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Xiao N, Huang X, Yang D, Zang W, Kiselev S, Bolkov MA, Shinwari K, Tuzankina I, Chereshnev V. Health-related quality of life in patients with inborn errors of immunity: A systematic review and meta-analysis. Prev Med 2024; 186:108079. [PMID: 39053518 DOI: 10.1016/j.ypmed.2024.108079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Inborn Errors of Immunity (IEI) significantly affect patients' health-related quality of life (HRQOL), presenting greater challenges than those faced by the healthy population and other chronic disease sufferers. Current research lacks comprehensive integration of this critical issue. OBJECTIVE This study explores HRQOL in IEI patients, identifies impacting factors, and advocates for increased research focus on their quality of life. METHODS Following systematic review and meta-analysis guidelines, a search of Scopus and PubMed until November 15, 2023, yielded 1633 publications. We evaluated the literature, assessed study quality, and compared the HRQOL of IEI patients to that of healthy individuals and other chronic disease patients. RESULTS Of 90 articles and 10,971 IEI patients analyzed, study quality varied (nine good, 63 moderate, and 18 poor). The Short Form-36 (SF-36) and Pediatric Quality of Life Inventory generic core scales (PedsQL) were the primary generic instruments used among adults and children, respectively, with 12 studies each using the disease-specific instruments. Meta-analysis showed IEI patients have significantly lower scores in general health, physical and mental health, and social and emotional roles compared to healthy populations. We noted significant differences between self and proxy reports, indicating caregiver anxiety and perception disparities. CONCLUSION Despite limitations like small sample sizes and reliance on generic instruments, this research underscores the substantially lower HRQOL among IEI patients, emphasizing the need for a patient-centered, multidisciplinary approach to improve their life quality and calling for more focused attention on IEI patients and their caregivers' HRQOL.
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Affiliation(s)
- Ningkun Xiao
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Yekaterinburg, Russia; Laboratory for Brain and Neurocognitive Development, Department of Psychology, Institution of Humanities, Ural Federal University, Yekaterinburg, Russia.
| | - Xinlin Huang
- Laboratory for Brain and Neurocognitive Development, Department of Psychology, Institution of Humanities, Ural Federal University, Yekaterinburg, Russia.
| | - Dandan Yang
- Guang'an District Women and Children's Hospital, Guang'an, China
| | - Wanli Zang
- Postgraduate School, University of Harbin Sport, Harbin, China.
| | - Sergey Kiselev
- Laboratory for Brain and Neurocognitive Development, Department of Psychology, Institution of Humanities, Ural Federal University, Yekaterinburg, Russia.
| | - Mikhail A Bolkov
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Khyber Shinwari
- Department Biology, Nangrahar University, Nangrahar, Afghanistan
| | - Irina Tuzankina
- Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia
| | - Valery Chereshnev
- Department of Immunochemistry, Institution of Chemical Engineering, Ural Federal University, Yekaterinburg, Russia; Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia.
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Verdicchio CV, Hollings M, Freene N. Understanding what factors underpin change in walking distance in patients with depression following completion of cardiac rehabilitation: commentary. Eur J Cardiovasc Nurs 2024:zvae078. [PMID: 38805179 DOI: 10.1093/eurjcn/zvae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/05/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Christian V Verdicchio
- Heart Support Australia, Canberra, ACT, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia
| | - Matthew Hollings
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole Freene
- Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT 2617, Australia
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Nordmeyer L, Leikert C, Sannemann L, Keller K, Leminski C, Meixner A, Peltzer S, Werner B, Kuntz L, Pfaff H, Schulz-Nieswandt F, Jessen F, Albus C. Quality of health care for patients with coronary heart disease and comorbid mental disorders: a prospective cohort study. BMC Psychol 2024; 12:288. [PMID: 38783365 PMCID: PMC11112883 DOI: 10.1186/s40359-024-01693-x] [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: 09/07/2023] [Accepted: 03/28/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is often associated with mental disorders (MDs). Comorbid MDs reduce the quality of life and increase cardiac morbidity and mortality. Nevertheless, there is little and inconsistent research on the management of MDs in CHD patients. To bridge this gap, this study aims to gain insight into the long-term course of MD-related health care for patients with CHD, in order to identify opportunities for care improvement. METHODS In this prospective cohort study, we investigated whether CHD patients with or without expert-rated MD at baseline (N = 364) received different MD-related health care from either their general practitioner (GP) or cardiologist at follow-up, M = 2.7 [2.0-4.0] years later. In the follow-up assessment, N = 131 CHD patients participated and received questionnaires capturing sociodemographic, mental health, and MD-related health care characteristics. Descriptive statistics, t-tests and chi-squared tests were used for analyses. RESULTS We found significant differences in MD-related health care. CHD patients with MD were more likely to be examined psychologically/psychiatrically (MD 55.9%, non-MD 16.7%, p = < .001) and diagnosed with MD (MD 55.9%, non-MD 13.5%, p = .020) by their GP or cardiologist. Recommendations for and responses to requests for psychotherapy were more likely in MD patients compared to non-MD patients (MD 38.7%, non-MD 11.8%, p = .012 and MD 38.5%, non-MD 11.8%, p = .031, respectively). No significant differences were found concerning physicians' active demand for patients' mental health, referral to a specialist for additional diagnostics, provision of information about the diagnosed MD and further treatment options, response to the patients' request for psychopharmacotherapy, help received in finding psychotherapy or psychopharmacotherapy, and actual receipt of these treatments. CONCLUSIONS The results indicate differences in MD-related health care of CHD patients with and without comorbid MD. However, they still highlight the need to further encourage primary care physicians treating CHD to adequately address MDs, provide further diagnostics, support, and information to affected patients. To address this, physicians may benefit from awareness training on the association between CHD and MDs and on appropriate communication with MD patients. TRIAL REGISTRATION German clinical trials register (Deutsches Register Klinischer Studien, DRKS) Registration Number: ID DRKS00022154, date of registration: 02.11.2021.
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Affiliation(s)
- Laura Nordmeyer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Charlotte Leikert
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Lena Sannemann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Kai Keller
- Chair of Quality Development and Evaluation in Rehabilitation, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Christin Leminski
- Chair of Quality Development and Evaluation in Rehabilitation, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Adriana Meixner
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Samia Peltzer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
| | - Belinda Werner
- Faculty of Management, Economics and Social Sciences, Institute of Sociology and Social Psychology (ISS), University of Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
- Centre for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Chair of Quality Development and Evaluation in Rehabilitation, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
- Centre for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
| | - Frank Schulz-Nieswandt
- Faculty of Management, Economics and Social Sciences, Institute of Sociology and Social Psychology (ISS), University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine and Cologne University Hospital, University of Cologne, Cologne, Germany.
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Lee S, Quinn L, Fritschi C, Fink AM, Park C, Reutrakul S, Collins EG. Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors. West J Nurs Res 2024; 46:333-343. [PMID: 38533821 DOI: 10.1177/01939459241240432] [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: 03/28/2024]
Abstract
BACKGROUND Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.
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Affiliation(s)
- Sueyeon Lee
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Lauretta Quinn
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Cynthia Fritschi
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Anne M Fink
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Eileen G Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Wu SH, Shi WQ, Li YH, Liu RH, Hu DY, Zheng LQ, Ma WL. Effect of Guanxin Danshen Dripping Pills on Coronary Heart Disease Comorbid with Depression or Anxiety: The ADECODE-Real World Study. Chin J Integr Med 2024; 30:443-448. [PMID: 37947990 DOI: 10.1007/s11655-023-3628-x] [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] [Accepted: 10/12/2022] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate the efficacy of Guanxin Danshen Dripping Pill (GXDSDP) in treating anxiety and depression in patients with coronary heart disease (CHD). METHODS A total of 1,428 patients diagnosed with CHD screened for anxiety, depression, and quality of life (QOL) at baseline received 0.4 g of GXDSDP treatment 3 times per day and returned for monthly reassessment. Patients were recruited after stable treatment for CHD and received assessment of General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Seattle Angina Questionnaire (SAQ) for evaluating anxiety, depression, and QOL. Patients were followed up 3 times, once every 4 weeks, during outpatient visits for 12 weeks. RESULTS At the third follow-up (F3), the anxiety symptom of 63.79% (673/1,055) of the patients improved to sub-clinical level, and the GAD-7 score improved significantly (8.11 vs. 3.87, P<0.01); 57.52% (585/1,017) patients' depressive symptoms improved to sub-clinical level, with a significant improvement in PHQ-9 score (8.69 vs. 4.41, P<0.01) at F3. All aspects of QOL significantly improved at the end of treatment compared to those at baseline (all P<0.01) as assessed by SAQ: physical limitation (31.17 vs. 34.14), anginal stability (2.74 vs. 4.14), anginal frequency (8.16 vs. 9.10), treatment satisfaction (13.43 vs. 16.29), and disease perception (8.69 vs. 11.02). CONCLUSIONS A fixed dosage of GXDSDP may be a potential treatment option for CHD patients comorbid with anxiety or depression. (Registration No. ChiCTR2100051523).
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Affiliation(s)
- Shi-Hao Wu
- Department of Geriatric Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Wei-Qi Shi
- Department of Geriatric Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Yu-Hang Li
- Department of Geriatric Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Ru-Hui Liu
- Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China
| | - Da-Yi Hu
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Li-Qiang Zheng
- School of Public Health, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Wen-Lin Ma
- Department of Geriatric Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065, China.
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Silva RD, Teixeira AC, Pinho JA, Marcos P, Santos JC. Sleep, anxiety, depression, and stress in critically ill patients: a descriptive study in a Portuguese intensive care unit. Acute Crit Care 2024; 39:312-320. [PMID: 38863362 PMCID: PMC11167415 DOI: 10.4266/acc.2023.01256] [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: 09/26/2023] [Revised: 03/02/2024] [Accepted: 04/05/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Sleep disorders are common among patients admitted to intensive care units (ICUs). This study aimed to assess the perceptions of sleep quality, anxiety, depression, and stress reported by ICU patients and the relationships between these perceptions and patient variables. METHODS This cross-sectional study used consecutive non-probabilistic sampling to select participants. All patients admitted for more than 72 hours of ICU hospitalization at a Portuguese hospital between March and June 2020 were asked to complete the "Richard Campbell Sleep Questionnaire" and "Anxiety, depression, and Stress Assessment Questionnaire." The resulting data were analyzed using descriptive statistics, Pearson's correlation coefficient, Student t-tests for independent samples, and analysis of variance. The significance level for rejecting the null hypothesis was set to α ≤0.05. RESULTS A total of 52 patients admitted to the ICU for at least 72 hours was recruited. The mean age of the participants was 64 years (standard deviation, 14.6); 32 (61.5%) of the participants were male. Approximately 19% had psychiatric disorders. The prevalence of self-reported poor sleep was higher in women (t[50]=2,147, P=0.037) and in participants with psychiatric problems, although this difference was not statistically significant (t[50]=-0.777, P=0.441). Those who reported having sleep disorders before hospitalization had a worse perception of their sleep. CONCLUSIONS Sleep quality perception was worse in female ICU patients, those with psychiatric disorders, and those with sleep alterations before hospitalization. Implementing early interventions and designing nonpharmacological techniques to improve sleep quality of ICU patients is essential.
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Affiliation(s)
- Rui Domingues Silva
- Departamento de Anestesiologia, Cuidados Intensivos e Emergência,Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Abílio Cardoso Teixeira
- Escola Superior de Saúde de Santa Maria, Porto, Portugal
- CINTESIS - Centro de Investigação em Tecnologias e Serviços de Saúde, Porto, Portugal
| | - José António Pinho
- Departamento de Anestesiologia, Cuidados Intensivos e Emergência,Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Escola Superior de Saúde de Santa Maria, Porto, Portugal
| | - Pedro Marcos
- Departamento de Anestesiologia, Cuidados Intensivos e Emergência,Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Carlos Santos
- Escola Superior de Enfermagem de Coimbra, Coimbra, Portugal
- CIDNUR - Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Lisboa, Portugal
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Helmark C, Harrison A, Pedersen SS, Doherty P. Screening for - and prevalence of - anxiety and depression in cardiac rehabilitation in the post-COVID era. An observational study. Int J Cardiol 2023; 393:131379. [PMID: 37734491 DOI: 10.1016/j.ijcard.2023.131379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Approximately 20-30% of patients with a cardiac disease suffer from anxiety and/or depression, leading to poor health outcomes. To identify this subgroup, clinical guidelines recommend screening for anxiety and depression in cardiac rehabilitation (CR). It is unknown how screening practice is delivered post-COVID. METHODS This observational study used data from the National Audit of Cardiac Rehabilitation from April 2018-March 2022. Descriptive statistics were used to assess screening rates and prevalence, while a multivariate logistic regression model was performed to analyse determinants for screening for anxiety and depression among patients participating in cardiac rehabilitation. RESULTS The population consisted of 245,705 patients, where 128,643 (52.4%) were screened and 117,062 (47.6%) were not. Patients attending CR during first year of COVID-19 were less likely to be screened. Patients with female gender, living alone, non-white ethnicity, living in the most deprived areas, current smoking, and physical inactivity were less likely to be screened, while patients who were revascularized, having an objective physical fitness test, and attending a certified CR center were more likely to be screened. For patients attending CR during COVID-19, the prevalence of anxiety and depression decreased significantly. For anxiety the prevalence dropped from 34.4% to 15.8%, for depression the prevalence dropped from 33.5% to 16.5%. CONCLUSION CR service provision was negatively impacted during COVID-19, leading to much lower screening for anxiety and depression in the CR setting. Prevalence of anxiety and depression decreased during COVID-19 for this population, possibly because psychologically affected patients refrained from attending CR.
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Affiliation(s)
- Charlotte Helmark
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark.
| | - Alex Harrison
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5330 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Patrick Doherty
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, United Kingdom
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Markser A, Blaschke K, Meyer I, Jessen F, Schubert I, Albus C. Claims data analysis of the health care utilization for patients with coronary heart disease and mental comorbidity. J Psychosom Res 2023; 172:111430. [PMID: 37421747 DOI: 10.1016/j.jpsychores.2023.111430] [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: 03/13/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE Mental disorders (MD) are a common comorbidity in patients with coronary heart disease (CHD) and have a significant impact on morbidity and mortality. The aim of this study was to determine to what extent mental disorders are diagnosed as comorbidity in patients with CHD and whether adequate therapeutic measures are taken. METHODS Claims data from 4435 Cologne citizens with diagnosed CHD and a hospital stay due to CHD in 2015 were examined through a longitudinal analysis. The data were analyzed descriptively with regard to mental disorders, investigating diagnostic examinations performed, prescriptions for psychotropic drugs, and utilization of psychotherapy. We differentiated between pre-existing MD, existing in the year before the CHD-related hospital stay, and incident MD with new onset during or within six months after hospitalization. RESULTS Psychodiagnostic examinations for mental disorders occurred very rarely during cardiological hospitalization (0.04%) and psychiatric/psychosomatic consultation sessions rarely (5%). The longitudinal analysis showed a high rate of pre-existing MDs (56%, n = 2490) and a new diagnosis of mental disorders in 7% (n = 302) of the patients. Within one year after inpatient treatment for CHD, psychotropic medication was prescribed in 64-67% of patients with newly diagnosed affective or neurotic, adjustment/somatoform disorder and 10-13% received outpatient psychotherapy. CONCLUSION The results indicate low rates of inpatient diagnostic examinations and low rates of adequate treatment of mental disorders in patients from Cologne with CHD and new onset mental disorders. The rate of prescriptions of psychopharmacotherapy after hospitalization due to CHD exceeds that of the utilization of outpatient psychotherapy.
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Affiliation(s)
- Anna Markser
- Dept. of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany.
| | - Katja Blaschke
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Ingo Meyer
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Frank Jessen
- Dept. of Psychiatry and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn, North Rhine-Westphalia, Germany.
| | - Ingrid Schubert
- PMV research group, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50931 Cologne, Germany.
| | - Christian Albus
- Dept. of Psychosomatics and Psychotherapy, Medical Faculty and University Hospital, University of Cologne, Germany.
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Tang Y, Chen Y, Guo Q, Zhang L, Liu H, Wang S, Wu X, Shen X, Tao L. MiR-126-Loaded Immunoliposomes against Vascular Endothelial Inflammation In Vitro and Vivo Evaluation. Pharmaceutics 2023; 15:pharmaceutics15051379. [PMID: 37242620 DOI: 10.3390/pharmaceutics15051379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/14/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Due to the accompaniment of vascular endothelial inflammation during the occurrence and development of cardiovascular diseases (CVD), treatment modalities against vascular endothelial inflammation have been intensively investigated for CVD prevention and/or treatment. Vascular cell adhesion molecule-1 (VCAM-1) is a typical transmembrane inflammatory protein specifically expressed by inflammatory vascular endothelial. By inhibiting VCAM-1 expression through the miR-126 mediated pathway, vascular endothelial inflammation can be efficiently relieved. Inspired by this, we developed a miR-126-loaded immunoliposome with VCAM-1 monoclonal antibody (VCAMab) decorated at its surface. This immunoliposome can be directly targeted to VCAM-1 at the inflammatory vascular endothelial membrane surface and achieve highly efficient treatment against inflammation response. The cellular experiment results showed the immunoliposome had a higher uptake rate towards inflammatory human vein endothelial cells (HUVECs) and can significantly downregulate the VCAM-1 expression level of inflammatory HUVECs. In vivo investigation further demonstrated that this immunoliposome displayed a higher accumulation rate at vascular inflammatory dysfunction sites than its non-VCAMab-modified counterpart. These results suggest that this novel nanoplatform can effectively deliver miR-126 to vascular inflammatory endothelium, opening a new avenue for the safe and effective delivery of miRNA for potential clinical application.
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Affiliation(s)
- Yongyu Tang
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Ying Chen
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Qianqian Guo
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Lidan Zhang
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Huanhuan Liu
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Sibu Wang
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Xingjie Wu
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
| | - Xiangchun Shen
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Endemic and Ethnic Diseases of Ministry of Education, Guizhou Medical University, Guiyang 550004, China
| | - Ling Tao
- The State Key Laboratory of Functions and Applications of Medicinal Plants, School of Pharmaceutical Sciences, Guizhou Medical University, University Town, Guian New District, Guiyang 550025, China
- The Department of Pharmacology of Materia Medica (The High Efficacy Application of Natural Medicinal Resources Engineering Center of Guizhou Province and The High Educational Key Laboratory of Guizhou Province for Natural Medicinal Pharmacology and Druggability), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
- The Key Laboratory of Optimal Utilization of Natural Medicine Resources (The Union Key Laboratory of Guiyang City-Guizhou Medical University), School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang 550031, China
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10
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Bush M, Evenson KR, Aylward A, Cyr JM, Kucharska-Newton A. Psychosocial services provided by licensed cardiac rehabilitation programs. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1093086. [PMID: 37064600 PMCID: PMC10101325 DOI: 10.3389/fresc.2023.1093086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/03/2023] [Indexed: 04/03/2023]
Abstract
BackgroundProfessional health organizations recommend that outpatient cardiac rehabilitation programs include activities to optimize the physical, mental, and social well-being of patients. The study objectives were to describe among cardiac rehabilitation programs (1) mental health assessments performed; (2) psychosocial services offered; and (3) leadership's perception of barriers to psychosocial services offerings.MethodsA cross-sectional survey of North Carolina licensed outpatient cardiac rehabilitation programs on their 2018 services was conducted. Descriptive statistics were used to summarize survey responses. Thematic analysis of free text questions related to barriers to programmatic establishment or expansion of psychosocial services was performed by two team members until consensus was reached.ResultsSixty-eight programs (89%) responded to the survey. Forty-eight programs (70%) indicated offering psychosocial services; however, a majority (73%) of programs reported not directly billing for those services. At program enrollment, mental health was assessed in 94% of programs of which 92% repeated the assessment at discharge. Depression was assessed with the 9-item Patient Health Questionnaire by a majority (75%) of programs. Psychosocial services included individual counseling (59%), counseling referrals (49%), and educational classes (29%). Directors reported lack of internal resources (92%) and patient beliefs (45%) as the top barriers to including or expanding psychosocial services at their facilities.ConclusionsCardiac rehabilitation programs routinely assess mental health but lack the resources to establish or expand psychosocial services. Interventions aimed at improving patient education and reducing stigma of mental health are important public health opportunities.
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Affiliation(s)
- Montika Bush
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Correspondence: Montika Bush
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Aileen Aylward
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julianne M. Cyr
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anna Kucharska-Newton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Epidemiology College of Public Health, University of Kentucky, Lexington, KY, United States
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11
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Holdgaard A, Eckhardt-Hansen C, Lassen CF, Kjesbu IE, Dall CH, Michaelsen KL, Sibilitz KL, Prescott E, Rasmusen HK. Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease: a randomized trial. Eur Heart J 2023; 44:986-996. [PMID: 36649937 DOI: 10.1093/eurheartj/ehac792] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/23/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To test whether usual outpatient cardiac rehabilitation (CR) supplemented by a cognitive-behavioural therapy (CBT) intervention may reduce anxiety and depression compared with usual CR. METHODS AND RESULTS In this multicentre randomized controlled trial, 147 cardiac patients (67% men, mean age 54 years, 92% with coronary artery disease) with psychological distress defined as a hospital anxiety and depression scale (HADS) anxiety or depression score ≥8 were randomized to five sessions of group CBT plus usual CR (intervention, n = 74) or CR alone (control, n = 73). Patients with severe distress or a psychiatric diagnosis were excluded. The intervention was delivered by cardiac nurses with CBT training and supervised by a psychologist. A reference, non-randomized group (background, n = 41) of consecutive patients without psychological distress receiving usual CR was included to explore the effect of time on HADS score. The primary outcome, total HADS score after 3 months, improved more in the intervention than in the control group [the mean total HADS score improved by 8.0 (standard deviation 5.6) vs. 4.1 (standard deviation 7.8), P < 0.001]. Significant between-group differences were maintained after 6 months. Compared with the control group, the intervention group also had greater adherence to CR (P = 0.003), more improvement in the heart-related quality of life (HeartQoL) at 6 months (P < 0.01), and a significant reduction in cardiac readmissions at 12 months (P < 0.01). The background group had no significant change in HADS score over time. CONCLUSION Brief CBT provided by cardiac nurses in relation to CR reduced anxiety and depression scores, improved HeartQoL and adherence to CR, and reduced cardiovascular readmissions. The programme is simple and may be implemented by CR nurses.
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Affiliation(s)
- Annette Holdgaard
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christine Eckhardt-Hansen
- Department of Social Medicine, Bispebjerg Frederiksberg Hospitals, University of Copenhagen, Denmark
| | - Christina Funch Lassen
- Department of Social Medicine, Bispebjerg Frederiksberg Hospitals, University of Copenhagen, Denmark
| | - Ingunn Eklo Kjesbu
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Christian Have Dall
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Kristine Lund Michaelsen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Hanne Kruuse Rasmusen
- Department of Cardiology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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den Uijl I, Ter Hoeve N, Sunamura M, Stam HJ, Boersma E, Lenzen MJ, Brouwers RWM, Tenbült-van Limpt NCCW, Ista E, van den Berg-Emons RJG. Cardiac rehabilitation designed for patients with obesity: OPTICARE XL RCT results on health-related quality of life and psychosocial well-being. Disabil Rehabil 2023; 45:1046-1055. [PMID: 35311438 DOI: 10.1080/09638288.2022.2050428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose We studied the effectiveness of a new cardiac rehabilitation (CR) program developed for patients with obesity compared with standard CR on HRQOL and psychosocial well-being.Materials and methods OPTICARE XL was a multicentre RCT in patients with cardiac disease and obesity (Netherlands Trial Register: NL5589). Patients were randomized to OPTICARE XL CR (n = 102) or standard CR (n = 99). The one-year OPTICARE XL CR group program included endurance and resistance exercises, behavioural coaching, and after-care. Standard CR consisted of a 6- to 12-week endurance exercise group program, and cardiovascular lifestyle education. Primary endpoint was HRQOL (MacNew) at six months post CR. Second, we assessed anxiety and depression (both HADS), fatigue (FSS), and participation in society (USER-P).Results In both groups, improvements in HRQOL were observed six months post CR. Mean HRQOL improved from 4.92 to 5.40 in standard CR [mean change (95% CI): 0.48 (0.28, 0.67)] and from 4.96 to 5.45 in OPTICARE XL CR (mean change (95% CI): 0.49 (0.29, 0.70), without between-group differences. Psychosocial well-being improvements within both groups were obtained at six months post CR, regardless of allocated program.Conclusions OPTICARE XL CR did not have added value in improving HRQOL and psychosocial well-being in patients with obesity.Implications for rehabilitationMore than a third of cardiac patients suffers from obesity, and standard cardiac rehabilitation (CR) programs are suboptimal in this increasing patient population.The OPTICARE XL CR program is a state-of-the art, one-year CR program designed for patients with obesity including aerobic and strength exercises, behavioural coaching towards a healthy diet and an active lifestyle, and after-care.Improvements in HRQOL and psychosocial well-being were comparable between patients with obesity allocated to standard CR and OPTICARE XL CR.Therefore, there was no additional benefit of OPTICARE XL CR.
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Affiliation(s)
- Iris den Uijl
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | - Nienke Ter Hoeve
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, The Netherlands
| | | | - Henk J Stam
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | | | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Gok Metin Z, Izgu N, Gulbahar Eren M, Eroglu H. Theory-based nursing interventions in adults with coronary heart disease: A systematic review and meta-analysis of randomized controlled trials. J Nurs Scholarsh 2023; 55:439-463. [PMID: 36411501 DOI: 10.1111/jnu.12839] [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: 05/09/2022] [Revised: 10/08/2022] [Accepted: 10/18/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to synthesize the outcomes of theory-based nursing interventions for coronary heart disease management. DESIGN AND METHODS Web of Science, Scopus, Science Direct, and PubMed databases were electronically searched from January 2013 to August 2021. The Preferred Reporting Item for Systematic Reviews and Meta-analyses statement guidelines was followed for this meta-analysis. Randomized controlled trials on patients with coronary heart disease, using a theory-based nursing intervention were eligible. Methodological quality was examined by two authors using the Modified Jadad Scale. Based on the heterogeneity test, the results were analyzed using a pool of data with 95% confidence intervals, p-values, and fixed or random-effect models (PROSPERO registration number X). FINDINGS A total of 1030 studies were initially retrieved, and 8 randomized controlled trials were eventually included in the meta-analysis after screening. The big majority (81.3%) of participants were males, and the mean age was 54.8 (SD = 8.7) years. This meta-analysis found theory-based nursing interventions had no significant effect on blood lipid profile, blood pressure, and healthy lifestyle. However, these interventions significantly reduced fasting blood glucose, and body mass index and improved the physical and psychological domains of quality of life. CONCLUSIONS The evidence from this meta-analysis reveals that theory-based nursing interventions have a positive effect on fasting blood glucose, body mass index, and quality of life. However, their effects on blood lipid profile, blood pressure, and a healthy lifestyle are inconclusive. The results of this metanalysis are largely based on a few trials and were limited in terms of the number of outcomes. Conducting well-designed randomized controlled trials with adequate power is needed to make a firm conclusion on the influence of theory-based nursing interventions on patient outcomes in the CHD population. CLINICAL RELEVANCE Considering the high mortality and morbidity of coronary heart disease, nurses may play a significant role in coronary heart disease management by providing interventions that are based on a certain theoretical framework. This meta-analysis provides insights into the implementation of theory-based nursing interventions in heart attack survivors or those newly diagnosed with coronary heart disease led by nurses and lasting longer than 6 months in coronary heart disease. In addition, future studies should consider enhancing the content of training programs for a healthy lifestyle within the theory-based nursing interventions and compare the effects of these interventions on acute and chronic coronary syndromes.
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Affiliation(s)
- Zehra Gok Metin
- Internal Medical Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Nur Izgu
- Internal Medicine Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Merve Gulbahar Eren
- Internal Medicine Nursing Department, Faculty of Health Science, Sakarya University, Sakarya, Turkey
| | - Hacer Eroglu
- Cardiovascular Surgery Clinic, Ankara Training and Research Hospital, Ankara, Turkey
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14
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Rioche R. Intervention de type gestion de situation complexe sur l’adhésion médicamenteuse des patients coronariens dépressifs. SOINS 2023; 68:55-58. [PMID: 37037648 DOI: 10.1016/j.soin.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Coronary artery disease is a chronic condition where medication adherence issues have consequences in terms of morbidity and mortality. Depression, which is one of the factors of non-adherence to treatment, is also a frequent comorbidity. A research protocol has been set on this subject. Its main objective is to compare the medication adherence of a group of coronary patients with depressive disorders and difficulties in following their doctor's prescription, who have benefited from a complex situation management type intervention, with that of a control group followed in routine practice.
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15
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Brørs G, Dalen H, Allore H, Deaton C, Fridlund B, Norman CD, Palm P, Wentzel-Larsen T, Norekvål TM. The association of electronic health literacy with behavioural and psychological coronary artery disease risk factors in patients after percutaneous coronary intervention: a 12-month follow-up study. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:125-135. [PMID: 36974270 PMCID: PMC10039428 DOI: 10.1093/ehjdh/ztad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/15/2023] [Indexed: 02/10/2023]
Abstract
Aims Fundamental roadblocks, such as non-use and low electronic health (eHealth) literacy, prevent the implementation of eHealth resources. The aims were to study internet usage for health information and eHealth literacy in patients after percutaneous coronary intervention (PCI). Further, we aimed to evaluate temporal changes and determine whether the use of the internet to find health information and eHealth literacy were associated with coronary artery disease (CAD) risk factors at the index admission and 12-month follow-up of the same population. Methods and results This prospective longitudinal study recruited 2924 adult patients with internet access treated by PCI in two Nordic countries. Assessments were made at baseline and 12-month follow-up, including a de novo question Have you used the internet to find information about health?, the eHealth literacy scale, and assessment of clinical, behavioural, and psychological CAD risk factors. Regression analyses were used. Patients' use of the internet for health information and their eHealth literacy were moderate at baseline but significantly lower at 12-month follow-up. Non-users of the internet for health information were more often smokers and had a lower burden of anxiety symptoms. Lower eHealth literacy was associated with a higher burden of depression symptoms at baseline and lower physical activity and being a smoker at baseline and at 12-month follow-up. Conclusion Non-use of the internet and lower eHealth literacy need to be considered when implementing eHealth resources, as they are associated with behavioural and psychological CAD risk factors. eHealth should therefore be designed and implemented with high-risk CAD patients in mind. Clinical trial registration ClinicalTrials.gov NCT03810612 https://clinicaltrials.gov/ct2/show/NCT03810612.
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Affiliation(s)
- Gunhild Brørs
- Department of Clinical Science, University of Bergen, PO Box 7804, Bergen 5020, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Håvard Dalen
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Cameron D Norman
- Cense Ltd. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Pernille Palm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Region East and South, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Department of Clinical Science, University of Bergen, PO Box 7804, Bergen 5020, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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16
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Wang CL, Huan N, Wang PL, Geng QS, Ma WL, Ma LH, Jiang HY, Meng XP, Zhang DW, Gou XJ, Hu DY, Chen KJ. Guanxin Danshen Dripping Pills Improve Quality of Life and Cardiovascular Prognoses of CHD Patients after PCI with Anxiety or Depression (GLAD Study): A Randomized Double-Blind Placebo-Controlled Study. Chin J Integr Med 2023; 29:195-204. [PMID: 36301456 DOI: 10.1007/s11655-022-3688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of Guanxin Danshen Dripping Pills (GXDS) in the treatment of depression or anxiety in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). METHODS From September 2017 to June 2019, 200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS (100 cases) and placebo control groups (100 cases) by block randomization and a random number table. Patients in the GXDS and control groups were given GXDS and placebo, respectively, 0.4 g each time, 3 times daily for 12 weeks. The primary outcomes were scores of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7) and the Seattle Angina Pectoris Scale (SAQ). The secondary outcomes included 12 Health Survey Summary Form (SF-12) scores and the first onset time and incidence of major adverse cardiovascular events (MACEs). Other indices including blood pressure, blood lipids, microcirculation and inflammatory-related indices, etc. were monitored at baseline, week 4, and week 12. RESULTS In the full analysis set (200 cases), after treatment, the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group (P<0.05). Compared with the baseline, the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18, respectively. The corrected mean difference between the two groups was -2.78 (95% CI: -3.47, -2.10; P<0.001). The total GAD-7 score in the GXDS group decreased by 3.48% compared with the baseline level, while that of the placebo group decreased by 1.13%. The corrected mean difference between the two groups was -2.35 (95% CI: -2.95, -1.76; P<0.001). The degree of improvement in SAQ score, SF-12 score, endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group, and the differences between the two groups were statistically significant (P<0.05). Similar results were obtained in the per protocol population analysis of 177 patients. Three cases of MACES were reported in this study (1 in the GXDS group and 2 in the placebo group), and no serious adverse events occurred. CONCLUSIONS GXDS can significantly alleviate depression and anxiety, relieve symptoms of angina, and improve quality of life in patients with CHD after PCI. (Registration No. ChiCTR1800014291).
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Affiliation(s)
- Cheng-Long Wang
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Na Huan
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Pei-Li Wang
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Qing-Shan Geng
- Department of Cardiovascular Disease, Guangdong Provincial People's Hospital, Guangzhou, 510055, China
| | - Wen-Lin Ma
- Department of Cardiovascular Disease, Shanghai Tongji Hospital, Shanghai, 200065, China
| | - Li-Hong Ma
- Department of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Hong-Yan Jiang
- Department of Cardiovascular Disease, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing, 100020, China
| | - Xiao-Ping Meng
- Department of Cardiovascular Disease, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130021, China
| | - Da-Wu Zhang
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Xiao-Jiang Gou
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China.,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China
| | - Da-Yi Hu
- Department of Cardiovascular Disease, People's Hospital of Peking University, Beijing, 100044, China
| | - Ke-Ji Chen
- Department of Cardiovascular Disease, Xiyuan Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100091, China. .,National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China.
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17
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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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18
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Ji X, Yu H. Factors Associated with Self-Regulatory Fatigue in Chinese Older Patients with Coronary Heart Disease: A Cross-Sectional Survey. Patient Prefer Adherence 2023; 17:941-949. [PMID: 37033294 PMCID: PMC10075807 DOI: 10.2147/ppa.s400996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/10/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose To identify important determinants of self-regulatory fatigue in older adults with coronary heart disease based on demographics, health literacy, and health empowerment factors. Patients and Methods A total of 201 older patients with coronary heart disease (CHD) from First Affiliated Hospital of Jinzhou Medical University by cluster sampling method. Demographic Questionnaire, the Health Literacy Management Scale (HLSCP), the Patient Perception Empowerment Scale (PPES), and the Self-Regulatory Fatigue Scale (SRF-S) were used to collect the data. Results The coronary heart disease elderly scored 44.20±6.98 points in self-regulatory fatigue. The results showed that residence, monthly household income, hospitalized times of CHD since illness, health literacy and health empowerment were significant determinants of self-regulatory fatigue (p<0.001). Self-regulatory fatigue was negatively correlated with health literacy (r=-0.639, P<0.01) and health empowerment (r=-0.580, P<0.01). Conclusion Residence, monthly household income, hospitalized times of CHD since illness influence self-regulatory fatigue among coronary heart disease patients. Health literacy and health empowerment were independent predictors of self-regulatory among coronary heart disease patients.
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Affiliation(s)
- Xiaofu Ji
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China
| | - Hongyu Yu
- School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China
- Correspondence: Hongyu Yu, School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, People’s Republic of China, Tel +86 15941628522, Email
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Melin EO, Wanby P, Neumark T, Holmberg S, Neumark ASN, Johansson K, Landin-Olsson M, Thulesius H, Hillman M, Thunander M. Depression was associated with younger age, female sex, obesity, smoking, and physical inactivity, in 1027 patients with newly diagnosed type 2 diabetes: a Swedish multicentre cross-sectional study. BMC Endocr Disord 2022; 22:273. [PMID: 36348470 PMCID: PMC9644465 DOI: 10.1186/s12902-022-01184-3] [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: 06/07/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. METHODS Multicentre, cross-sectional study. INCLUSION CRITERIA adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m2), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. RESULTS In 1027 T2D patients, aged 18-94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m2 (OR 1.7), BMI ≥ 40 kg/m2 (OR 2.3), smoking (OR 1.9), physical inactivity (OR 1.8), and women (OR 1.6) (all p ≤ 0.013). Younger women (n = 113), ≤ 59 years, compared to younger men (n = 217) had higher prevalence of current depression (31% vs 12%), previous depression (43 vs 19%), anxiety (42% vs 25%), antidepressant use (37% vs 12%), BMI ≥ 30 kg/m2 (73% vs 60%) and BMI ≥ 40 kg/m2) (18% vs 9%), and smoking (26% vs 16%) (all p ≤ 0.029). Older women (n = 297), ≥ 60 years, compared to older men (n = 400) had higher prevalence of previous depression (45% vs 12%), anxiety (18% vs 10%), antidepressant use (20% vs 8%), BMI ≥ 30 kg/m2 (55% vs 47%), BMI ≥ 40 kg/m2 (7% vs 3%) (all p ≤ 0.048), but not of current depression (both 9%). Compared to the Swedish general population (depression (women 11.2%, men 12.3%) and antidepressant use (women 9.8%, men 5.3%)), the younger women had higher prevalence of current depression, and all patients had higher prevalence of antidepressant use. CONCLUSIONS In patients with newly diagnosed T2D, the younger women had the highest prevalence of depression, anxiety, and obesity. The prevalence of depression in young women and antidepressant use in all patients were higher than in the Swedish general population. Three risk factors for CVD, obesity, smoking, and physical inactivity, were associated with depression.
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Affiliation(s)
- Eva O Melin
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden.
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden.
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden.
- Region Kronoberg, Primary Care, Växjö, Sweden.
| | - Pär Wanby
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden
- Department of Internal Medicine, Endocrinology, Kalmar County Hospital, Region Kalmar, Sweden
| | - Thomas Neumark
- Regional Executive Office - Coordination of Health Care, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Sara Holmberg
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Karin Johansson
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Region Kronoberg, Primary Care, Växjö, Sweden
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden
- Department of Diabetology and Endocrinology, Skane University Hospital, Lund, Sweden
| | - Hans Thulesius
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Region Kronoberg, Primary Care, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Clinical Sciences, Division of Family Medicine, Lund University, Malmö, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Diabetes Research Laboratory, Biomedical Centre, Lund University, Lund, Sweden
| | - Maria Thunander
- Department of Clinical Sciences, Diabetology and Endocrinology, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Box 1223, 351 12, Växjö, Sweden
- Department of Internal Medicine, Endocrinology and Diabetes, Växjö Central Hospital, Region Kronoberg, Växjö, Sweden
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Peltzer S, Köstler U, Müller H, Scholten N, Schulz-Nieswandt F, Jessen F, Albus C. The psychological consequences of living with coronary heart disease: Are patients' psychological needs served? A mixed-method study in Germany. Health Expect 2022; 25:2746-2761. [PMID: 36269637 DOI: 10.1111/hex.13467] [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: 09/28/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This mixed-method study explores psychological needs, access and barriers in coronary heart disease (CHD) patients with and without mental health issues (MHI) within the German healthcare system. METHODS This study was conducted in three different healthcare settings: two hospitals, two rehabilitation clinics and three cardiology practices in Cologne, Germany. Patients were screened for angiographically documented CHD and other inclusion criteria. In total, 364 CHD patients took part in this study. It consisted of two parts: In the first part, participants filled in a newly developed questionnaire about their psychological needs, access and barriers within the healthcare system and their contact with their doctor in these matters. Then, patients were screened for MHIs with the help of the Hospital Anxiety and Depression Scale (HADS). When a score above seven was scored on the HADS, patients were additionally screened for specific MHIs using the Structured Clinical Interview for DSM-IV Axis I Disorders. In the second part, 20 participants were subsequently interviewed in a semi-structured interview to generate more in-depth findings. RESULTS The interviews show that CHD patients with and without MHI experienced a cardiac event as life-changing and had an urgent need to talk about CHD with their doctor, mostly the general practitioner (GP). When the GP spoke to the patient shortly after the cardiac event, patients experienced relief and were better able to cope with their illness. Only 9.1% reported being aided in their search for psychotherapeutic treatment or drug treatment (4.1%). CONCLUSION The needs of CHD patients with and without MHI were not adequately satisfied within our sample. Psychological measures are necessary for sufficient improvement, such as training of doctors in doctor-patient communication (e.g., better support in coping with MHI/CHD), improvements in the procedure (more time for conversations during doctor contacts), and improvement of structural requirements (referring patients faster to psychotherapists). PATIENT OR PUBLIC CONTRIBUTION We received input from patients during pretests and used the feedback to tailor our questionnaire and the interview guidelines. Afterwards, we disseminated the main results for the patient and public involvement (e.g., public lectures, leaflets for self-help groups, etc.).
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Affiliation(s)
- Samia Peltzer
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Ursula Köstler
- Department of Social Policy and Methods of Qualitative Social Research, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Hendrik Müller
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Frank Schulz-Nieswandt
- Department of Social Policy and Methods of Qualitative Social Research, Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, University Hospital Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany
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21
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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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22
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Ju Y, Liu T, Zhang K, Lin X, Zheng E, Leng J. The relationship between Comprehensive Geriatric Assessment parameters and depression in elderly patients. Front Aging Neurosci 2022; 14:936024. [PMID: 35959294 PMCID: PMC9360413 DOI: 10.3389/fnagi.2022.936024] [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: 05/04/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Depression is common and serious among elderly patients. The treatment of elderly depression is often delayed owing to insufficient diagnosis, which eventually leads to adverse consequences. Aims To explore the association between the parameters of the Comprehensive Geriatric Assessment and depression in elderly patients. Methods A cross-sectional study of 211 outpatients and inpatients aged ≥ 65 years from the Comprehensive Geriatric Assessment database was conducted. A Comprehensive Geriatric Assessment inventory was prepared by compiling and screening general characteristics, chronic diseases (cardiovascular disease, diabetes, and peptic ulcer disease), nutritional status, daily living ability, anthropometric measurements (body mass index (BMI), upper arm circumference, and calf circumference), and blood biochemical indicators (hemoglobin, albumin, prealbumin, triglycerides, and low-density lipoprotein cholesterol). The Geriatric Depression Scale was also conducted for each elderly patient to screen for depression. A multivariable logistic regression analysis was used to determine the association between the parameters of the Comprehensive Geriatric Assessment and geriatric depression. Results There were 63 patients in the depression group with a median age of 84.00 years, and 148 patients in the non-depression group with a median age of 78.50 years. After controlling for confounders, the risk of depression in elderly patients with cardiovascular diseases was 6.011 times higher than that in those without cardiovascular diseases (p < 0.001); and the risk of depression in elderly patients with peptic ulcer diseases was 4.352 times higher than that in those without peptic ulcer diseases (p < 0.001); the risk of depression in elderly patients decreased by 22.6% for each 1-point increase in the Mini Nutritional Assessment (p < 0.001). The risk of depression in elderly patients decreased by 19.9% for each 1-point increase in calf circumference (p = 0.002), and by 13.0% for each 1-point increase in albumin (p = 0.014). Conclusion Our findings suggest that Comprehensive Geriatric Assessment parameters, such as cardiovascular disease, peptic ulcer disease, Mini Nutritional Assessment score, calf circumference, and albumin, were associated with depression. The Comprehensive Geriatric Assessment can assist in the early identification of depression in the elderly population.
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23
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Rotvig C, Christensen AV, Juel K, Svendsen JH, Jørgensen MB, Rasmussen TB, Borregaard B, Thrysoee L, Thorup CB, Mols RE, Berg SK. The association between cardiac drug therapy and anxiety among cardiac patients: results from the national DenHeart survey. BMC Cardiovasc Disord 2022; 22:280. [PMID: 35725383 PMCID: PMC9210711 DOI: 10.1186/s12872-022-02724-4] [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: 04/06/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuropsychiatric side effects of cardiac drugs such as nervousness, mood swings and agitation may be misinterpreted as symptoms of anxiety. Anxiety in cardiac patients is highly prevalent and associated with poor outcomes, thus an accurate identification is essential. The objectives were to: (I) describe the possible neuropsychiatric side effects of common cardiac drug therapies, (II) describe the use of cardiac drug therapy in cardiac patients with self-reported symptoms of anxiety compared to those with no symptoms of anxiety, and (III) investigate the association between the use of cardiac drug therapy and self-reported symptoms of anxiety. METHODS DenHeart is a large national cross-sectional survey combined with national register data. Symptoms of anxiety were measured by the Hospital Anxiety and Depression Scale (HADS-A) on patients with ischemic heart disease, arrhythmia, heart failure and heart valve disease. Side effects were obtained from 'product summaries', and data on redeemed prescriptions obtained from the Danish National Prescription Registry. Multivariate logistic regression analyses explored the association between cardiac drug therapies and symptoms of anxiety (HADS-A ≥ 8). RESULTS Among 8998 respondents 2891 (32%) reported symptoms of anxiety (HADS-A ≥ 8). Neuropsychiatric side effects were reported from digoxin, antiarrhythmics, beta-blockers, ACE-inhibitors and angiotensin receptor antagonists. Statistically significant higher odds of reporting HADS ≥ 8 was found in users of diuretics, lipid-lowering agents, nitrates, antiarrhythmics and beta-blockers compared to patients with no prescription. CONCLUSION Some cardiac drugs were associated with self-reported symptoms of anxiety among patients with cardiac disease. Of these drugs neuropsychiatric side effects were only reported for antiarrhythmics and beta-blockers. Increased awareness about the possible adverse effects from these drugs are important.
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Affiliation(s)
- Camilla Rotvig
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | | | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Copenhagen, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Lars Thrysoee
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Brun Thorup
- Department of Cardiology and Department of Cardiothoracic Surgery and Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Selina Kikkenborg Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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24
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Chen X, Liu Z, Yang Y, Chen G, Wan Q, Qin G, Yan L, Wang G, Qin Y, Luo Z, Tang X, Huo Y, Hu R, Ye Z, Shi L, Gao Z, Su Q, Mu Y, Zhao J, Chen L, Zeng T, Li Q, Shen F, Chen L, Zhang Y, Wang Y, Deng H, Liu C, Wu S, Yang T, Li M, Xu Y, Xu M, Wang T, Zhao Z, Lu J, Bi Y, Yu X, Wang W, Ning G. Depression Status, Lifestyle, and Metabolic Factors With Subsequent Risk for Major Cardiovascular Events: The China Cardiometabolic Disease and Cancer Cohort (4C) Study. Front Cardiovasc Med 2022; 9:865063. [PMID: 35694670 PMCID: PMC9177939 DOI: 10.3389/fcvm.2022.865063] [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: 01/31/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background We aimed to evaluate the association between depression and major cardiovascular events and test whether the relationship between depression and cardiovascular events is influenced by lifestyle or metabolic risk factors. Methods The China Cardiometabolic Disease and Cancer Cohort (4C) Study was a nationwide, multicenter, prospective cohort study. About 92,869 participants without cardiovascular disease or cancer at baseline were included. Depression status was evaluated by the Patient Health Questionnaire-9 (PHQ-9). Lifestyle information was collected by the questionnaire, and metabolic risk factors including waist circumference, blood pressure, lipid profiles, and plasma glucose were measured. Major cardiovascular events including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure events were validated based on medical records. Results During an average of 3.8 years of follow-up, we detected 2,076 cardiovascular events and showed that participants with depressive symptoms had an increased risk for cardiovascular events after adjustments [hazard ratio (HR): 1.29; 95% confidence index (CI): 1.08–1.53]. Stratified on metabolic risk status, the relationship between depression and cardiovascular events tended to be stronger according to the increasing numbers of metabolic risk factors, with HR (95% CI) of 0.98 (0.72–1.35) in the category with 0–2 metabolic risk factors, 1.36 (0.996–1.87) and 1.47 (1.13–1.92) for those with 3, and 4–5 metabolic risk factors, respectively, indicating an interaction effect (P = 0.039). Conclusion Depression was independently associated with an increased risk of major cardiovascular events. The effect was particularly prominent among populations at higher metabolic risk.
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Affiliation(s)
- Xi Chen
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
| | - Zhelong Liu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
| | - Yan Yang
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
| | - Qin Wan
- The Affiliated Hospital of Luzhou Medical College, Luzhou, China
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guixia Wang
- The First Hospital of Jilin University, Changchun, China
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xulei Tang
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Yanan Huo
- Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Zhengnan Gao
- Dalian Municipal Central Hospital, Dalian, China
| | - Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiming Mu
- Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jiajun Zhao
- Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Lulu Chen
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianshu Zeng
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Li Chen
- Qilu Hospital of Shandong University, Jinan, China
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading District, Shanghai, China
| | - Youmin Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huacong Deng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
| | - Shengli Wu
- Karamay Municipal People’s Hospital, Xinjiang, China
| | - Tao Yang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Disease, Wuhan, China
- *Correspondence: Xuefeng Yu,
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Weiqing Wang,
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Guang Ning,
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25
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Monroe EJ, Hardy R, Holmquist J, Brand JC. Obesity and Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2022; 15:180-186. [PMID: 35511332 DOI: 10.1007/s12178-022-09753-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Rates of obesity and reverse total shoulder arthroplasty (rTSA) in the USA have both escalated with time. Obese patients experience arthritis at higher rates than normal weight patients; therefore, these numbers go hand in hand. Obesity has been correlated with health comorbidities such as anxiety, cardiovascular disease, diabetes, and metabolic syndrome as well as poorer outcomes and higher complication rates following lower extremity arthroplasty. The current review investigates these comorbidities as they relate to obese patients undergoing rTSA. RECENT FINDINGS Functional outcomes are similar to normal weight counterparts. Although longer operative times and a large soft tissue envelope would intuitively predispose these patients to higher risk for infection or other complications, this has not been reliably demonstrated. Technical considerations and awareness of potential risks in the obese patient demographic may aid the surgeon in preoperative planning and counseling of their patient. Obese patients undergoing rTSA have been shown to have higher risks specifically for infection, revision, and medical complications; however, this has not been consistently demonstrated in the single surgeon series where, more often, no difference in these metrics has been found. Outcomes measures and satisfaction are reliably improved, even when considering superobese patients, and majority of studies find their improvements and absolute values to be in line with their normal weight counterparts. Thus, rTSA does not seem to carry the same level of adverse risk associated with lower joint arthroplasty but potential for higher risk still bears consideration when counseling obese patients. Attention to factors that may negatively affect prosthesis positioning may optimize retention rates and limit early failure.
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Affiliation(s)
- Emily J Monroe
- Heartland Orthopedic Specialists, 111 17th Ave E, Ste 101, Alexandria, MN, 56308, USA.
| | - Richard Hardy
- Heartland Orthopedic Specialists, 111 17th Ave E, Ste 101, Alexandria, MN, 56308, USA
| | - James Holmquist
- Heartland Orthopedic Specialists, 111 17th Ave E, Ste 101, Alexandria, MN, 56308, USA
| | - Jefferson C Brand
- Heartland Orthopedic Specialists, 111 17th Ave E, Ste 101, Alexandria, MN, 56308, USA
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Association of patient-reported psychosocial healthcare and risk of readmissions and mortality in patients with ischemic heart disease: A population-based cohort study. J Psychosom Res 2022; 156:110776. [PMID: 35276588 DOI: 10.1016/j.jpsychores.2022.110776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Psychosocial risk factors are common in patients with ischemic heart disease (IHD) and linked to poor prognosis. Psychosocial healthcare is recommended in international guidelines and has demonstrated positive effects, primarily on psychosocial symptoms. We examined the association between patient-reported psychosocial healthcare and hospital readmissions and mortality in patients with IHD. METHODS A population-based cohort study with register-based follow-up. Patient-reported psychosocial healthcare was measured by seven items in a survey sent to a random sample of patients with incident IHD in Denmark in 2014. We used multivariable Cox proportional hazards models and Poisson regression to examine the association between psychosocial healthcare and readmissions and all-cause mortality. RESULTS In total, 1083 (57%) patients were followed up to 4½ years. Low psychosocial support was reported by 53.4%, medium by 26.2% and high by 20.4% patients. The hazard of acute cardiac readmission for patients reporting low psychosocial healthcare was 2.08 higher than for patients reporting high psychosocial healthcare (95%CI:1.01-4.30). No association was found with time to first all-cause readmission. The acute cardiac readmission rate was 3.24 (95%CI:1.66-6.29) and 4.23 (95%CI:2.15-8.33) times higher among patients reporting low and medium psychosocial healthcare compared to high, and the all-cause readmission rate was 1.30 (95%CI:1.16-1.46) and 1.32 (95%CI:1.17-1.49) times higher. The hazard of death was 2.86 (95%CI:1.23-6.69) and 2.88 (95%CI:1.18-7.04) times higher among patients reporting low and medium psychosocial healthcare compared to high. CONCLUSION In patients with IHD, a high level of patient-reported psychosocial healthcare was significantly associated with reduced hospital readmissions and all-cause mortality.
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Vaillancourt M, Busseuil D, D'Antono B. Severity of psychological distress over five years differs as a function of sex and presence of coronary artery disease. Aging Ment Health 2022; 26:762-774. [PMID: 33764244 DOI: 10.1080/13607863.2021.1901262] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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; meanage = 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.
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Affiliation(s)
- Monica Vaillancourt
- Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - David Busseuil
- Research Center, Montreal Heart Institute, Montreal, Canada
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
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Gender differences in cardiovascular risk factor awareness: Results from the ESC EORP EUROASPIRE V Registry. Int J Cardiol 2022; 352:152-157. [PMID: 35122913 DOI: 10.1016/j.ijcard.2022.01.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patient risk factor awareness is essential to decrease the risk of recurrent coronary events. The aim of this study was to provide up-to-date evidence on existing gender differences in the patients' knowledge of risk factors and information provided by healthcare professionals. METHODS Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey, including data on CHD patients across 27 European countries. Consecutive patients (18-80 years), hospitalized for a coronary event or surgical procedure, were retrospectively identified. Information on risk factor awareness was collected from medical records, medical examination, and structured questionnaires during the study visit (six months to two years after hospitalization). RESULTS Patient information was available for 8261 patients, of which 25.8% were women. Although women with obesity were significantly less aware about their actual (OR = 0.66, CI = 0.52-0.85) and target weight levels (OR = 0.66, CI = 0.54-0.81), no significant gender differences in risk factor awareness were found in disfavour of women. Remarkably, women with hypertension and women with raised low-density lipoprotein cholesterol (LDL-C) levels were even more aware about their target blood pressure levels (OR = 1.21, CI = 1.01-1.46) and actual cholesterol levels (OR = 1.18, CI = 1.02-1.36), respectively. Moreover, there is some indication that women were more informed by a healthcare professional if they had raised CHD risk factor levels. CONCLUSIONS Our study showed only few gender differences in disfavour of women in terms of risk factor awareness and information provided by a healthcare professional. Nevertheless, previous EUROASPIRE V findings demonstrated that women still have a poorer risk factor control in secondary CHD prevention.
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Yang G, Li W, Klupp N, Cao H, Liu J, Bensoussan A, Kiat H, Karamacoska D, Chang D. Does tai chi improve psychological well-being and quality of life in patients with cardiovascular disease and/or cardiovascular risk factors? A systematic review. BMC Complement Med Ther 2022; 22:3. [PMID: 34983493 PMCID: PMC8725570 DOI: 10.1186/s12906-021-03482-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 12/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Psychological risk factors have been recognised as potential, modifiable risk factors in the development and progression of cardiovascular disease (CVD). Tai Chi, a mind-body exercise, has the potential to improve psychological well-being and quality of life. We aim to assess the effects and safety of Tai Chi on psychological well-being and quality of life in people with CVD and/or cardiovascular risk factors. METHODS We searched for randomised controlled trials evaluating Tai Chi for psychological well-being and quality of life in people with CVD and cardiovascular risk factors, from major English and Chinese databases until 30 July 2021. Two authors independently conducted study selection and data extraction. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Review Manager software was used for meta-analysis. RESULTS We included 37 studies (38 reports) involving 3525 participants in this review. The methodological quality of the included studies was generally poor. Positive effects of Tai Chi on stress, self-efficacy, and mood were found in several individual studies. Meta-analyses demonstrated favourable effects of Tai Chi plus usual care in reducing anxiety (SMD - 2.13, 95% confidence interval (CI): - 2.55, - 1.70, 3 studies, I2 = 60%) and depression (SMD -0.86, 95% CI: - 1.35, - 0.37, 6 studies, I2 = 88%), and improving mental health (MD 7.86, 95% CI: 5.20, 10.52, 11 studies, I2 = 71%) and bodily pain (MD 6.76, 95% CI: 4.13, 9.39, 11 studies, I2 = 75%) domains of the 36-Item Short Form Survey (scale from 0 to 100), compared with usual care alone. Tai Chi did not increase adverse events (RR 0.50, 95% CI: 0.21, 1.20, 5 RCTs, I2 = 0%), compared with control group. However, less than 30% of included studies reported safety information. CONCLUSIONS Tai Chi seems to be beneficial in the management of anxiety, depression, and quality of life, and safe to practice in people with CVD and/or cardiovascular risk factors. Monitoring and reporting of safety information are highly recommended for future research. More well-designed studies are warranted to determine the effects and safety of Tai Chi on psychological well-being and quality of life in this population. SYSTEMATIC REVIEW REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO), CRD42016042905. Registered on 26 August 2016.
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Affiliation(s)
- Guoyan Yang
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Wenyuan Li
- Hospital of Traditional Chinese Medicine Affiliated to Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
| | - Nerida Klupp
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Huijuan Cao
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Alan Bensoussan
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Hosen Kiat
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, 2109, Australia
- Cardiac Health Institute, Sydney, NSW, 2122, Australia
| | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Tully PJ, Turnbull DA, Horowitz JD, Beltrame JF, Baune BT, Sauer-Zavala S, Baumeister H, Bean CG, Pinto RB, Cosh S, Wittert GA. Transdiagnostic Cognitive-Behavioral Therapy for Depression and Anxiety Disorders in Cardiovascular Disease Patients: Results From the CHAMPS Pilot-Feasibility Trial. Front Psychiatry 2022; 13:741039. [PMID: 35492726 PMCID: PMC9050199 DOI: 10.3389/fpsyt.2022.741039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/24/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The aim of the Cardiovascular Health in Anxiety and Mood Problems Study (CHAMPS) is to pilot the Unified Protocol (UP) for the transdiagnostic treatment of depression and anxiety disorders in patients recently hospitalized for cardiovascular diseases (CVDs) and evaluate the feasibility. METHODS The present study is a controlled, block randomized pragmatic pilot-feasibility trial incorporating qualitative interview data, comparing UP (n = 9) with enhanced usual care (EUC, n = 10). Eligible trial participants had a recent CVD-cause admission and were above the severity threshold for depression or anxiety denoted by Patient Health Questionnaire (PHQ-9) total scores ≥10 and/or Generalized Anxiety Disorder (GAD-7) total scores ≥7 respectively on two occasions, and met criteria for one or more depression or anxiety disorders determined by structured clinical interview. Study outcomes were analyzed as intention-to-treat using linear mixed models and qualitative interview data were analyzed with content analysis. RESULTS Quantitative and qualitative measured indicated acceptability of the transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders. Satisfaction with UP was comparable to antidepressant therapy and higher than general physician counseling. However, there were difficulties recruiting participants with current disorders and distress on two occasions. The UP was associated with a reduction in total number of disorders determined by blinded raters. Linear mixed models indicated that a significantly greater reduction in anxiety symptoms was evident in the UP group by comparison to the EUC group (GAD-7, p between groups = 0.011; Overall Anxiety Severity and Impairment Scale, p between groups = 0.013). Results favored the UP group by comparison to EUC for change over 6 months on measures of physical quality of life and harmful alcohol use. There was no difference between the two groups on changes in depression symptoms (PHQ-9), stress, metacognitive worry beliefs, physical activity, or adherence. DISCUSSION In conclusion, this feasibility trial indicates acceptability of transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders that is tempered by difficulties with recruitment. Larger trials are required to clarify the efficacy of transdiagnostic depression and anxiety disorder CBT in populations with CVDs and depressive or anxiety disorders. CLINICAL TRIAL REGISTRATION https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12615000555550, identifier: ACTRN12615000555550.
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Affiliation(s)
- Phillip J Tully
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - Deborah A Turnbull
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - John D Horowitz
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
| | - John F Beltrame
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Basil Hetzel Institute, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Christopher G Bean
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Ronette B Pinto
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Suzie Cosh
- School of Psychology, The University of New England, Armidale, NSW, Australia
| | - Gary A Wittert
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, School of Medicine, The University of Adelaide, Adelaide, SA, Australia
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Factors Associated with Anxiety and Depressive Symptoms in 2775 Patients with Arterial Hypertension and Coronary Heart Disease: Results from the COMETA Multicenter Study. Glob Heart 2021; 16:73. [PMID: 34900564 PMCID: PMC8533660 DOI: 10.5334/gh.1017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
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.
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Wang L, Sun Y, Zhan J, Wu Z, Zhang P, Wen X, Ge S, Han X, Lu L. Effects of Exercise Therapy on Anxiety and Depression in Patients With Coronary Heart Disease: A Meta-Analysis of a Randomized Controlled Study. Front Cardiovasc Med 2021; 8:730155. [PMID: 34708086 PMCID: PMC8542712 DOI: 10.3389/fcvm.2021.730155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023] Open
Abstract
Objective: The purpose of this review was to evaluate the effect of exercise therapy on anxiety and depression symptoms in patients with coronary heart disease (CHD). Methods: A systematic review of papers published between January 2000 and February 2021 was conducted. MEDLINE, Embase, the Cochrane Library and Web of Science were searched. Meta-analysis was used to compare the results of the included studies. Bias risk assessment was performed using the Cochrane Collaboration bias risk tool. If half or more of the seven items in Randomized controlled trials (RCTs) were low-risk, then the RCT was considered low-risk research; otherwise, it was high-risk. Statistical analyses were performed using RevMan version 5.3 and STATA version 12.0. Results: We performed a meta-analysis of 11 randomized clinical studies including 771 subjects. Eight studies (73%) were of high quality. Compared with the control group, the exercise group showed a significant improvement in anxiety [standard mean difference (SMD) = −0.61; 95% confidence interval (CI): −0.86, −0.35]. The depression level in the exercise group was also significantly reduced (SMD = −0.48; 95% CI: −0.92, −0.04). Aerobic fitness and athletic endurance also improved [mean difference (MD) = 0.77; 95% CI: 0.58, 0.95; and MD = 20.69; 95% CI: 6.91, 34.46; respectively]. Conclusions: This meta-analysis suggests that exercise therapy may be effective in alleviating anxiety and depression symptoms in patients with coronary heart disease. Due to methodological weaknesses, rigorous research needs to be designed to further confirm the effectiveness of exercise therapy in improving the mental health of patients with coronary heart disease. Systematic Review Registration:https://inplasy.com/projects/, identifier: INPLASY202160017.
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Affiliation(s)
- Lina Wang
- Department of General Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yangli Sun
- Department of General Medicine, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jie Zhan
- Department of Rehabilitation, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiyuan Wu
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Peiming Zhang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaopeng Wen
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Shuqi Ge
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xu Han
- Department of Urology (Henan Institute of Urology), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liming Lu
- Evidence-Based Medicine and Data Science Centre, Guangzhou University of Chinese Medicine, Guangzhou, China
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Xinkeshu Improves Endothelial Function and Augments Reendothelialization Capacity in Coronary Artery Disease with Anxiety/Depression. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5561272. [PMID: 34336100 PMCID: PMC8313340 DOI: 10.1155/2021/5561272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 11/21/2022]
Abstract
The disruption of endothelial homeostasis is the hallmark of coronary artery disease (CAD) and psychological disorders such as anxiety/depression. Xinkeshu (XKS), a traditional Chinese patent medicine, plays an essential role in CAD and psychological condition; however, the mechanisms underlying the effects of XKS on the endothelial function and endogenous endothelium-repair capacity in CAD patients with anxiety/depression remain elusive. In this study, endothelial function and endothelial progenitor cell- (EPC-) mediated reendothelialization capacity were compared among age-matched healthy subjects, CAD patients with or without anxiety/depression. Besides, CAD patients with anxiety/depression received 1-month XKS treatment. Anxiety/depression symptoms were evaluated by Generalized Anxiety Disorder 7-item (GAD-7)/Patient Health Questionnaire-9 (PHQ-9) score, endothelial function was tested by flow mediated dilation (FMD) measurement, and EPC-mediated reendothelialization capacity was evaluated by a carotid artery injury model in nude mouse (n = 6) with the injection of XKS-incubated EPCs from CAD patients with anxiety/depression. The results showed that FMD and EPC-mediated reendothelialization capacity of CAD patients with anxiety/depression were compromised compared to healthy subjects and CAD patients without anxiety/depression. After 1 month of XKS treatment, FMD increased from 4.29 ± 1.65 to 4.87 ± 1.58% (P < 0.05) in CAD patients with anxiety/depression, whereas it remained unchanged in the controls. Moreover, XKS decreased GAD-7 and PHQ-9 scores. Meanwhile, incubating XKS enhanced in vivo reendothelialization capacity and in vitro apoptosis of EPCs from CAD patients with anxiety/depression, which was associated with the upregulation of CXC-chemokine receptor 7 (CXCR7) and inhibition of phosphorylation of p38 signaling. CXCR7 knockdown abolished the beneficial effects of XKS, which was rescued by p38 inhibitor SB203580. Our data demonstrate for the first time that XKS improves endothelial function and enhances EPC-mediated reendothelialization through CXCR7/p38/cleaved casepase-3 signaling and provides novel insight into the detailed mechanism of XKS in maintaining endothelial homeostasis in CAD patients with anxiety/depression.
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Sun Y, Huang S, Wan C, Ruan Q, Xie X, Wei D, Li G, Lin S, Li H, Wu S. Knockdown of lncRNA ENST00000609755.1 Confers Protection Against Early oxLDL-Induced Coronary Heart Disease. Front Cardiovasc Med 2021; 8:650212. [PMID: 34095248 PMCID: PMC8175657 DOI: 10.3389/fcvm.2021.650212] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background: This study investigated the association between long non-coding RNAs (lncRNAs) and coronary heart disease (CHD) and further elucidated the potential biological roles of lncRNAs in CHD pathogenesis. Methods: A case-control study (590 patients and 590 controls) was conducted from February 2017 and March 2019 in Fuzhou, China. Environmental factors were investigated using questionnaires and physical examinations. Five representative lncRNAs were screened using lncRNA microarray (peripheral blood in 5 cases and 5 controls) and further verified by quantitative real-time polymerase chain reaction (peripheral blood leukocyte in 100 cases and 100 controls). Oxidized low-density lipoprotein (oxLDL) was used to induce a human coronary artery endothelial cell (HCAECs) injury model, and loss of function was used to elucidate the role of lncRNA ENST00000609755.1 (lnc-MICALL2-2) in oxLDL-induced HCAECs injury. Results: A total of 320 lncRNAs were found dysregulated in CHD patients (fold change> 2, p < 0.05). The results of a discovery microarray, population verification and HCAEC experiments suggested the lnc-MICALL2-2 is upregulated in CHD subjects and in an oxLDL-induced HCAECs injury model. Conversely, lnc-MICALL2-2 inhibition in vitro attenuated the effects of oxLDL on HCAECs morphology, proliferation, and apoptosis. Conclusion: Elevated expression of lnc-MICALL2-2 is an independent risk factor for CHD, and knockdown subsequently confers protection against early pathological processes of oxLDL-induced CHD.
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Affiliation(s)
- Yi Sun
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shuna Huang
- Department of Clinical Research and Translation Center Office, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chunyu Wan
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Qishuang Ruan
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoxu Xie
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Donghong Wei
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Guobo Li
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shaowei Lin
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Huangyuan Li
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Siying Wu
- School of Public Health, Fujian Medical University, Fuzhou, China
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Psychosocial Risk Factors in Cardiac Rehabilitation: Time to Screen Beyond Anxiety and Depression. Glob Heart 2021; 16:16. [PMID: 33833940 PMCID: PMC7894368 DOI: 10.5334/gh.896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Although it is well acknowledged that psychosocial risk factors (PSRF) such as low socio-economic status, stress, social isolation, negative emotions and negative personality patterns may contribute to the development and adverse outcome of cardiovascular disease (CVD), screening for PSRF in CVD patients is usually limited to anxiety and depression, mainly for feasibility reasons. We therefore aimed to develop a user-friendly screening battery for routine assessment of PSRFs and to evaluate this instrument regarding feasibility of application, PSRF results and attendance of psychological counselling if recommended to cardiac rehabilitation (CR) patients. Methods This is a prospective single center cohort study including 609 consecutive CR patients. We first developed a screening instrument based on seven validated scales for the most relevant PSRFs with totally 90 questions presented in a uniform graphical design to facilitate completion called Psychocardiogram® (PCG) and applied the instrument in consecutive patients attending CR. Patients with positive screening results were invited to a psychological counseling session. Results Six hundred and nine consecutive patients, aged 34 to 86 years (mean 60.7 years), 85% men, entering the CR program at the Bern University Hospital with ischemic heart failure (CHF), coronary artery disease (CAD) or peripheral artery disease, were included in this study. Eighty-three point three percent of the patients completed the PCG within 40 minutes. Vital exhaustion and Type-D personality were the most prevalent PSRFs (56.9% and 51.1%, respectively), whereas low social support (14.4%) and elevated depressive symptoms (15.9%), were the least prevalent ones. After screening, 120 patients (52.86%) with at least one PSRF made use of psychological counseling. Conclusions We found the PCG to be a useful screening tool for PSRF in CR patients with the potential to get new insights into the prevalence of particular PSRF in specific populations and to better study their impact on occurrence and outcome of CVD.
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Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2021; 33:85-107. [PMID: 33495044 DOI: 10.1016/j.arteri.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022]
Abstract
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
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Lee S, Collins EG. Factors influencing physical activity after cardiac surgery: An integrative review. Heart Lung 2021; 50:136-145. [DOI: 10.1016/j.hrtlng.2020.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
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Vynckier P, Ferrannini G, Rydén L, Jankowski P, De Backer T, Gevaert S, De Bacquer D, De Smedt D. Gender gap in risk factor control of coronary patients far from closing: results from the European Society of Cardiology EUROASPIRE V registry. Eur J Prev Cardiol 2020; 29:344-351. [PMID: 33624111 DOI: 10.1093/eurjpc/zwaa144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
AIMS This study aims to provide an overview on contemporary gender differences in the risk factor control of coronary heart disease (CHD) patients. METHODS AND RESULTS Analyses were based on the cross-sectional ESC (European Society of Cardiology) EORP (EurObservational Research Programme) EUROASPIRE V (European Survey of Cardiovascular Disease Prevention and Diabetes) survey including data on CHD patients across 27 European countries. Men and women between 18 and 80 years old, hospitalized for a first or recurrent coronary event were included in the study. Data were available for 8261 patients of which 25.8% women. Overall, women had a worse risk factor control compared with men. Whereas women were more likely to be non-smokers (79.3% vs. 87.2%; P < 0.001), they were less likely to reach recommended levels of physical activity (36.8% vs. 27.5%; P < 0.001), and they were less likely to be non-obese (65.1% vs. 54.3%; P < 0.001). There is indication that risk factors such as smoking behaviour and obesity differed depending on country income level. No gender differences could be observed in blood pressure on target (P > 0.05). Moreover, a lower proportion of women reached low-density lipoprotein cholesterol (LDL-C) target levels (31.4% vs. 22.1%; P < 0.001), and they were less likely to reach glycated haemoglobin (HbA1c) targets if having self-reported diabetes (56.7% vs. 48.6%; P < 0.001). CONCLUSION The risk factor control of CHD women is substantial worse compared with men despite little gender differences in cardiovascular medication intake. Further actions are needed to increase the awareness of the worse risk factor control in female CHD patients.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tine De Backer
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Peltzer S, Müller H, Köstler U, Schulz-Nieswandt F, Jessen F, Albus C. Detection and treatment of mental disorders in patients with coronary heart disease (MenDis-CHD): A cross-sectional study. PLoS One 2020; 15:e0243800. [PMID: 33315906 PMCID: PMC7735609 DOI: 10.1371/journal.pone.0243800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Mental disorders (MD) are associated with an increased risk of developing coronary heart disease (CHD) and with higher CHD-related morbidity and mortality. There is a strong recommendation to routinely screen CHD patients for MDs, diagnosis, and treatment by recent guidelines. The current study aimed at mapping CHD patients' (1) state of diagnostics and, if necessary, treatment of MDs, (2) trajectories and detection rate in healthcare, and (3) the influence of MDs and its management on quality of life and patient satisfaction. The design was a cross-sectional study in three settings (two hospitals, two rehabilitation clinics, three cardiology practices). CHD patients were screened for MDs with the Hospital Anxiety and Depression Scale (HADS), and, if screened-positive, examined for MDs with the Structured Clinical Interview for DSM-IV (SCID-I). Quality of Life (EQ-5D), Patient Assessment of Care for Chronic Conditions (PACIC), and previous routine diagnostics and treatment for MDs were examined. Descriptive statistics, Chi-squared tests, and ANOVA were used for analyses. Analyses of the data of 364 patients resulted in 33.8% positive HADS-screenings and 28.0% SCID-I diagnoses. The detection rate of correctly pre-diagnosed MDs was 49.0%. Physicians actively approached approximately thirty percent of patients on MDs; however, only 6.6% of patients underwent psychotherapy and 4.1% medication therapy through psychotherapists/psychiatrists. MD patients scored significantly lower on EQ-5D and the PACIC. The state of diagnostic and treatment of comorbid MDs in patients with CHD is insufficient. Patients showed a positive attitude towards addressing MDs and were satisfied with medical treatment, but less with MD-related advice. Physicians in secondary care need more training inadequately addressing mental comorbidity.
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Affiliation(s)
- Samia Peltzer
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, North Rhine-Westphalia, Germany
- * E-mail:
| | - Hendrik Müller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Ursula Köstler
- Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Frank Schulz-Nieswandt
- Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, North Rhine-Westphalia, Germany
- German Center for Neurodegenerative Diseases (DZNE), Bonn, North Rhine-Westphalia, Germany
| | - Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, North Rhine-Westphalia, Germany
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Zwas DR, Keren A, Amir O, Gotsman I. Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression. J Clin Med 2020; 9:jcm9123967. [PMID: 33297471 PMCID: PMC7762354 DOI: 10.3390/jcm9123967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Few studies have evaluated the effect of pharmacologic treatment of anxiety on outcomes in heart failure (HF) patients. This study examined the impact of treatment with anxiolytics on clinical outcomes in a real-world sample of HF patients with and without depression. METHODS Patients diagnosed with HF were retrieved from a large HMO database. Patients prescribed anxiolytic medication and patients diagnosed with depression and/or prescribed anti-depressant medication were followed for cardiac-related hospitalizations and death. RESULTS The study cohort included 6293 HF patients. Treatment with anxiolytics was associated with decreased one-year survival compared to untreated individuals, with a greater reduction in survival seen in patients diagnosed with depression and/or treated with anti-depressants. Multi-variable analysis adjusting for age, sex, NYHA class, cardiac risk factors and laboratory parameters found that treatment with anxiolytics remained a predictor of mortality even when adjusting for depression. Depression combined with anxiolytic treatment was predictive of increased mortality, and treatment with anxiolytics alone, depression alone and anxiolytic treatment together with depression were each associated with an increased hazard ratio for a composite outcome of death and hospitalization. CONCLUSIONS In this real-world study of HF patients, both treatment with anxiolytics and depression were associated with increased mortality, and anxiolytic therapy remained a predictor of mortality when adjusting for depression. Treatment of anxiety together with depression was associated with the highest risk of mortality. Safe and effective treatment for anxiety and depression is warranted to alleviate the detrimental impact of these disorders on quality and of life and adverse events.
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Affiliation(s)
- Donna R. Zwas
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
- Correspondence: ; Tel.: +972-2-6776564; Fax: +972-2- 6411028
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
| | - Offer Amir
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
| | - Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem 91120, Israel; (A.K.); (O.A.); (I.G.)
- Heart Failure Center, Clalit Health Services, Tel Aviv 16250, Israel
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Sweda R, Siontis GC, Nikolakopoulou A, Windecker S, Pilgrim T. Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian meta-analysis. ESC Heart Fail 2020; 7:3610-3620. [PMID: 32935927 PMCID: PMC7754966 DOI: 10.1002/ehf2.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/09/2020] [Indexed: 01/09/2023] Open
Abstract
AIMS The aim of this study is to investigate the effect of antidepressant therapy on mortality and cardiovascular outcomes in patients with acute coronary syndrome (ACS). METHODS AND RESULTS We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and performed a Bayesian random-effects meta-analysis of randomized controlled trials that investigated antidepressant pharmacotherapy in patients following ACS. The primary outcome was all-cause mortality. Secondary outcomes were repeat hospitalizations and recurrent myocardial infarctions (MIs). Ten randomized controlled trials with a total of 1935 patients qualified for inclusion. Selective serotonin reuptake inhibitors were investigated in six, bupropion in three, and mirtazapine in one trial. Placebo was used as control in eight trials. There was no difference in all-cause mortality [odds ratio (OR) 0.97, 95% credible interval (CrI) 0.66-1.42] and recurrent MI (OR 0.64, 95% CrI 0.40-1.02) between patients receiving antidepressants compared with controls, whereas antidepressant therapy was associated with less repeat hospitalizations (OR 0.62, 95% CrI 0.40-0.94). In patients with ACS and concomitant depression, antidepressants reduced the odds of recurrent MI compared with usual care/placebo (OR 0.45, 95% CrI 0.25-0.81). Extended funnel plots suggest robustness of the observations. CONCLUSIONS Antidepressants in patients following ACS have no effect on mortality but reduce repeat hospitalizations; in patients with depression, there is a reduced risk of recurrent MI with antidepressant therapy.
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Affiliation(s)
- Romy Sweda
- Department of CardiologyInselspital, Bern University Hospital, University of BernBernCH‐3010Switzerland
- ARTORG Center for Biomedical Engineering ResearchUniversity of BernBernSwitzerland
| | - George C.M. Siontis
- Department of CardiologyInselspital, Bern University Hospital, University of BernBernCH‐3010Switzerland
| | - Adriani Nikolakopoulou
- Institute of Social and Preventive Medicine and Clinical Trials UnitBern University HospitalBernSwitzerland
| | - Stephan Windecker
- Department of CardiologyInselspital, Bern University Hospital, University of BernBernCH‐3010Switzerland
| | - Thomas Pilgrim
- Department of CardiologyInselspital, Bern University Hospital, University of BernBernCH‐3010Switzerland
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Vynckier P, Ferrannini G, Rydén L, Tokgözoğlu L, Bruthans J, Kotseva K, Wood D, De Backer T, Gevaert S, De Bacquer D, De Smedt D. Medical Treatment in Coronary Patients: Is there Still a Gender Gap? Results from European Society of Cardiology EUROASPIRE V Registry. Cardiovasc Drugs Ther 2020; 35:801-808. [PMID: 33068226 DOI: 10.1007/s10557-020-07095-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE This study is aimed at investigating gender differences in the medical management of patients with coronary heart disease (CHD). METHODS Analyses were based on the ESC EORP EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) survey. Consecutive patients between 18 and 80 years, hospitalized for a coronary event, were included in the study. Information on cardiovascular medication intake at hospital discharge and at follow-up (≥ 6 months to < 2 years after hospitalization) was collected. RESULTS Data was available for 8261 patients (25.8% women). Overall, no gender differences were observed in the prescription and use of cardioprotective medication like aspirin, beta-blockers, and ACE-I/ARBs (P > 0.01) at discharge and follow-up respectively. However, a statistically significant difference was found in the use of statins at follow-up, in disfavor of women (82.8% vs. 77.7%; P < 0.001). In contrast, at follow-up, women were more likely to use diuretics (31.5% vs. 39.5%; P < 0.001) and calcium channel blockers (21.2% vs. 28.8%; P < 0.001), whereas men were more likely to use anticoagulants (8.8% vs. 7.0%; P < 0.001). Overall, no gender differences were found in total daily dose intake (P > 0.01). Furthermore, women were less likely than men to have received a CABG (20.4% vs. 13.2%; P < 0.001) or PCI (82.1% vs. 74.9%; P < 0.001) at follow-up. No gender differences were observed in prescribed (P = 0.10) and attended (P = 0.63) cardiac rehabilitation programs. CONCLUSION The EUROASPIRE V results show only limited gender differences in the medical management of CHD patients. Current findings suggest growing awareness about risk in female CHD patients.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lale Tokgözoğlu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Jan Bruthans
- Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Prague, Czech Republic
| | - Kornelia Kotseva
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart & Lung Institute Imperial College London, London, UK
| | - David Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway, Ireland.,National Heart & Lung Institute Imperial College London, London, UK
| | - Tine De Backer
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Armario P, Brotons C, Elosua R, Alonso de Leciñana M, Castro A, Clarà A, Cortés O, Díaz Rodriguez Á, Herranz M, Justo S, Lahoz C, Pedro-Botet J, Pérez Pérez A, Santamaria R, Tresserras R, Aznar Lain S, Royo-Bordonada MÁ. [Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Cardiovascular Prevention Guidelines]. HIPERTENSION Y RIESGO VASCULAR 2020; 38:21-43. [PMID: 33069629 DOI: 10.1016/j.hipert.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022]
Abstract
We present the adaptation for Spain of the updated European Cardiovascular Prevention Guidelines. In this update, greater stress is laid on the population approach, and especially on the promotion of physical activity and healthy diet through dietary, leisure and active transport policies in Spain. To estimate vascular risk, note should be made of the importance of recalibrating the tables used, by adapting them to population shifts in the prevalence of risk factors and incidence of vascular diseases, with particular attention to the role of chronic kidney disease. At an individual level, the key element is personalised support for changes in behaviour, adherence to medication in high-risk individuals and patients with vascular disease, the fostering of physical activity, and cessation of smoking habit. Furthermore, recent clinical trials with PCSK9 inhibitors are reviewed, along with the need to simplify pharmacological treatment of arterial hypertension to improve control and adherence to treatment. In the case of patients with type 2 diabetes mellitus and vascular disease or high vascular disease risk, when lifestyle changes and metformin are inadequate, the use of drugs with proven vascular benefit should be prioritised. Lastly, guidelines on peripheral arterial disease and other specific diseases are included, as is a recommendation against prescribing antiaggregants in primary prevention.
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Affiliation(s)
- Pedro Armario
- Sociedad Española-Liga Española para la Lucha contra la Hipertensión Arterial, Madrid, España.
| | - Carlos Brotons
- Sociedad Española de Medicina de Familia y Comunitaria, Barcelona, España
| | | | | | - Almudena Castro
- Sociedad Española de Cardiología-Coordinadora Nacional Sección de Prevención, Madrid, España
| | - Albert Clarà
- Sociedad Española de Angiología y Cirugía Vascular, Madrid, España
| | - Olga Cortés
- Asociación Española Pediatría de Atención Primaria, Madrid, España
| | | | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria-FAECAP, Madrid, España
| | | | - Carlos Lahoz
- Sociedad Española de Medicina Interna, Madrid, España
| | | | | | | | - Ricard Tresserras
- Sociedad Española de Salud Pública y Administración Sanitaria-SESPAS, Barcelona, España
| | - Susana Aznar Lain
- Facultad de Ciencias del Deporte, Universidad Castilla La Mancha, Toledo, España
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Zinckernagel L, Ersbøll AK, Holmberg T, Pedersen SS, Timm HU, Zwisler AD. What are the prevalence and predictors of psychosocial healthcare among patients with heart disease? A nationwide population-based cohort study. BMJ Open 2020; 10:e037691. [PMID: 33040000 PMCID: PMC7549489 DOI: 10.1136/bmjopen-2020-037691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Psychosocial healthcare is recommended, but little is known about how patients perceive the level of care and whether subgroups of patients experience less psychosocial healthcare than others. We examined the prevalence of patient-reported psychosocial healthcare and factors predicting patient-reported lack of psychosocial healthcare among patients with heart disease. DESIGN A cohort study. SETTING Denmark, nationwide. PARTICIPANTS A registry-based random sample of 5000 patients with incident heart disease in 2013. MEASURES Patient-reported psychosocial healthcare was obtained from a survey and potential predictors before disease onset from registries. We used multivariable logistic regression analysis to determine predictors of patient-reported lack of care. RESULTS We received responses from 56%; 40% reported lacking information on psychosocial aspects, 51% lacking psychosocial rehabilitation and support and 32% reported lacking both types of psychosocial healthcare. The type of heart disease was the strongest predictor of patient-reported lack of psychosocial healthcare, especially among patients with atrial fibrillation (OR: 3.11-3.98). Older age (OR: 1.48-2.05), female gender (OR: 1.27-1.53) and no contact with general practitioner (OR: 1.47-1.84) also predicted patient-reported lack of psychosocial healthcare. Patients outside the labour force (OR: 1.29) and living in the capital region (OR: 1.50) more frequently reported lacking psychosocial rehabilitation and support, and patients with recent (OR: 1.63) or past (OR: 1.33) anxiety or depression and severe comorbidities (OR: 1.34) more frequently reported lacking both types of psychosocial healthcare. CONCLUSIONS Many patients with heart disease reported lacking psychosocial healthcare. Importantly, patients who most need psychosocial healthcare are not those who report receiving it. Our results call for action to translate guidelines into clinical practice.
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Affiliation(s)
- Line Zinckernagel
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Annette Kjær Ersbøll
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
| | - Teresa Holmberg
- The National Institute of Public Health, the University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, the University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Helle Ussing Timm
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Ann-Dorthe Zwisler
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, the University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
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Luque B, Castillo-Mayén R, Cuadrado E, Gutiérrez-Domingo T, Rubio SJ, Arenas A, Delgado-Lista J, Pérez Martínez P, Tabernero C. The Role of Emotional Regulation and Affective Balance on Health Perception in Cardiovascular Disease Patients According to Sex Differences. J Clin Med 2020; 9:E3165. [PMID: 33007817 PMCID: PMC7599936 DOI: 10.3390/jcm9103165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/21/2020] [Accepted: 09/28/2020] [Indexed: 11/17/2022] Open
Abstract
One of the challenges of aging is the increase of people with chronic diseases, such as cardiovascular disease (CVD). Men and women experience the disease differently. Therefore, it has an impact on how CVD is treated and its outcomes. This research analyzed the relationship between psychosocial variables and health promotion among cardiovascular patients, paying special attention to sex differences. A longitudinal study with cardiovascular patients (747 in phase 1 (122 women) and 586 in phase 2 (83 women)) was carried out. Participants were evaluated based on their sociodemographic characteristics, affective balance, regulatory negative affect self-efficacy, stress and anxiety regulation strategies, and perceived global health. Results showed that men presented significantly higher scores in positive affect, affective balance, and self-efficacy to regulate negative emotions, while women presented significantly higher scores in negative affect and the use of passive strategies to cope with stressful situations. Regression analyses showed that all psychological variables studied in phase 1 were significant predictors of health perception in phase 2. According to the results, it is necessary to include strategies to improve cardiovascular health through education and emotional regulation, with a gender focus.
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Affiliation(s)
- Bárbara Luque
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Department of Psychology, University of Córdoba, 14071 Córdoba, Spain
| | - Rosario Castillo-Mayén
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Department of Psychology, University of Córdoba, 14071 Córdoba, Spain
| | - Esther Cuadrado
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Department of Psychology, University of Córdoba, 14071 Córdoba, Spain
| | - Tamara Gutiérrez-Domingo
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Department of Psychology, University of Córdoba, 14071 Córdoba, Spain
| | - Sebastián J. Rubio
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Department of Didactics of Experimental Sciences, University of Córdoba, 14071 Cordoba, Spain
| | - Alicia Arenas
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Department of Social Psychology, University of Seville, 41018 Seville, Spain
| | - Javier Delgado-Lista
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Cordoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28007 Madrid, Spain
| | - Pablo Pérez Martínez
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Medicine (Medicine, Dermatology and Otorhinolaryngology), University of Córdoba, 14004 Cordoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28007 Madrid, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14004 Córdoba, Spain; (E.C.); (T.G.-D.); (S.J.R.); (A.A.); (J.D.-L.); (P.P.M.)
- Instituto de Neurociencias de Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain
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Marzolini S, Colella TJF. Factors That Predispose Women to Greater Depressive Symptoms: A Sex-, Age-, and Diagnosis-Matched Cardiac Rehabilitation Cohort. Can J Cardiol 2020; 37:382-390. [PMID: 32882330 DOI: 10.1016/j.cjca.2020.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023] Open
Abstract
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 (VO2peak), 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 VO2peak, 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.
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Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Tracey J F Colella
- KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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47
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Nacul L, O'Boyle S, Palla L, Nacul FE, Mudie K, Kingdon CC, Cliff JM, Clark TG, Dockrell HM, Lacerda EM. How Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Progresses: The Natural History of ME/CFS. Front Neurol 2020; 11:826. [PMID: 32849252 PMCID: PMC7431524 DOI: 10.3389/fneur.2020.00826] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/01/2020] [Indexed: 12/25/2022] Open
Abstract
We propose a framework for understanding and interpreting the pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) that considers wider determinants of health and long-term temporal variation in pathophysiological features and disease phenotype throughout the natural history of the disease. As in other chronic diseases, ME/CFS evolves through different stages, from asymptomatic predisposition, progressing to a prodromal stage, and then to symptomatic disease. Disease incidence depends on genetic makeup and environment factors, the exposure to singular or repeated insults, and the nature of the host response. In people who develop ME/CFS, normal homeostatic processes in response to adverse insults may be replaced by aberrant responses leading to dysfunctional states. Thus, the predominantly neuro-immune manifestations, underlined by a hyper-metabolic state, that characterize early disease, may be followed by various processes leading to multi-systemic abnormalities and related symptoms. This abnormal state and the effects of a range of mediators such as products of oxidative and nitrosamine stress, may lead to progressive cell and metabolic dysfunction culminating in a hypometabolic state with low energy production. These processes do not seem to happen uniformly; although a spiraling of progressive inter-related and self-sustaining abnormalities may ensue, reversion to states of milder abnormalities is possible if the host is able to restate responses to improve homeostatic equilibrium. With time variation in disease presentation, no single ME/CFS case description, set of diagnostic criteria, or molecular feature is currently representative of all patients at different disease stages. While acknowledging its limitations due to the incomplete research evidence, we suggest the proposed framework may support future research design and health care interventions for people with ME/CFS.
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Affiliation(s)
- Luis Nacul
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- B.C. Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Shennae O'Boyle
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luigi Palla
- Department of Medical Statistics, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Flavio E. Nacul
- Pro-Cardiaco Hospital and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kathleen Mudie
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline C. Kingdon
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline M. Cliff
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Taane G. Clark
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eliana M. Lacerda
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Evaluation of Psychological Stress Parameters in Coronary Patients by Three Different Questionnaires as Pre-Requisite for Comprehensive Rehabilitation. Brain Sci 2020; 10:brainsci10050316. [PMID: 32455944 PMCID: PMC7288090 DOI: 10.3390/brainsci10050316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Negative psychological conditions are common in patients with cardiovascular diseases. Although depression has been scrutinized over the years in these patients, only recently has anxiety emerged as another important risk factor. The purpose of this study was to compare the parameters of psychological stress in a population of coronary patients with and without myocardial revascularization procedures and to analyze lifestyle and socio-economic contributors to the state of health of these patients before inclusion in a comprehensive individualized rehabilitation program. Methods: This study included 500 patients with coronary artery disease (CAD) in stable condition divided in 2 groups: 200 patients who underwent coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) (Group 1) and 300 patients without myocardial revascularization (Group 2) with stable angina or thrombolyzed myocardial infarction. The protocol included screening for anxiety/depression after procedure using three different scales: Duke Anxiety-Depression Scale, Hospital Anxiety and Depression Scale (HADS) and the Type D Personality Scale (DS-14) scale that evaluates negative affectivity (NA) and social inhibition (SI). Results: Significant differences between groups were observed for HAD-A (9.1 ± 4.18 for Group 1 vs. 7.8 ± 4.03 for Group 2, p = 0.002) and DUKE scores (30.2 ± 12.25 for Group 1 vs. 22.7 ± 12.13 for Group 2, p < 0.001). HAD-A scores (p = 0.01) and DUKE scores (p = 0.04) were significantly higher in patients who underwent PTCA vs. CABG. CAD patients without myocardial revascularization (Group 2, n = 300) presented anxiety in proportion of 72.3% (n = 217) out of which 10.7% (n = 32) had severe anxiety, and 180 patients had depression (a proportion of 60%) out of which 1.3% (n = 4) presented severe depression. The correlation between the presence of type 2 diabetes mellitus (T2DM) and type D personality in revascularized patients (n = 200) was significant (Chi2 test, p = 0.010). By applying multinomial regression according to the Cox and Snell R-square model and multivariate linear regression by the Enter method, we demonstrated that male gender, age and marital status proved significant predictors for psychological stress in our study population. Conclusions: The results obtained in this study provide a framework for monitoring anxiety, depression and type D personality in coronary patients before inclusion in comprehensive rehabilitation programs. Behavioral and psychological stress responses in patients with CAD significantly correlate with risk factors, and could influence the evolution of the disease. Moreover, other factors like gender, income and marital status also seem to play a decisive role. Evaluation of psychological stress parameters contributes to a better individualization at the start of these programs, because it allows adjusting of all potential factors that may influence positive outcomes.
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Tokgozoglu L, Canpolat U. Does depression and anxiety increase subclinical atherosclerosis more in dyslipidemic women than men? Eur J Prev Cardiol 2020; 27:797-799. [PMID: 31615293 DOI: 10.1177/2047487319883722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Turkey
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50
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Sedlak T, Herscovici R, Cook-Wiens G, Handberg E, Wei J, Shufelt C, Bittner V, Reis SE, Reichek N, Pepine C, Bairey Merz CN. Predicted Versus Observed Major Adverse Cardiac Event Risk in Women With Evidence of Ischemia and No Obstructive Coronary Artery Disease: A Report From WISE (Women's Ischemia Syndrome Evaluation). J Am Heart Assoc 2020; 9:e013234. [PMID: 32268814 PMCID: PMC7428651 DOI: 10.1161/jaha.119.013234] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Primary prevention risk scores are commonly used to predict cardiovascular (CVD) outcomes. The applicability of these scores in patients with evidence of myocardial ischemia but no obstructive coronary artery disease is unclear. Methods and Results Among 935 women with signs and symptoms of ischemia enrolled in WISE (Women's Ischemia Syndrome Evaluation), 567 had no obstructive coronary artery disease on angiography. Of these, 433 had had available risk data for 6 commonly used scores: Framingham Risk Score, Reynolds Risk Score, Adult Treatment Panel III, Atherosclerotic Cardiovascular Disease, Systematic Coronary Risk Evaluation, Cardiovascular Risk Score 2. Score-specific CVD rates were assessed. For each score, we evaluated predicted versus observed event rates at 10-year follow-up using c statistic. Recalibration was done for 3 of the 6 scores. The 433 women had a mean age of 56.9±9.4 years, 82.5% were white, 52.7% had hypertension, 43.6% had dyslipidemia, and 16.9% had diabetes mellitus. The observed 10-year score-specific CVD rates varied between 5.54% (Systematic Coronary Risk Evaluation) to 28.87% (Framingham Risk Score), whereas predicted event rates varied from 1.86% (Systematic Coronary Risk Evaluation) to 6.99% (Cardiovascular Risk Score 2). The majority of scores showed moderate discrimination (c statistic 0.53 for Atherosclerotic Cardiovascular Disease and Systematic Coronary Risk Evaluation; 0.78 for Framingham Risk Score) and underestimated risk (statistical discordance -58% for Adult Treatment Panel III; -84% for Atherosclerotic Cardiovascular Disease). Recalibrated Reynolds Risk Score, Atherosclerotic Cardiovascular Disease, and Framingham Risk Score had improved performance, but significant underestimation remained. Conclusions Commonly used CVD risk scores fail to accurately predict CVD rates in women with ischemia and no obstructive coronary artery disease. These results emphasize the need for new risk assessment scores to reliably assess this population.
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Affiliation(s)
- Tara Sedlak
- Vancouver General Hospital Vancouver British Columbia Canada
| | - Romana Herscovici
- Barbra Streisand Women's Heart Center Cedars-Sinai Heart Institute Los Angeles CA
| | - Galen Cook-Wiens
- Barbra Streisand Women's Heart Center Cedars-Sinai Heart Institute Los Angeles CA
| | | | - Janet Wei
- Barbra Streisand Women's Heart Center Cedars-Sinai Heart Institute Los Angeles CA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center Cedars-Sinai Heart Institute Los Angeles CA
| | - Vera Bittner
- Division of Cardiovascular Disease University of Alabama at Birmingham AL
| | | | | | | | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center Cedars-Sinai Heart Institute Los Angeles CA
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