 and 10 years regardless of their depression status at baseline compared to higher physical activity groups. Higher body mass index, <10 years of education, and lower physical activity were associated with depression symptom progression; female and lower physical activity were associated with anxiety symptom progression.

Conclusions

Patients with CHD had a consistent burden of depression and anxiety symptoms. Secondary prevention strategies should target depression and anxiety and include a physical activity component.

The role of beta-adrenolytic drugs in treating anxiety disorders

Introduction: Beta blockers are mainly used in treating cardiovascular diseases. However, it has been observed that these drugs have also an anxiolytic potential. Over the years, a number of clinical trials have been conducted aimed at determining the effectiveness of beta blockers in treating anxiety disorders.

The aim of the article: The main objective of the article is to present the significance and position of adrenolytic drugs in the pharmacotherapy of anxiety disorders on the basis of available literature. Moreover, the authors also decided to take into account the data from current research results, considering the problem of side effects of using adrenolytic drugs - especially the controversial reports on their effect on the development of affective disorders.

Method: An analysis was conducted of articles from Medline/PubMed database, selected on the basis of the following key words: anxiety disorders, beta blockers, adrenolytic drugs, as well as on the basis of their dates of publication: 1960-2017. In order to conduct a reliable and complete review of literature, the authors decided to include works from quite an extended period of time. The articles included in the review were published in Polish and English.

Results: The review of articles concerning the treatment of anxiety disorders clearly suggests that propranolol is effective in reducing the frequency of panic attacks and the tendency for avoidance behavior in patients with agoraphobia. Other studies report on potential benefits in terms of early interventional prevention and treating posttraumatic stress disorder with propranolol. However, there is lack of randomized clinical trials concerning the therapeutic effect of other adrenolytic drugs in treating anxiety disorders. Early research works reported that (mainly lipophilic) beta blockers may have a depressogenic effect; however, the latest studies have not confirmed it.

The contemporary research on the therapeutic potential of beta blockers in treating anxiety disorders is insufficient. What seems to be most promising, however, are reports concerning the desirable effects of using adrenolytic drugs in treating posttraumatic stress disorder, which implicates the necessity of conducting further research verifying the validity of their application.

Factors associated with acute depressive symptoms in patients with comorbid depression attending cardiac rehabilitation

Background

The literature suggests that comorbid depression, defined in this paper as a history of depression prior to a cardiovascular event, has an impact on later onset depression as well as constituting increased risk of mortality and adverse cardiac events. However, which factors are associated with depression, specifically in patients with comorbid depression, is unclear. Therefore, this paper investigates the factors associated with depression in patients with comorbid depression attending cardiac rehabilitation (CR).

Methods

This observational study used routinely collected data from the British Heart Foundation National Audit of Cardiac Rehabilitation for the time period between April 2012 and March 2017. CR participants with comorbid depression were selected as the study population. An independent t-test and chi-square test were used to compare the association between acute depression symptoms and baseline characteristics in this population.

Results

A total of 2715 CR patients with comorbid depression were analysed. Characteristics associated with acute depressive symptoms in patients with comorbid depression were found to be: young age (MD: 2.71, 95% CI 1.91, 3.50), increased number of comorbidities (MD: -0.50, 95% CI -0.66, − 0.34), increased weight (MD: -1.94, 95% CI -3.35, − 0.52), high BMI (MD: -1.94, 95% CI -3.35, − 0.52), HADS anxiety (MD: -5.17, 95% CI -5.47, − 4.87), comorbid anxiety (52.4%, p <  0.001), physical inactivity (150 min moderate physical activity a week and 75 min vigorous exercise a week; 27.5%, p <  0.001; 5.6%, p <  0.001 respectively), smoking (12.7%, p <  0.001), and being less likely to be partnered (63.6%, p <  0.001).

Conclusion

The study demonstrated the association between a variety of clinical and socio-demographic factors and depression. The findings of the research indicated that, at CR baseline assessment, caution must be taken with patients with comorbid depression, specifically those with higher level depressive symptoms at the start of rehabilitation. Furthermore, their multi-comorbid condition must also be taken into account. Patients with higher depression symptoms and comorbid depression scored five points higher on the HADS anxiety scale in comparison to patients with lower level depression symptoms at the start of CR, which demonstrated that anxiety and depression are interrelated and present together.

Emergency department patients' clinical and demographic characteristics regarding Hospital Anxiety subscale

OBJECTIVE

To evaluate clinical and demographic characteristics of the emergency department (ED) patients using Hospital Anxiety and Depression Scale (HADS) which includes anxiety (HAD-A) subscale.

MATERIALS AND METHODS

In this cross-sectional study, all consecutive adult patients admitted to the community hospital-based ED in the study period were enrolled prospectively. HAD-A items were responded by the patients themselves. Demographic characteristics, history, and clinical findings were analyzed.

RESULTS

Four hundred and ninety-eight consecutive ED patients with eligible conditions were enrolled. Mean age was 44.1 ± 16.5 (range 18-90) and 53.0% (n = 264) were female. The presence of pathological examination finding was significantly associated with a tendency to have a HAD-A score higher than 10 (p = .044). Presence of systemic disease was significantly associated with higher anxiety scores (t-test, p = .029). Patients presented with acute exacerbation of a chronic illness and those with psychological condition had significantly higher HAD-A scores (p = .014 and p = .008, respectively).

CONCLUSIONS

High acuity, presence of pathological finding, higher income, presence of a systemic disease, acute exacerbation of a chronic illness were significantly associated with higher anxiety scores.

The Mediating Role of Perceived Social Support Between Physical Activity Habit Strength and Depressive Symptoms in People Seeking to Decrease Their Cardiovascular Risk: Cross-Sectional Study

BACKGROUND

Regular physical activity treatment has been advocated for the prevention and rehabilitation of patients at risk of cardiovascular diseases and depressive symptoms. How physical activity is related to depressive symptoms is widely discussed.

OBJECTIVE

The aim of this internet-based study was to investigate the role of perceived social support in the relationship between physical activity habit strength and depressive symptoms.

METHODS

In total, 790 participants (mean 50.9 years, SD 12.2, range 20-84 years) who were interested in reducing their cardiovascular risk were recruited in Germany and the Netherlands. Data collection was conducted via an internet-based questionnaire addressing physical activity habit strength, depressive symptoms, and perceived social support. Cross-sectional data analysis was done with SPSS version 24 using the Macro PROCESS version 2 16.3 by Hayes with bootstrapping (10,000 samples), providing 95% CIs.

RESULTS

Physical activity habit strength was negatively related to depressive symptoms (r=-.13, P=.006), but this interrelation disappeared when controlling for perceived social support (beta=-.14, SE 0.09, P=.11). However, there was an indirect relationship between physical activity habit strength and depressive symptoms, which was mediated via perceived social support (beta=-.13; SE 0.04, 95% CI -0.21 to 0.06). The negative relationship between physical activity habit strength and depressive symptoms was fully mediated by perceived social support.

CONCLUSIONS

We suggest that physical activity treatment in people interested in reducing their cardiovascular risk should also embed social support to target depressive symptoms. Internet-based interventions and electronic health may provide a good option for doing so.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/73Y9RfdiY).

Psychiatric diagnoses and their influencing factors in patients complaining of sleep problems: A study of a psychiatric consultation-liaison service

Objective This study aimed to identify misdiagnosed or undiagnosed psychiatric disorders and the factors associated with these disorders in patients with sleep problems who are referred to a consultation-liaison service. Method Records of all inpatients receiving a consultation from the Psychiatry Department between January and December 2016 were retrospectively reviewed. Psychiatric diagnoses were analyzed using descriptive statistics, and the factors associated with the risk of these disorders in patients with sleep problems were determined by multiple logistic regression analysis. Results Of the 331 referral patients whose referral reason was simply having trouble in sleeping, only 97 patients were diagnosed with primary sleep disorder after consultation. The recognition rate of psychiatric disorders in inpatients with sleep problems among nonpsychiatric physicians was 29.3%. Anxiety (107, 45.7%) was the most common psychiatric diagnosis in patients with sleep problems followed by organic mental disorder (83, 35.5%), depression (37, 15.8%), and other mental disorders (8, 3.4%). Multiple logistic regression analysis revealed that a course >1 month (OR = 3.656, 95% CI = 2.171-6.156, p = 0.000) and sleep-wake rhythm disturbances (OR = 25.008, 95% CI = 5.826-107.341, p = 0.000) were associated with increased risks of psychiatric disorders. Conclusions The study showed that recognition rate of psychiatric disorders in inpatients with sleep problems was very low. A course >1 month and sleep-wake rhythm disturbances were associated with increased risks of disorders and could be used as indicators by nonpsychiatric physicians to improve diagnoses.

Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths

The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.

Mental Health and Psychosocial Functioning Over the Lifespan of German Patients Undergoing Cardiac Catheterization for Coronary Artery Disease

Background: Psychological problems are common in patients with coronary artery disease (CAD) and are associated with poor outcome. However, data on the prevalence of distinct mental disorders and their relevance to patients' functioning in daily life are scarce. Method: In this retrospective study, a total of 514 German patients with CAD as diagnosed by cardiac catheterization were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (M.I.N.I.) and psychosocial functioning was evaluated using the Global Assessment of Functioning (GAF) scale. Results: Twenty-nine percent of the participants suffered from at least one mental disorder after the onset of their CAD (mean time since onset = 10.86 years, SD = 8.15). In comparison to the period before onset of CAD, elevated prevalence rates were found for severe depressive episodes, agoraphobia, dysthymia, panic disorder, and hypochondria. Predictors of mental disorders after the onset of CAD were female gender, younger age at onset of CAD as well as mental disorders and low GAF scores before onset. GAF scores decreased after the onset of CAD, recovered only partially, and were influenced by mental disorders before onset in women but not in men. Conclusions: Mental disorders-especially depression and agoraphobia-are frequent in patients with CAD, with women, patients with a younger age at onset of CAD and patients with any history of mental disorders especially at risk. Regardless of whether patients meet any specific diagnostic criteria, psychosocial functioning is markedly impaired after the onset of CAD, underscoring the need for specific mental health programs for this patient population. Future research, ideally using a prospective design, is necessary to confirm these findings and to further the knowledge of prevalence rates of mental disorders and of modifiable risk factors for the development of mental disorders in patients with CAD.

Association of Depression and Anxiety With the 10-Year Risk of Cardiovascular Mortality in a Primary Care Population of Latvia Using the SCORE System

Background: Depression and anxiety have been recognized as independent risk factors for both the development and prognosis of cardiovascular (CV) diseases (CVD). The Systematic Coronary Risk Evaluation (SCORE) function measures the 10-year risk of a fatal CVD and is a crucial tool for guiding CV patient management. This study is the first in Latvia to investigate the association of depression and anxiety with the 10-year CV mortality risk in a primary care population. Methods: This cross-sectional study was conducted at 24 primary care facilities. During a 1-week period in 2015, all consecutive adult patients were invited to complete a nine-item Patient Health Questionnaire (PHQ-9) and a seven-item Generalized Anxiety Disorder scale (GAD-7) followed by sociodemographic questionnaire and physical measurements. The diagnostic Mini International Neuropsychiatric Interview (M.I.N.I.) was administered by telephone in the period of 2 weeks after the first contact at the primary care facility. A hierarchical multivariate analysis was performed. Results: The study population consisted of 1,569 subjects. Depressive symptoms (PHQ-9 ≥10) were associated with a 1.57 (95% confidence interval (CI): 1.06-2.33) times higher odds of a very high CV mortality risk (SCORE ≥10%), but current anxiety disorder (M.I.N.I.) reduced the CV mortality risk with an odds ratio of 0.58 (95% CI: 0.38-0.90). Conclusions: Our findings suggest that individuals with SCORE ≥10% should be screened and treated for depression to potentially delay the development and improve the prognosis of CVD. Anxiety could possibly have a protective influence on CV prognosis.

Social inequality in phase II cardiac rehabilitation attendance: The impact of potential mediators

BACKGROUND

Cardiac rehabilitation participation is an essential component of the contemporary management of coronary heart disease. However, patients with low socioeconomic position are less likely to attend the rehabilitation programme.

AIM

We aimed to explore the effect of potential mediators between socioeconomic position defined by educational attainment and cardiac rehabilitation attendance.

METHODS

Prospective observational study of patients with acute coronary syndrome ( N=302). Logistic regression and mediation analysis was conducted to explore mechanisms of non-attendance.

RESULTS

Thirty per cent attended full cardiac rehabilitation. Patients with low educational attainment, comorbidities, long commute to cardiac rehabilitation centre, and lone dwelling were less likely to attend full cardiac rehabilitation, whereas patients with high anxiety and depression score were more likely to attend full cardiac rehabilitation. Patients with low educational attainment had lower self-efficacy and longer commute compared with patients with high educational attainment. The potential mediators included in the study, however, did not have a significant mediation effect.

CONCLUSION

Our study demonstrated a variety of mechanisms contributing to cardiac rehabilitation non-attendance. Further, the study demonstrated that non-attendance was especially related to the cardiac rehabilitation elements involving lifestyle modifications. However, the mechanisms explaining social inequality in full cardiac rehabilitation are still not fully understood.

Anxiety and depression in older patients: the role of culture and acculturation

Background

Anxiety and depression are major health concerns in general among older adults and especially during hospitalization, as they lead to numerous negative outcomes. There is currently no sufficient body of research examining the role of cultural background in patients’ experience of these conditions. Better identifying patients at risk may help reduce inequity and provide patient-centered, culturally sensitive care. The current study explores the roles of culture and acculturation in anxiety and depression levels in recent and veteran Russian immigrants compared with native Israelis and veteran immigrants from Middle Eastern countries.

Methods

Secondary analysis of a prospective cohort study of cognitively intact older adults (70+) hospitalized for acute conditions in internal medical units in two hospitals in Israel during 2009–11. Depression and anxiety were assessed within 48 h of admission through personal interview using the Tucker Depression Rating and the Short Anxiety Screening Tests. Demographic and health data were collected from electronic health records. Immigration status was defined by country and emigration year. Study hypotheses were tested employing analyses of covariance, modeling anxiety and depression symptoms separately, controlling for potential confounders.

Results

Significant differences between study groups were observed in fully adjusted models for anxiety symptoms (F_{[3, 515]} = 5.24, p < .01) when both veteran (21 ± 5.83) and recent (20.2 ± 5.23) Russian immigrants expressed higher anxiety levels than native Israelis (18.35 ± 5.23) and veteran immigrants (18 ± 5.03) (from p = .05 to p < 0.01). No significant differences were found in anxiety symptoms between recent and veteran Russian immigrants. Both depression and anxiety symptoms showed an interaction effect of study immigration groups by sex: while no differences were observed among native Israelis, significantly higher depression and anxiety were observed among women than men in the other groups.

Conclusions

Culture of origin may play a central role in determining expression of anxiety symptoms and perhaps modify acculturation. During hospitalization, special attention should be given to the level of anxiety among not only recent but also veteran immigrants. Further research may explore whether elevated anxiety is a result of stress due to hospitalization or a stable trait.

Does Tai Chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review protocol

INTRODUCTION

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Psychological risk factors such as stress, anxiety and depression are known to play a significant and independent role in the development and progression of CVD and its risk factors. Tai Chi has been reported to be potentially effective for health and well-being. It is of value to assess the effectiveness and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors.

METHODS AND ANALYSIS

We will include all relevant randomised controlled trials on Tai Chi for stress, anxiety, depression, psychological well-being and quality of life in people with CVD and cardiovascular risk factors. Literature searching will be conducted until 31 December 2016 from major English and Chinese databases. Two authors will conduct data selection and extraction independently. Quality assessment will be conducted using the risk of bias tool recommended by the Cochrane Collaboration. We will conduct data analysis using Cochrane's RevMan software. Forest plots and summary of findings tables will illustrate the results from a meta-analysis if sufficient studies are identified.

ETHICS AND DISSEMINATION

Ethics approval is not required as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical practice and further research on Tai Chi and CVDs.

DISCUSSION

This review will summarise the evidence on Tai Chi for psychological well-being and quality of life in people with CVD and their risk factors. We anticipate that the results of this review would be useful for healthcare professionals and researchers on Tai Chi and CVDs.

TRIAL REGISTRATION NUMBER

International Prospective Register for Systematic Reviews (PROSPERO) number CRD42016042905.

Impact of perceived control on all-cause and cardiovascular disease mortality in three urban populations of Central and Eastern Europe: the HAPIEE study

Background

Inverse associations between perceived control and cardiovascular disease (CVD) have been reported in studies from Western Europe and the USA. To assess this relationship across different populations, we investigated the association between perceived control and all-cause and CVD mortality in three population-based cohorts of Eastern European countries.

Methods

We analysed data from a prospective cohort study in random population samples in Krakow (Poland), Novosibirsk (Russia) and six Czech towns. Baseline survey included structured questionnaire and objective examination in a clinic. Perceived control was assessed using an 11-item scale developed by the MacArthur Foundation Programme on Successful Midlife. Information on vital status was obtained from death registers. Effect of perceived control on mortality was assessed using Cox proportional hazards models.

Results

A total of 2377 deaths (1003 from CVD) occurred among 27 249 participants over a median 7-year follow-up. In the Czech and Polish cohorts, perceived control was inversely associated with mortality; the adjusted HRs for the lowest versus highest control quintiles were 1.71 (1.34 to 2.19) in men and 1.63 (1.14 to 2.35) in women for all-cause mortality and 2.31 (1.48 to 3.59) and 5.50 (2.14 to 14.13) for CVD deaths. There was no association between perceived control and mortality in Russia; the adjusted HRs for all-cause mortality were 1.03 (0.79 to 1.34) in men and 1.29 (0.82 to 2.02) in women.

Conclusions

Low perceived control was associated with increased risk of all-cause and CVD mortality in Czech and Polish cohorts but not in Russia. It is possible that this inconsistency may partly reflect a different sociocultural understanding of the concept of control in Russia.

Screening for symptoms of anxiety and depression in patients admitted to a university hospital with acute coronary syndrome

Abstract Objective: To investigate the prevalence of anxiety and depression in patients admitted for acute coronary syndrome to a university hospital and to examine associations with use of psychotropic drugs. Methods: Ninety-one patients who had had an acute coronary event were enrolled on this cross-sectional prevalence study. Characteristics of the study population and the prevalence rates of depression and anxiety in the sample were assessed using the Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) psychiatric consultation protocol, which includes clinical and sociodemographic data, and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of symptoms of anxiety was 48.4% (44 patients) and the prevalence of depressive symptoms was 26.4% (24 patients). Of these, 19 patients (20.9% of the whole sample) had scores indicative of both types of symptoms concomitantly. Considering the whole sample, just 17 patients (18.7%) were receiving treatment for anxiety or depression with benzodiazepines and/or antidepressants. Conclusions: Anxiety and depression are disorders that are more prevalent among patients with acute coronary syndrome than in the general population, but they are generally under-diagnosed and under-treated. Patients with anxiety and depression simultaneously had higher scores on the HADS for anxiety and depression and therefore require more intensive care.

Predictors of coronary artery disease in middle-aged Taiwanese women at premenopause, postmenopause and after undergoing hysterectomy

AIMS AND OBJECTIVES

To examine the predictors of coronary artery disease among middle-aged women at various menopausal statuses.

BACKGROUND

Few studies have explored coronary artery disease predictors among middle-aged women at various menopausal statuses, particularly with the inclusion of women who underwent a hysterectomy.

DESIGN

A cross-sectional design was adopted.

METHODS

Two hundred and twenty-five middle-aged women who were waiting for catheterisation examinations because of possible coronary artery disease were selected. These patients were divided into premenopausal (n = 41), postmenopausal (n = 143) and women who had undergone a hysterectomy groups (n = 41). The differences in the risk factors for coronary artery disease between patients with coronary artery disease (catheterisation results showing stenosis of >50% in at least one major coronary artery) and those without coronary artery disease in the three groups were compared.

RESULTS

The participants were aged 56·8 ± 5·9 years. In the premenopausal group, the odds of coronary artery disease among ever or current smokers was 8·46 times the odds of coronary artery disease for the never smokers. In the postmenopausal group, the odds of coronary artery disease among diabetes patients was 2·89 times the odds of coronary artery disease for those without diabetes. Each additional point on the Chinese Beck Depression Inventory-II increased the risk of coronary artery disease by 5%. In the hysterectomy group, each additional increase in 1 mmHg in systolic blood pressure increased the risk of coronary artery disease by 4%.

CONCLUSIONS

Smoking, diabetes, depression and systolic blood pressure are predictors of coronary artery disease in middle-aged women at premenopause, postmenopause and after undergoing hysterectomy respectively.

RELEVANCE TO CLINICAL PRACTICE

These results are beneficial for middle-aged women at various menopausal stages to effectively implement prevention of coronary artery disease. These findings were among women being evaluated for possible coronary artery disease, we suggest the need for further study in lager, longitudinal studies.

Gender-specific secondary prevention? Differential psychosocial risk factors for major cardiovascular events

Objective

To explore the psychosocial determinants and interhospital variability on a major acute cardiovascular event (MACE), during follow-up of a multicenter cohort of patients hospitalised with heart disease, participating in a nurse-led secondary prevention programme.

Methods

Outcome data were retrospectively analysed from 602 cardiac inpatients randomised to postdischarge standard care (n=296), or home-based intervention (n=306), with prolonged follow-up of individualised multidisciplinary support. Baseline psychosocial profiling comprised depressive status, health-related quality of life (HRQoL), social isolation and mild cognitive impairment (MCI). Multivariate analyses examined the independent correlates of a composite 2-year MACE rate of all-cause mortality and unplanned cardiovascular-related hospitalisation, according to gender.

Results

Participants were aged 70±10 years, 431 (72%) were men and 377 (63%) had coronary artery disease. During 2-year follow-up, 165 (27%) participants (114 men, 51 women; p=0.431) experienced a MACE. Independent correlates of a MACE in men were depressive status (OR 1.95, 95% CI 1.06 to 3.58; p=0.032), low physical HRQoL (OR 0.98, 95% CI 0.96 to 1.00; p=0.027) and increasing comorbidity (OR 1.14, 95% CI 1.04 to 1.25; p=0.004). In women, age (OR 1.06, 95% CI 1.02 to 1.12; p=0.008), MCI (OR 2.38, 95% CI 1.09 to 5.18; p=0.029) and hospital site predicted a MACE (OR 2.32, 95% CI 1.09 to 4.93; p=0.029).

Conclusions

Psychological determinants, cognitive impairment and responses to secondary prevention are different for men and women with heart disease and appear to modulate cardiovascular-specific outcomes. Early detection of psychosocial factors through routine screening and gender-specific secondary prevention is encouraged.

Trial registration number

12608000014358.