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Scovelle AJ, Oldenburg B, Taylor CB, Hare DL, Thomas EE, Toukhsati SR, Oldroyd J, Russell JD, O'Neil A. Resting Heart Rate and Heart Rate Variability in the Year Following Acute Coronary Syndrome: How Do Women Fare? Heart Lung Circ 2020; 30:128-134. [PMID: 32839115 DOI: 10.1016/j.hlc.2020.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/22/2020] [Accepted: 06/15/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Women experience poorer health outcomes following acute coronary syndrome (ACS). Heart rate (HR) and heart rate variability (HRV) have emerged as sensitive and cost-effective markers of autonomic function and prognostic risk factors of poor cardiac outcomes. The aim of the current study was to investigate whether sex-specific differences existed across HR and five parameters of HRV, at 1 and 12 months following ACS diagnosis. METHODS Between January 2013 and June 2014, a sample of 416 ACS patients was enrolled in the Anxiety Depression & Heart Rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) longitudinal cohort study. At 1 and 12 months following discharge, patient HR and HRV (root mean square of successive differences [RMSDD], standard deviation of RR intervals [SDRR], high frequency power [HF], low frequency power [LF], very low frequency power [VLF]) was measured via three-lead electrocardiogram. RESULTS At 1 month post-ACS, sex was a significant predictor of HR and VLF power in fully- adjusted models. At 12 months post-ACS, sex was a predictor of HR, SDRR and VLF power in fully-adjusted models. CONCLUSION Sex-specific differences in resting HR and HRV were observed in the year following ACS, whereby women had higher HR and lower HRV, suggestive of poorer autonomic function. Further large-scale cohort studies examining autonomic function as a driver of sex-specific outcomes following ACS are required.
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Affiliation(s)
- Anna J Scovelle
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia.
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia
| | - C Barr Taylor
- Department of Psychiatry, Stanford and Palo Alto Universities, Palo Alto, CA, US
| | - David L Hare
- School of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia
| | - Emma E Thomas
- Centre for Online Health, Centre for Health Services Research, University of Queensland, Brisbane, Qld, Australia
| | - Samia R Toukhsati
- School of Medicine, University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia; School of Science, Psychology and Sport, Federation University, Melbourne, Vic, Australia
| | - John Oldroyd
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Josephine D Russell
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Vic, Australia
| | - Adrienne O'Neil
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Vic, Australia
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O'Neil A, Scovelle AJ, Thomas E, Russell JD, Taylor CB, Hare DL, Toukhsati S, Oldroyd J, Rangani WPT, Dheerasinghe DSAF, Oldenburg B. Sex-Specific Differences in Percutaneous Coronary Intervention Outcomes After a Cardiac Event: A Cohort Study Examining the Role of Depression, Worry and Autonomic Function. Heart Lung Circ 2020; 29:1449-1458. [PMID: 32414636 DOI: 10.1016/j.hlc.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/22/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND To determine whether differential all-cause hospital readmission exists for men and women 2 years after percutaneous coronary intervention (PCI) treatment for acute coronary syndrome (ACS), and to identify potential autonomic and psychological pathways contributing to this association. METHODS Four hundred and sixteen (416) patients admitted with ACS were recruited from coronary care wards. Participants attended the study centre at one (T0) and 12 (T1) months following discharge. Heart rate variability (HRV) was used to assess autonomic functioning measured via a three-lead electrocardiogram. Psychological variables of interest (pathological worry, depression and phobic anxiety) were measured using validated self-report questionnaires. Percutaneous coronary intervention treatment data were collected from hospital records. The primary outcome was 2-year all-cause hospital readmission (yes/no). Logistic regression modelling using both complete case analysis and multiple imputation analysis was applied. RESULTS Men who received PCI had a significant reduction in the odds of being rehospitalised over the following 2 years, relative to women who did not (OR=0.45, 95% CI=0.20, 0.98). No other group benefited to this extent. Adjustment for age, ACS severity and Very Low Frequency (VLF) Power appeared to strengthen the association in both the complete case analysis and multiple imputation analysis models. The inclusion of depression and worry also marginally explained these associations in the multiple imputation analysis model. CONCLUSIONS Men who receive PCI after ACS were less likely to be readmitted to hospital over the following 2 years than their female counterparts. The small sample size of women and observational study design limit interpretation of the findings. However, heart rate variability, specifically VLF power, requires further investigation as a driver of such sex-specific outcomes.
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Affiliation(s)
- Adrienne O'Neil
- Institute for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, Vic, Australia; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia.
| | - Anna J Scovelle
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Emma Thomas
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia; Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Josephine D Russell
- Institute for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, Vic, Australia
| | - C Barr Taylor
- Department of Psychiatry, Stanford and Palo Alto Universities, Palo Alto, CA, USA
| | - David L Hare
- School of Medicine, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia
| | - Samia Toukhsati
- School of Medicine, The University of Melbourne, Melbourne, Vic, Australia; Department of Cardiology, Austin Hospital, Melbourne, Vic, Australia; School of Health and Life Sciences, Federation University, Melbourne, Vic, Australia
| | - John Oldroyd
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - W P Thanuja Rangani
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - D S Anoja F Dheerasinghe
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
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O'Neil A, Taylor CB, Hare DL, Thomas E, Toukhsati SR, Oldroyd J, Scovelle AJ, Oldenburg B. The relationship between phobic anxiety and 2-year readmission after Acute Coronary Syndrome: What is the role of heart rate variability? J Affect Disord 2019; 247:73-80. [PMID: 30654268 DOI: 10.1016/j.jad.2018.12.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 11/15/2018] [Accepted: 12/24/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Phobic anxiety is a risk factor for poor prognosis following Acute Coronary Syndrome (ACS). A psychophysiological marker of vagal function, autonomic dysfunction may play a critical role in this relationship. The aim of the study was two-fold: to assess whether phobic anxiety was characterised by autonomic dysfunction (heart rate variability) in the short (1-month) and longer term (12-months) following ACS, and (ii) to quantify the extent to which HRV parameters modified the effect of phobic anxiety on all-cause hospital readmission over 2 years. METHODS The ADVENT study followed 416 ACS patients. At 1-month following discharge (T0), phobic anxiety and autonomic functioning were assessed using the Crown Crisp Index (CCI) and 11 indices of heart rate variability (HRV), respectively. HRV was measured again at 12-months (T1) (n = 359). Hospital readmission (all cause) was derived from an audit of hospital records by two medically trained research fellows. Generalised linear modelling (GLM) was used to first determine the association between CCI score at T0 and HRV parameters at T0 and T1. Binary logistic regression was used to measure the relationship between CCI scores and readmission (yes/no) and the extent to which HRV parameters modified this effect. RESULTS CCI scores were associated with 7 of the 11 indices of HRV: Average RR (ms), SDRR (ms), RMSSD (ms), SDSD (ms), pRR50 (%), LF Powers (ms2) and HF Powers (ms2) at T0 but not T1. CCI scores at T0 significantly predicted likelihood of readmission to hospital in the subsequent 2 year period. No parameter of HRV at T0 modified this effect. LIMITATIONS We were unable to provide adjudicated major adverse coronary events outcome data, or account for changes in medication adherence, diet or physical activity. CONCLUSIONS While phobic anxiety is associated with both reduced vagal function in the short term after an ACS event and 2 year all cause readmission, HRV does not appear to be the pathway by which phobic anxiety drives this outcome.
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Affiliation(s)
- Adrienne O'Neil
- Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207, Bouverie St., Parkville, Melbourne, VIC, Australia.
| | - C Barr Taylor
- Department of Psychiatry, Stanford and Palo Alto Universities, Palo Alto, CA, United States
| | - David L Hare
- School of Medicine, University of Melbourne Parkville, Melbourne, VIC, Australia; Department of Cardiology, Austin Hospital, Heidelberg, VIC, Australia
| | - Emma Thomas
- Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207, Bouverie St., Parkville, Melbourne, VIC, Australia
| | - Samia R Toukhsati
- School of Medicine, University of Melbourne Parkville, Melbourne, VIC, Australia; Department of Cardiology, Austin Hospital, Heidelberg, VIC, Australia; Federation University Australia, School of Health and Life Sciences, Berwick, VIC Australia
| | - John Oldroyd
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Anna J Scovelle
- Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207, Bouverie St., Parkville, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207, Bouverie St., Parkville, Melbourne, VIC, Australia
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Thomas E, Lotfaliany M, Grace SL, Oldenburg B, Taylor CB, Hare DL, Rangani WT, Dheerasinghe DAF, Cadilhac DA, O'Neil A. Effect of cardiac rehabilitation on 24-month all-cause hospital readmissions: A prospective cohort study. Eur J Cardiovasc Nurs 2018; 18:234-244. [PMID: 30547678 DOI: 10.1177/1474515118820176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ageing populations and increasing survival following acute coronary syndrome has resulted in large numbers of people living with cardiovascular disease and at high risk of hospitalizations. Rising hospital admissions have a significant financial cost to the healthcare system. AIM The purpose of this study was to determine whether cardiac rehabilitation is protective against long-term hospital readmission (frequency and length) following acute coronary syndrome. METHODS Data from 416 Australian patients with acute coronary syndrome enrolled in the Anxiety Depression and heart rate Variability in cardiac patients: Evaluating the impact of Negative emotions on functioning after Twenty four months (ADVENT) prospective cohort study between January 2013-June 2014 was analyzed secondarily. Participants self-reported cardiac rehabilitation attendance over the 12 months post-discharge. All-cause readmission data were extracted from hospital records 24 months post-index event. The association between cardiac rehabilitation and all-cause readmission, frequency of readmissions, and length of stay was assessed using three methods (a) regression analysis, (b) propensity score matching, and (c) inverse probability treatment weighting. RESULTS Overall, 416 patients consented (53% of eligible patients), of which 414 (99.5%) survived the first 30 days post-discharge and were included in the analysis. Medical records were located for 409 participants after 24 months (98% follow-up rate). In total, 267 (65%) reported attending cardiac rehabilitation; there were 392 readmissions by 239 patients. Cardiac rehabilitation attendance was not associated with all-cause hospital readmission; however, it was associated with lower frequency of hospital admissions (odds ratio 0.53, 95% confidence interval: 0.31-0.91 p-value:0.022) and length of stay (coefficient -1.21 days, 95% confidence interval: -2.46-0.26; marginally significant p-value: 0.055) in adjusted models. CONCLUSION This study substantiates the long-term benefits of cardiac rehabilitation on readmissions, including length of stay, which would result in lower costs to the healthcare system.
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Affiliation(s)
- Emma Thomas
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Mojtaba Lotfaliany
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Sherry L Grace
- 2 School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Brian Oldenburg
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - C Barr Taylor
- 3 Department of Psychiatry, Stanford and Palo Alto Universities, USA
| | - David L Hare
- 4 School of Medicine, University of Melbourne, Australia.,5 Department of Cardiology, Austin Hospital, Australia
| | - Wp Thanuja Rangani
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
| | | | - Dominique A Cadilhac
- 6 School of Clinical Sciences at Monash Health, Monash University, Australia.,7 Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Adrienne O'Neil
- 1 Melbourne School of Population and Global Health, University of Melbourne, Australia
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Trudel-Fitzgerald C, Tworoger SS, Poole EM, Zhang X, Giovannucci EL, Meyerhardt JA, Kubzansky LD. Psychological symptoms and subsequent healthy lifestyle after a colorectal cancer diagnosis. Health Psychol 2017; 37:207-217. [PMID: 29154605 DOI: 10.1037/hea0000571] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Although medical professionals recommend lifestyle changes following a colorectal cancer (CRC) diagnosis to improve outcomes, such changes are not consistently implemented. This study examines whether higher distress is associated with lower likelihood of engaging in favorable behaviors after CRC diagnosis. METHOD Women from the Nurses' Health Study prospective cohort who completed anxiety (n = 145) and depression (n = 227) symptom scales within 4 years after receiving a CRC diagnosis were included. Measures of lifestyle (diet, physical activity, alcohol, smoking, body mass index [BMI]) were queried prediagnosis, when psychological symptoms were assessed (1988 and 1992, respectively), and then every 4 years thereafter until 2010. Women were categorized according to initial psychological symptoms levels and followed through 2010 or until last follow-up completed. RESULTS Higher versus lower anxiety symptoms were significantly related to unhealthier lifestyle scores throughout follow-up (β = -0.25, CI [-0.44, -0.05]); however, the rate of change over time was similar across groups (pinteraction effect = 0.41). Stratified analyses hinted that higher anxiety and depression symptoms were related to increased odds of reporting a future unhealthy lifestyle within 10-years postdiagnosis. Beyond 10 years, anxiety became statistically unrelated with future lifestyle, and higher depressive symptoms were associated with lower odds of subsequently having an unhealthy lifestyle, albeit nonstatistically significant (OR = 0.35, 95% CI [0.10, 1.24], p = 0.10). CONCLUSIONS Among women with CRC, higher anxiety and depression symptoms were associated with subsequent unhealthier lifestyle in the 10 years following diagnosis. With replication, such findings may suggest that treating psychological symptoms early in the cancer trajectory may not solely reduce psychological distress but also promote healthier lifestyle. (PsycINFO Database Record
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Affiliation(s)
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital
| | - Elizabeth M Poole
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital
| | | | | | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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7
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O'Neil A, Fisher AJ, Kibbey KJ, Jacka FN, Kotowicz MA, Williams LJ, Stuart AL, Berk M, Lewandowski PA, Taylor CB, Pasco JA. Depression is a risk factor for incident coronary heart disease in women: An 18-year longitudinal study. J Affect Disord 2016; 196:117-24. [PMID: 26921864 DOI: 10.1016/j.jad.2016.02.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/12/2015] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND According to a recent position paper by the American Heart Association, it remains unclear whether depression is a risk factor for incident Coronary Heart Disease (CHD). We assessed whether a depressive disorder independently predicts 18-year incident CHD in women. METHOD A prospective longitudinal study of 860 women enrolled in the Geelong Osteoporosis Study (1993-2011) was conducted. Participants were derived from an age-stratified, representative sample of women (20-94 years) randomly selected from electoral rolls in South-Eastern Australia. The exposure was a diagnosis of a depressive disorder using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders. Outcomes data were collected from hospital medical records: (1) PRIMARY OUTCOME: a composite measure of cardiac death, non-fatal Myocardial Infarction or coronary intervention. (2) Secondary outcome: any cardiac event (un/stable angina, cardiac event not otherwise defined) occurring over the study period. RESULTS Seven participants were excluded based on CHD history. Eighty-three participants (9.6%) recorded ≥1 cardiac event over the study period; 47 had a diagnosis that met criteria for inclusion in the primary analysis. Baseline depression predicted 18-year incidence, adjusting for (1) anxiety (adj. OR:2.39; 95% CIs:1.19-4.82), plus (2) typical risk factors (adj. OR:3.22; 95% CIs:1.45-6.93), plus (3) atypical risk factors (adj. OR:3.28; 95% CIs:1.36-7.90). This relationship held when including all cardiac events. No relationship was observed between depression and recurrent cardiac events. CONCLUSION The results of this study support the contention that depression is an independent risk factor for CHD incidence in women. Moreover, the strength of association between depression and CHD incidence was of a greater magnitude than any typical and atypical risk factor.
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Affiliation(s)
- Adrienne O'Neil
- Melbourne School of Population & Global Health, University of Melbourne, Carlton, VIC, Australia; School of Medicine, Deakin University, Geelong, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia.
| | - Aaron J Fisher
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Katherine J Kibbey
- Barwon Health, Geelong Hospital, Geelong, VIC, Australia; Monash Health, Melbourne, VIC, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Felice N Jacka
- School of Medicine, Deakin University, Geelong, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Centre for Adolescent Health, Murdoch Children's Research Centre, Parkville, VIC, Australia; Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mark A Kotowicz
- School of Medicine, Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong Hospital, Geelong, VIC, Australia; Department of Psychiatry & Behavioral Medicine, Stanford University & Palo Alto University, CA, USA
| | - Lana J Williams
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Amanda L Stuart
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Michael Berk
- School of Medicine, Deakin University, Geelong, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia; Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Orygen Youth Health Research Centre, Parkville, VIC, Australia; Mental Health Research Institute, Parkville, VIC, Australia
| | | | - Craig B Taylor
- Department of Psychiatry & Behavioral Medicine, Stanford University & Palo Alto University, CA, USA
| | - Julie A Pasco
- School of Medicine, Deakin University, Geelong, VIC, Australia; Western Medical School, The University of Melbourne, St Albans, VIC, Australia
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Testing item response theory invariance of the standardized Quality-of-life Disease Impact Scale (QDIS(®)) in acute coronary syndrome patients: differential functioning of items and test. Qual Life Res 2015; 24:1809-22. [PMID: 25601166 DOI: 10.1007/s11136-015-0916-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The Quality-of-life (QOL) Disease Impact Scale (QDIS(®)) standardizes the content and scoring of QOL impact attributed to different diseases using item response theory (IRT). This study examined the IRT invariance of the QDIS-standardized IRT parameters in an independent sample. METHOD The differential functioning of items and test (DFIT) of a static short-form (QDIS-7) was examined across two independent sources: patients hospitalized for acute coronary syndrome (ACS) in the TRACE-CORE study (N = 1,544) and chronically ill US adults in the QDIS standardization sample. "ACS-specific" IRT item parameters were calibrated and linearly transformed to compare to "standardized" IRT item parameters. Differences in IRT model-expected item, scale and theta scores were examined. The DFIT results were also compared in a standard logistic regression differential item functioning analysis. RESULTS Item parameters estimated in the ACS sample showed lower discrimination parameters than the standardized discrimination parameters, but only small differences were found for thresholds parameters. In DFIT, results on the non-compensatory differential item functioning index (range 0.005-0.074) were all below the threshold of 0.096. Item differences were further canceled out at the scale level. IRT-based theta scores for ACS patients using standardized and ACS-specific item parameters were highly correlated (r = 0.995, root-mean-square difference = 0.09). Using standardized item parameters, ACS patients scored one-half standard deviation higher (indicating greater QOL impact) compared to chronically ill adults in the standardization sample. CONCLUSION The study showed sufficient IRT invariance to warrant the use of standardized IRT scoring of QDIS-7 for studies comparing the QOL impact attributed to acute coronary disease and other chronic conditions.
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Walter S, Glymour MM, Koenen K, Liang L, Tchetgen Tchetgen EJ, Cornelis M, Chang SC, Rewak M, Rimm E, Kawachi I, Kubzansky LD. Do genetic risk scores for body mass index predict risk of phobic anxiety? Evidence for a shared genetic risk factor. Psychol Med 2015; 45:181-191. [PMID: 25065638 PMCID: PMC4387884 DOI: 10.1017/s0033291714001226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Obesity and anxiety are often linked but the direction of effects is not clear. METHOD Using genetic instrumental variable (IV) analyses in 5911 female participants from the Nurses' Health Study (NHS, initiated 1976) and 3697 male participants from the Health Professional Follow-up Study (HPFS, initiated 1986), we aimed to determine whether obesity increases symptoms of phobic anxiety. As instrumental variables we used the fat mass and obesity-associated (FTO) gene, the melanocortin 4 receptor (MC4R) gene and a genetic risk score (GRS) based on 32 single nucleotide polymorphisms (SNPs) that significantly predict body mass index (BMI). 'Functional' GRSs corresponding with specific biological pathways that shape BMI (adipogenesis, appetite and cardiopulmonary) were considered. The main outcome was phobic anxiety measured by the Crown Crisp Index (CCI) in 2004 in the NHS and in 2000 in the HPFS. RESULTS In observational analysis, a 1-unit higher BMI was associated with higher phobic anxiety symptoms [women: β = 0.05, 95% confidence interval (CI) 0.030-0.068; men: β = 0.04, 95% CI 0.016-0.071). IV analyses showed that BMI was associated with higher phobic anxiety symptoms in the FTO-instrumented analysis (p = 0.005) but not in the GRS-instrumented analysis (p = 0.256). Functional GRSs showed heterogeneous, non-significant effects of BMI on phobic anxiety symptoms. CONCLUSIONS Our findings do not provide conclusive evidence in favor of the hypothesis that higher BMI leads to higher levels of phobic anxiety, but rather suggest that genes that influence obesity, in particular FTO, may have direct effects on phobic anxiety, and hence that obesity and phobic anxiety may share common genetic determinants.
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Affiliation(s)
- S Walter
- Department of Social and Behavioral Sciences,Harvard School of Public Health,Boston, MA,USA
| | - M M Glymour
- Department of Social and Behavioral Sciences,Harvard School of Public Health,Boston, MA,USA
| | - K Koenen
- Mailman School of Public Health,Columbia University,New York, NY,USA
| | - L Liang
- Department of Epidemiology,Harvard School of Public Health,Boston, MA,USA
| | | | - M Cornelis
- Department of Nutrition,Harvard School of Public Health,Boston, MA,USA
| | - S-C Chang
- Department of Social and Behavioral Sciences,Harvard School of Public Health,Boston, MA,USA
| | - M Rewak
- Department of Social and Behavioral Sciences,Harvard School of Public Health,Boston, MA,USA
| | - E Rimm
- Department of Epidemiology,Harvard School of Public Health,Boston, MA,USA
| | - I Kawachi
- Department of Social and Behavioral Sciences,Harvard School of Public Health,Boston, MA,USA
| | - L D Kubzansky
- Department of Social and Behavioral Sciences,Harvard School of Public Health,Boston, MA,USA
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