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Hurley K, Ryan M, Puffenberger D, Parker-Davis T, Bensitel A, Liu X, Cameron SJ, Tefera L. Psychological distress in pulmonary embolism survivors in a pulmonary embolism response team clinic: Protocol for a prospective observational study. Res Pract Thromb Haemost 2023; 7:100045. [PMID: 36876285 PMCID: PMC9975272 DOI: 10.1016/j.rpth.2023.100045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
Background Pulmonary embolism (PE) is a leading cause of cardiovascular death. Psychological distress in PE is understudied and underrecognized. Objectives The primary aim of this proposed protocol was to describe the incidence of psychological distress symptoms (anxiety, depression, posttraumatic stress, and fear of recurrence) in the survivors of PE after discharge from hospitalization. The secondary aim was to assess the influence of acute disease, etiology, and treatment of PE on psychological distress. Methods This is a prospective observational cohort study in a large tertiary care referral center. The participants are adult patients presenting to the hospital with PE fulfilling objective pulmonary embolism response team (PERT) activation criteria. After discharge, patients complete a series of validated measures of psychological distress (anxiety, depression, posttraumatic stress, and fear of recurrence) and quality of life at follow-ups approximately 1, 3, 6, and 12 months after diagnosis and treatment of their PE. Factors influencing each type of distress are evaluated. Conclusion This protocol aims to identify the unmet needs of patients experiencing psychological distress following PE. It will describe anxiety, depression, fear of recurrence, and posttraumatic symptoms in PE survivors during the first year of outpatient follow-up in a PERT clinic.
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Affiliation(s)
- Karen Hurley
- Department of Psychiatry and Psychology, Neurological Institute, Center for Adult Behavioral Health, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Melinda Ryan
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Debra Puffenberger
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Tamra Parker-Davis
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Albatoul Bensitel
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Xuefeng Liu
- Department of Quantitative Health Science, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Scott J. Cameron
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Leben Tefera
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Norton J, Pastore M, Ancelin M, Hotopf M, Tylee A, Mann A, Palacios J. Time-dependent cognitive and somatic symptoms of depression as predictors of new cardiac-related events in at-risk patients: the UPBEAT-UK cohort. Psychol Med 2021; 51:1271-1278. [PMID: 31996279 DOI: 10.1017/s0033291719004082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence suggests that somatic rather than cognitive depressive symptoms are risk factors for recurrent cardiac events in at-risk patients. However, this has never been explored using a time-dependent approach in a narrow time-frame, allowing a cardiac event-free time-window. METHODS The analysis was performed on 595 participants [70.6% male, median age 72 (27-98)] drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Depressive symptomatology was measured using the Patient Health Questionnaire-9 (PHQ-9) (four somatic, five cognitive items). New cardiac events (NCEs) including cardiac-related mortality were identified by expert examination of patient records. Analyses were performed using Cox proportional hazard models with delayed entry, with time-dependent depressive dimensions and covariates measured 12-18 months (median: 14.1, IQR: 3.5) prior to the event, with a 12-month cardiac event-free gap. RESULTS There were 95 NCEs during the follow-up [median time-to-event from baseline: 22.3 months (IQR: 13.4)]. Both the somatic (HR 1.12, 95% CI 1.05-1.20, p = 0.001) and cognitive dimensions (HR 1.11, 95% CI 1.03-1.18, p = 0.004) were time-dependent risk factors for an NCE in the multi-adjusted models. Specific symptoms (poor appetite/overeating for the somatic dimension, hopelessness and feeling like a failure for the cognitive dimension) were also significantly associated. CONCLUSION This is the first study of the association between depressive symptom dimensions and NCEs in at-risk patients using a time-to-event standardised approach. Both dimensions considered apart were independent predictors of an NCE, along with specific items, suggesting regular assessments and tailored interventions targeting specific depressive symptoms may help to prevent NCEs in at-risk populations.
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Affiliation(s)
- J Norton
- Inserm U1061, Montpellier, France
- University of Montpellier, Montpellier, France
| | - M Pastore
- University of Montpellier, Montpellier, France
- StatABio, CNRS, INSERM, Montpellier, France
| | - M Ancelin
- Inserm U1061, Montpellier, France
- University of Montpellier, Montpellier, France
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - A Tylee
- Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Mann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Palacios
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Effectiveness of e-Health cardiac rehabilitation program on quality of life associated with symptoms of anxiety and depression in moderate-risk patients. Sci Rep 2021; 11:3760. [PMID: 33580174 PMCID: PMC7881008 DOI: 10.1038/s41598-021-83231-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 01/25/2021] [Indexed: 01/30/2023] Open
Abstract
Exploring new models of medical care requires evaluating the impact of new care strategies not only on physiological parameters but also on the quality of life of the patient. On the other hand the presence of anxiety together with depression requires further consideration when planning appropriate management strategies. The aim of this study was to examine the effectiveness of a home-based cardiac rehabilitation program incorporating an e-Health technology on health-related quality of life associated with symptoms of anxiety and depression in moderate-risk patients. A multicenter, randomized controlled clinical trial was designed to compare a traditional hospital based cardiac rehabilitation program (n = 38, 35 male) with a mixed home surveillance program where patients exercised at home with a remote electrocardiographic monitoring device (n = 33, 31 male). The Short Form-36 (SF-36) Health Survey and the Goldberg questionnaire were used to evaluate quality of life and the presence of symptoms of anxiety and depression respectively. The results of this study show that the type of cardiac rehabilitation program did not influence the improvement in quality of life (p = 0.854), but the presence of symptoms of anxiety and depression did (p = 0.001). Although both programs achieved a decrease in anxiety and depression symptoms and improved functional capacity (p ≤ 0.001), a significant interaction effect was found between the group with or without anxiety and depression symptoms and the type of program in the bodily pain dimension (p = 0.021). Trial registration: Retrospectively registered NCT02796404 (10/06/2016) in clinialtrials.gov.
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Norton J, Pastore M, Hotopf M, Tylee A, Mann A, Ancelin ML, Palacios J. Time-dependent depression and anxiety symptoms as risk factors for recurrent cardiac events: findings from the UPBEAT-UK study. Psychol Med 2021; 52:1-9. [PMID: 33565388 DOI: 10.1017/s0033291721000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Depression is a well-known risk factor for recurrent cardiac events (RCEs) but findings are less consistent for anxiety, not previously reported on using a time-dependent approach. We aimed to study the prognostic effect of anxiety and depression symptom levels on RCEs. METHODS Data (N = 595) were drawn from the UPBEAT-UK heart disease patient cohort with 6-monthly follow-ups over 3 years. Hospital Anxiety and Depression Scale symptoms were grouped into: agitation (three items), anxiety (four items), and depression (seven items) subscales. We performed two types of multivariate analyses using Cox proportional hazard models with delayed entry: with baseline variables (long-term analysis), and with variables measured 12-to-18 months prior to the event (short-term time-dependent analysis), as RCE risk factors. RESULTS In the baseline analysis, both anxiety and depression, but not agitation, were separate RCE risk factors, with a moderating effect when considered jointly. In the short-term time-dependent analysis, elevated scores on the anxiety subscale were associated with increased RCE risk even when adjusted for depression [hazard ratio (95% confidence interval) 1.22 (1.05-1.41), p = 0.009]. Depression was no longer a significant predictor when adjusted for anxiety [1.05 (0.87-1.27), p = 0.61]. For anxiety, individual items associated with RCEs differed between the two approaches: item 5 'worrying thoughts' was the most significant long-term risk factor [1.52 (1.21-1.91), p = 0.0004] whereas item 13 'feelings of panic' was the most significant time-dependent short-term risk factor [1.52 (1.18-1.95), p = 0.001]. CONCLUSIONS Anxiety is an important short-term preventable and potentially causal risk factor for RCEs, to be targeted in secondary cardiac disease prevention programmes.
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Affiliation(s)
- Joanna Norton
- Univ Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Manuela Pastore
- Univ Montpellier, CNRS, Inserm, Biocampus UAR3426, Montpellier, France
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andre Tylee
- Department of Health Services and Population Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony Mann
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marie-Laure Ancelin
- Univ Montpellier, Inserm, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Jorge Palacios
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Çağlar A, Kaçer İ. Anxiety levels in patients admitted to the emergency department with myocardial infarction or COVID-19 pneumonia. PSYCHOL HEALTH MED 2021; 27:228-236. [PMID: 33486994 DOI: 10.1080/13548506.2021.1876893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The COVID-19 related high morbidity and mortality have led to a common fear and anxiety. This study aimed to determine the state/trait and death anxiety levels of patients with myocardial infarction (MI) and COVID-19 pneumonia. The study was conducted at the emergency department of a tertiary hospital in Central Anatolia of Turkey. 120 patients with myocardial infarction , 120 patients with COVID-19 pneumonia, and 120 healthy volunteers as a control group were included in the study. The participants filled out the questionnaire that included the State-Trait Anxiety Inventory (STAI) and the Thorson-Powell's Revised Death Anxiety Scale (RDAS). All scores of patient groups were significantly higher than the control group. There was no significant difference in terms of STAI-S, STAI-T, and RDAS scores between COVID-19 pneumonia and MI groups. The anxiety risk increased 2.14-fold for STAI-T and 1.97-fold for STAI-S in patients with COVID-19 pneumonia compared to the control group. In this study, the state/trait and death anxiety levels of patients with COVID-19 pneumonia were as high as patients with myocardial infarction.COVID-19 pneumonia-related anxiety was associated with chronic diseases and smoking. Knowing the level of anxiety in these patients is important to provide better health services in the emergency departments.
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Affiliation(s)
- Ahmet Çağlar
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - İlker Kaçer
- Department of Emergency Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
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Lee C, Lee SC, Shin YS, Park S, Won KB, Ann SH, Ko EJ. Severity, Progress, and Related Factors of Mood Disorders in Patients with Coronary Artery Disease: A Retrospective Study. Healthcare (Basel) 2020; 8:healthcare8040568. [PMID: 33339355 PMCID: PMC7766069 DOI: 10.3390/healthcare8040568] [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: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 12/14/2022] Open
Abstract
Patients with coronary artery disease (CAD) are more likely to experience depression and anxiety, which, in turn, are risk factors for CAD. The Beck depression inventory (BDI) and Beck anxiety inventory (BAI) were applied for mood evaluation during hospitalization and again 3 months after discharge in 118 patients with CAD, and cardiopulmonary exercise tests were conducted in the outpatient department. Of the patients diagnosed with CAD, 40 (33.9%) had depressive moods, and 51 (43.2%) had anxious moods. A family history of CAD, low Korean activity scale index (KASI), and use of beta-blockers were independent factors causing depressive mood, while lower left ventricular ejection fraction (LVEF) and low KASI score were independent factors causing anxious mood. A considerable number of patients (35.7% with depressive mood and 25.0% with anxious mood) still had emotional problems after 3 months of discharge. The change values of BDI were associated with lower LVEF and longer hospital stay, while those of BAI was associated with a longer hospital stay. Since some patients had depressive and anxious moods after three months of discharge, evaluating and treating them are essential.
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Affiliation(s)
- Changbae Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Sang Cheol Lee
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Yeon Seob Shin
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (C.L.); (S.C.L.); (Y.S.S.)
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Ki Bum Won
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 44033, Korea; (S.P.); (K.B.W.); (S.H.A.)
| | - Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Korea
- Correspondence:
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Mikhaylov AY, Yumashev AV, Kolpak E. Quality of life, anxiety and depressive disorders in patients with extrasystolic arrhythmia. Arch Med Sci 2020; 18:328-335. [PMID: 35316917 PMCID: PMC8924838 DOI: 10.5114/aoms.2020.101359] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction The aim of this study was to perform a comparative and economic analysis of the degree of development of anxiety-depressive disorder in patients with different types of extrasystolic arrhythmia using different assessment scales. Material and methods The study was conducted in 2018-2019 at the premises of clinic No. 4, involving 450 patients (Moscow, Russia). Patients were divided into three groups: with coronary heart disease (CHD) (147 patients), with myocardiodystrophy (MCD) (113) and with cardiopsychoneurosis (CPN) (190). Everyone underwent round-the-clock electrocardiography (ECG) and echocardiography. If symptoms of depressive disorder are detected in a timely manner, the risk of adverse cardiovascular diseases may be reduced. Results Depression and anxiety indicators on all three scales differed significantly (p ≤ 0.05) in patients with supraventricular extrasystole (more than 40 points on the Zung scale, 14 points on the Montgomery-Asberg depression scale, more than 38 points on Zung and 3 points on Covi anxiety scales). For patients with ventricular extrasystole, a significant difference was established between groups 1 and 2 only in terms of the level of depression on the Zung scale. Factors of psychogenic origin determine the development of cardiac rhythm disturbances. Conclusions The study showed that for supraventricular extrasystoles, these factors determine the overall health of the patient. The differences between the three groups are significant on all scales of depression and anxiety (p ≤ 0.05). The most susceptible to depression and anxiety are patients with extrasystolic arrhythmias diagnosed with CHD, as well as MCD.
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Affiliation(s)
- Alexey Y. Mikhaylov
- Financial Research Institute of the Ministry of Finance of the Russian Federation, Moscow, Russia
| | - Alexei V. Yumashev
- Department of Prosthetic Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Eugeny Kolpak
- Department of Applied Mathematics and Control Process, Saint Petersburg State University, Saint Petersburg, Russia
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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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Chilcot J, Lee E, Tylee A, Brown J, Weinman J, Hotopf M, Palacios JE. Distinct Distress Symptom Trajectories Over 3 Years Are Associated With Baseline Illness Perceptions in Individuals With Coronary Heart Disease. Ann Behav Med 2020; 54:374-379. [PMID: 31773149 DOI: 10.1093/abm/kaz054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depression and anxiety symptoms (termed distress) are common among coronary heart disease (CHD) patients and associated with poor outcomes. Illness perceptions predict distinct outcome trajectories in other long-term conditions, yet it is not known how they relate to distress trajectories in CHD. PURPOSE This study aimed to examine whether baseline illness perceptions are associated with distress symptom trajectories among primary care CHD patients. METHODS This is a secondary analysis of 803 CHD patients from the UPBEAT-UK study, who completed the Hospital Anxiety and Depression Scale every 6 months for 3 years. Baseline assessments included the Brief Illness Perception Questionnaire. Using latent class growth analysis, Palacios et al. (2018) identified five distinct distress symptom trajectories ("stable low," "chronic high," "improving," "worsening," and "fluctuating") in this cohort. Adjusted multinomial logistic regression analyses were used to test the association between baseline illness perceptions and distress symptom trajectories. RESULTS Compared with the stable low distress trajectory, stronger illness identity (odds ratio [OR] = 1.31, p < .01), higher perceived consequences (OR = 1.47, p < .01), illness-related emotion (OR = 1.66, p < .01), and illness concerns (OR = 1.36, p < .01) increased the odds of having chronic high distress. Stronger illness coherence (OR = 0.89, p < .05) and personal (OR = 0.77, p < .01) and treatment control (OR = 0.75, p < .01) reduced the odds of chronic high distress. Worsening distress symptoms were associated with weaker perceptions of treatment control, higher perceived consequences, and greater illness-related concerns and emotions. CONCLUSIONS Illness perceptions of CHD are associated with distress symptom trajectories. Therapeutically modifying unhelpful illness perceptions in CHD patients who experience high levels of distress could potentially improve mental health outcomes.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London Bridge, London, UK
| | - Ester Lee
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London Bridge, London, UK
| | - Andre Tylee
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - June Brown
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Weinman
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London Bridge, London, UK.,Institute of Pharmaceutical Science, King's College London, London, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jorge E Palacios
- e-Mental Health Research Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
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10
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de Heer EW, Palacios JE, Adèr HJ, van Marwijk HWJ, Tylee A, van der Feltz-Cornelis CM. Chest pain, depression and anxiety in coronary heart disease: Consequence or cause? A prospective clinical study in primary care. J Psychosom Res 2020; 129:109891. [PMID: 31865173 DOI: 10.1016/j.jpsychores.2019.109891] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine if chest pain increases the risk of depression and anxiety, or, on the other hand, depression and anxiety increase the risk of chest pain onset in patients with coronary heart disease (CHD). DESIGN Prospective clinical study. SETTING 16 general practices in the Greater London Primary Care Research Network. PARTICIPANTS 803 participants with a confirmed diagnosis of CHD at baseline on the Quality and Outcomes Framework (QOF) CHD registers. MAIN OUTCOME MEASURES Rose Angina Questionnaire, HADS depression and anxiety subscales and PHQ-9 were assessed at seven time points, each 6 months apart. Multi-Level Analysis (MLA) and Structural Equation Modelling (SEM) were applied. RESULTS Chest pain predicts both more severe anxiety and depression symptoms at all time points until 30 months after baseline. However, although anxiety predicted chest pain in the short term with a strong association, this association did not last after 18 months. Depression had only a small, negative association with chest pain. CONCLUSIONS In persons with CHD, chest pain increases the risk of both anxiety and depression to a great extent. However, anxiety and depression have only limited effects on the risk for chest pain. This evidence suggests that anxiety and depression tend to be consequences rather than causes of cardiac chest pain. Intervention studies that support persons with CHD by providing this information should be devised and evaluated, thus deconstructing potentially catastrophic cognitions and strengthening emotional coping.
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Affiliation(s)
- Eric W de Heer
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, 5042 Tilburg, The Netherlands; Tilburg School of Behavioural and Social Sciences, Tranzo Department, Tilburg University, 5073 Tilburg, The Netherlands.
| | - Jorge E Palacios
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF London, UK
| | - Herman J Adèr
- Johannes van Kessel Advising, 1273, SB Huizen, The Netherlands
| | - Harm W J van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Falmer, BN1 9PX Brighton, UK
| | - Andre Tylee
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, SE5 8AF London, UK
| | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, 5042 Tilburg, The Netherlands; Tilburg School of Behavioural and Social Sciences, Tranzo Department, Tilburg University, 5073 Tilburg, The Netherlands; Mental Health and Addictions Research Group, Department of Health Sciences, University of York, YO10 5DD York, UK
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11
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Ludwig VM, Bayley A, Cook DG, Stahl D, Treasure JL, Asthworth M, Greenough A, Winkley K, Bornstein SR, Ismail K. Association between depressive symptoms and objectively measured daily step count in individuals at high risk of cardiovascular disease in South London, UK: a cross-sectional study. BMJ Open 2018; 8:e020942. [PMID: 29654044 PMCID: PMC5898324 DOI: 10.1136/bmjopen-2017-020942] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Depressive symptoms are common but rarely considered a risk factor for unhealthy lifestyles associated with cardiovascular disease (CVD). This study investigates whether depressive symptoms are associated with reduced physical activity (PA) in individuals at high risk of developing CVD. DESIGN Secondary analysis of the cross-sectional baseline data from a randomised controlled trial of an intensive lifestyle intervention. SETTING 135 primary care practices in South London, UK. PARTICIPANTS 1742 adults, 49-74 years, 86% male at high (≥20%) risk of developing CVD in the next 10 years as defined via QRISK2 score. OUTCOME MEASURES The main explanatory variable was depressive symptoms measured via the Patient Health Questionnaire-9 (PHQ-9). The main outcome was daily step count measured with an accelerometer (ActiGraph GT3X) stratified by weekdays and weekend days. RESULTS The median daily step count of the total sample was 6151 (IQR 3510) with significant differences (P<0.001) in mean daily step count between participants with low (PHQ-9 score: 0-4), mild (PHQ-9 score: 5-9) and moderate to severe depressive symptoms (PHQ-9 score: ≥10). Controlling for age, gender, ethnicity, education level, body mass index (BMI), smoking, consumption of alcohol, day of the week and season, individuals with mild depressive symptoms and those with moderate to severe depressive symptoms walked 13.3% (95% CI 18.8% to 7.9%) and 15.6% (95% CI 23.7% to 6.5%) less than non-depressed individuals, respectively. Furthermore, male gender, white ethnicity, higher education level, lower BMI, non-smoking, moderate alcohol intake, weekdays and summer season were independently associated with higher step count. CONCLUSIONS People at high risk of CVD with depressive symptoms have lower levels of PA. TRIAL REGISTRATION ISRCTN84864870; Pre-results.
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Affiliation(s)
- Vera M Ludwig
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Adam Bayley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet L Treasure
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Asthworth
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Anne Greenough
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Kirsty Winkley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stefan R Bornstein
- Department of Medicine III, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Internet-Delivered Self-management Support for Improving Coronary Heart Disease and Self-management-Related Outcomes: A Systematic Review. J Cardiovasc Nurs 2018; 32:E9-E23. [PMID: 28107251 PMCID: PMC5469565 DOI: 10.1097/jcn.0000000000000392] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Coronary heart disease (CHD) is associated with significant morbidity and mortality, including mental health comorbidity, which is associated with poor outcomes. Self-management is key, but there is limited access to self-management support. Internet-delivered interventions may increase access. OBJECTIVE The aim of this study was to conduct a systematic review to (1) determine the effectiveness of Internet-delivered CHD self-management support for improving CHD, mood, and self-management related outcomes and (2) identify and describe essential components for effectiveness. METHOD Randomized controlled trials that met prespecified eligibility criteria were identified using a systematic search of 3 healthcare databases (Medline, PsychINFO, and Embase). RESULTS Seven trials, which included 1321 CHD patients, were eligible for inclusion. There was considerable heterogeneity between studies in terms of the intervention content, outcomes measured, and study quality. All 7 of the studies reported significant positive between-group effects, in particular for lifestyle-related outcomes. Personalization of interventions and provision of support to promote engagement may be associated with improved outcomes, although more data are required to confirm this. The theoretical basis of interventions was poorly developed though evidence-based behavior change interventions were used. CONCLUSION More well-designed randomized controlled trials are needed. These should also explore how interventions work and how to improve participant retention and satisfaction and examine the role of personalization and support within interventions.
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13
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van Eck van der Sluijs JF, Castelijns H, Eijsbroek V, Rijnders CAT, van Marwijk HWJ, van der Feltz-Cornelis CM. Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis. Gen Hosp Psychiatry 2018; 50:1-14. [PMID: 28957682 DOI: 10.1016/j.genhosppsych.2017.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so. METHODS Systematic review and meta-analysis was conducted using PubMed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively. RESULTS Twenty RCTs were included, with N=4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d=0.27 (95%CI 0.21;0.33). Best physical outcomes in CC were found for hypertension with comorbiddepression. Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences. CONCLUSIONS CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple medical conditions is needed. PROTOCOL REGISTRATION NUMBER The protocol for this systematic review and meta-analysis has been registered at the International Prospective Register of Systematic Reviews (PROSPERO) on February 19th 2016: http://www.crd.york.ac.uk/PROSPERO/DisplayPDF.php?ID=CRD42016035553.
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Affiliation(s)
- Jonna F van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands; Department of Residency Training, GGz Breburg, Tilburg, The Netherlands
| | - Hilde Castelijns
- Centre for Mental Health Care, PsyQ Tilburg-Parnassia Groep, Tilburg, The Netherlands
| | - Vera Eijsbroek
- Department of Residency Training, GGz Breburg, Tilburg, The Netherlands
| | | | - Harm W J van Marwijk
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, United Kingdom; Department of General Practice & Elderly Care Medicine and the EMGO+, Institute for Health and Care Research of VU University Medical Centre (VUmc), Amsterdam, The Netherlands
| | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands; Tranzo Department, Tilburg University, Tilburg, The Netherlands.
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14
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Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. J Psychosom Res 2018; 104:1-8. [PMID: 29275777 DOI: 10.1016/j.jpsychores.2017.10.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND As mortality from coronary heart disease (CHD) falls, years lived with disability increase. Depression and anxiety are known indicators of poor outcomes in CHD, but most research has measured distress symptoms at one time point, often following acute events. Here we consider the long-term trajectories of these symptoms in established CHD, and examine their association to distinct measures of disability and impact on costs. METHODS AND RESULTS 803 patients with diagnosis of CHD were recruited from primary care, and completed detailed assessments every 6months for 3years. Latent class growth analysis (LCGA) was used to identify 5 distinct symptom trajectories based on the Hospital Anxiety and Depression Questionnaire (HADS): 'stable low', 'chronic high', 'improving', 'worsening', and 'fluctuating'. The 'chronic high' group had highest association with reporting of chest pain (RRR 5.8, CI 2.9 to 11.7), smoking (2.9, 1.1 to 6.3), and poorer physical (0.88, 0.83-0.93) and mental (0.78, 0.73-0.84) quality of life. The 'chronic high' and 'worsening' trajectories had significantly higher health-care costs over the 'stable low' trajectory (107.2% and 95.5% increase, respectively). In addition, our trajectories were the only significant variable associated with increased health-care costs across the 3years. CONCLUSIONS Symptoms of depression and anxiety are highly prevalent in stable CHD patients, and their long-term trajectories are the single biggest driver of health care costs. Managing morbidity in these patients, in which depression and anxiety play a key role in, should become the primary focus of policy makers and future clinical trials.
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Affiliation(s)
- Jorge Palacios
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK.
| | | | - Anthony Mann
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Andre Tylee
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, UK
| | - Matthew Hotopf
- Psychological Medicine Department, Institute of Psychiatry, Psychology, and Neuroscience, UK; South London and Maudsley NHS Foundation Trust, UK
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15
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Saillour-Glénisson F, Duhamel S, Fourneyron E, Huiart L, Joseph JP, Langlois E, Pincemail S, Ramel V, Renaud T, Roberts T, Sibé M, Thiessard F, Wittwer J, Salmi LR. Protocole of a controlled before-after evaluation of a national health information technology-based program to improve healthcare coordination and access to information. BMC Health Serv Res 2017; 17:297. [PMID: 28431579 PMCID: PMC5399879 DOI: 10.1186/s12913-017-2199-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. METHODS EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database. DISCUSSION EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02837406 , 08/18/2016.
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Affiliation(s)
- Florence Saillour-Glénisson
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Sylvie Duhamel
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
| | - Emmanuelle Fourneyron
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
| | - Laetitia Huiart
- CHU, Unité de Soutien Méthodologique, Saint-Denis, F-97400 France
- Groupe Hospitalier Est Réunion, Route Nationale 3 30, 97470, Saint-Benoît-de-Carmaux, France
| | - Jean Philippe Joseph
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
| | - Emmanuel Langlois
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
- Centre Emile Durkheim, Science Politique et Sociologie Comparatives, Université de Bordeaux, 3Ter, Place de la Victoire 33076, Bordeaux, Cedex France
| | - Stephane Pincemail
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
| | - Viviane Ramel
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Thomas Renaud
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Tamara Roberts
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
| | - Matthieu Sibé
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Frantz Thiessard
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Jerome Wittwer
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Louis Rachid Salmi
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - for the EvaTSN Research group
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
- CHU, Unité de Soutien Méthodologique, Saint-Denis, F-97400 France
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
- Groupe Hospitalier Est Réunion, Route Nationale 3 30, 97470, Saint-Benoît-de-Carmaux, France
- Centre Emile Durkheim, Science Politique et Sociologie Comparatives, Université de Bordeaux, 3Ter, Place de la Victoire 33076, Bordeaux, Cedex France
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Meneghetti CC, Guidolin BL, Zimmermann PR, Sfoggia A. Screening for symptoms of anxiety and depression in patients admitted to a university hospital with acute coronary syndrome. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:12-18. [DOI: 10.1590/2237-6089-2016-0004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 10/01/2016] [Indexed: 11/22/2022]
Abstract
Abstract Objective: To investigate the prevalence of anxiety and depression in patients admitted for acute coronary syndrome to a university hospital and to examine associations with use of psychotropic drugs. Methods: Ninety-one patients who had had an acute coronary event were enrolled on this cross-sectional prevalence study. Characteristics of the study population and the prevalence rates of depression and anxiety in the sample were assessed using the Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) psychiatric consultation protocol, which includes clinical and sociodemographic data, and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of symptoms of anxiety was 48.4% (44 patients) and the prevalence of depressive symptoms was 26.4% (24 patients). Of these, 19 patients (20.9% of the whole sample) had scores indicative of both types of symptoms concomitantly. Considering the whole sample, just 17 patients (18.7%) were receiving treatment for anxiety or depression with benzodiazepines and/or antidepressants. Conclusions: Anxiety and depression are disorders that are more prevalent among patients with acute coronary syndrome than in the general population, but they are generally under-diagnosed and under-treated. Patients with anxiety and depression simultaneously had higher scores on the HADS for anxiety and depression and therefore require more intensive care.
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Affiliation(s)
| | | | | | - Ana Sfoggia
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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17
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Anxiety and anger immediately prior to myocardial infarction and long-term mortality: Characteristics of high-risk patients. J Psychosom Res 2017; 93:19-27. [PMID: 28107888 PMCID: PMC5260840 DOI: 10.1016/j.jpsychores.2016.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Acute high levels of anger and anxiety are associated with an elevated risk of myocardial infarction (MI) in the following two hours. MIs preceded by these acute negative emotions may also have a poor long-term prognosis, but information about high-risk patients is lacking. We examined whether young age and female sex are associated with MIs that are preceded by negative emotions and whether age and sex moderate the subsequent increased mortality risk following MI preceded by negative emotions. METHODS We conducted a secondary analysis of the Determinants of Myocardial Infarction Onset Study (N=2176, mean age=60.1±12.3years, 29.2% women). Anxiety and anger immediately prior to (0-2h) MI and the day before (24-26h) MI were assessed using a structured interview. Subsequent 10-year all-cause mortality was determined using the US National Death Index. RESULTS Anxiety during the 0-2h pre-MI period was associated with younger age (OR=0.98,95% CI=0.96-0.99 per year) and female sex (OR=1.50,95% CI=1.11-2.02). Anger in the 0-2h pre-MI period was also associated with younger age (OR=0.95,95% CI=0.94-0.96) but not with sex (OR=0.93,95% CI=0.67-1.28). During follow-up, 580 (26.7%) patients died. Mortality rate was higher if MI occurred immediately after high anxiety, particularly in patients ≥65years (HR=1.80,95% CI=1.28-2.54) vs. younger patients (HR=0.87,95% CI=0.55-1.40; p-interaction=0.015). Other interactions with sex or anger were not significant. CONCLUSIONS Patients with high anxiety or anger levels in the critical 2-hour period prior to MI are younger than those without such emotional precipitants. In addition, pre-MI anxiety is associated with an elevated 10-year mortality risk in patients aged ≥65years.
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Barley E, Lawson V. Using health psychology techniques to manage chronic physical symptoms. ACTA ACUST UNITED AC 2016; 25:1258-1262. [PMID: 27935345 DOI: 10.12968/bjon.2016.25.22.1258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.
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Affiliation(s)
- Elizabeth Barley
- Professor in Health and Wellbeing, College of Nursing, Midwifery and Healthcare, University of West London
| | - Victoria Lawson
- Principal Health Psychologist, Southwark Talking Therapies Service, London
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19
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Feng HP, Chien WC, Cheng WT, Chung CH, Cheng SM, Tzeng WC. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4464. [PMID: 27559951 PMCID: PMC5400317 DOI: 10.1097/md.0000000000004464] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI.
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Affiliation(s)
- Hsin-Pei Feng
- Institute of Medical Sciences and School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital and School of Public Health, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wei-Tung Cheng
- Kaohsiung Armed Forces General Hospital Gangshan Branch, Kaohsiung CityTaiwan (ROC)
| | - Chi-Hsiang Chung
- Taiwanese Injury Prevention and Safety Promotion Association, School of Public Health, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Shu-Meng Cheng
- Internal Medicine, School of Medicine and Division of Cardiology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan (ROC)
| | - Wen-Chii Tzeng
- School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC)
- Correspondence: Wen-Chii Tzeng, School of Nursing, National Defense Medical Center, Taipei City, Taiwan (ROC) (e-mail: )
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A Single, One-Off Measure of Depression and Anxiety Predicts Future Symptoms, Higher Healthcare Costs, and Lower Quality of Life in Coronary Heart Disease Patients: Analysis from a Multi-Wave, Primary Care Cohort Study. PLoS One 2016; 11:e0158163. [PMID: 27463115 PMCID: PMC4963085 DOI: 10.1371/journal.pone.0158163] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To determine whether a one-off, baseline measure of depression and anxiety in a primary care, coronary heart disease (CHD) population predicts ongoing symptoms, costs, and quality of life across a 3-year follow-up. Design Longitudinal cohort study. Setting 16 General Practice surgeries across South-East London Participants 803 adults (70% male, mean age 71 years) contributing up to 7 follow-up points. Main outcome measures Ongoing reporting of symptoms, health care costs, and quality of life. Results At baseline, 27% of the sample screened positive for symptoms of depression and anxiety, as measured by the Hospital Anxiety and Depression Scale (HADS). The probability of scoring above the cut-off throughout the follow-up was 71.5% (p<0.001) for those screening positive at baseline, and for those screening negative, the probability of scoring below the cut-off throughout the follow-up was 97.6% (p<0.001). Total health care costs were 39% higher during follow-up for those screening positive (p<0.05). Quality of life as measured by the SF-12 was lower on the mental component during follow-up for those screening positive (-0.75, CI -1.53 to 0.03, p = 0.059), and significantly lower on the physical component (-4.99, CI -6.23 to -.376, p<0.001). Conclusions A one-off measure for depression and anxiety symptoms in CHD predicts future symptoms, costs, and quality of life over the subsequent three-years. These findings suggest symptoms of depression and anxiety in CHD persist throughout long periods and are detrimental to a patient’s quality of life, whilst incurring higher health care costs for primary and secondary care services. Screening for these symptoms at the primary care level is important to identify and manage patients at risk of the negative effects of this comorbidity. Implementation of screening, and possible collaborative care strategies and interventions that help mitigate this risk should be the ongoing focus of researchers and policy-makers.
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Tylee A, Barley EA, Walters P, Achilla E, Borschmann R, Leese M, McCrone P, Palacios J, Smith A, Simmonds R, Rose D, Murray J, van Marwijk H, Williams P, Mann A. UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundDepression is common in patients with coronary heart disease (CHD) but the relationship is uncertain. In the UK, general practitioners (GPs) have been remunerated for finding depression in CHD patients; however, it is unclear how to manage these patients.ObjectivesOur aim was to explore the relationship between CHD and depression in a GP population and to develop nurse-led personalised care (PC) for patients with CHD and depression.DesignThe UPBEAT-UK study consisted of four related studies. A cohort study of patients from CHD registers to explore the relationship between CHD and depression. A metasynthesis of relevant literature and two qualitative studies [patients’ perspectives and GP/practice nurse (PN) views on management of CHD and depression] helped develop an intervention. A pilot randomised controlled trial (RCT) of PC was conducted.SettingThirty-three GP surgeries in south London.ParticipantsAdult patients on GP CHD registers.InterventionsFrom the qualitative studies, we developed nurse-led PC, combining case management and self-management theory. Following biopsychosocial assessment, a PC plan was devised for each patient with chest pain and depressive symptoms. Nurses helped patients address their most important related problems. Use of existing resources was promoted. Nurse time was conserved through telephone follow-up.Main outcome measuresThe main outcome of the pilot study of our newly developed PC for people with depression and CHD was to assess the acceptability and feasibility of the intervention and to decide on the best outcome measures. Depression, measured by the Hospital Anxiety and Depression Scale – depression subscale, and chest pain, measured by the Rose angina questionnaire, were the main outcome measures for the feasibility and cohort studies. Cardiac outcomes in the cohort study included: attendance at rapid access chest pain clinics, stent insertion, bypass graft surgery, myocardial infarction and cardiovascular death. Service use and costs were measured and linked to quality-adjusted life-years (QALYs). Data for the pilot RCT were obtained by research assistants from patient interviews at baseline, 1, 6 and 12 months for the pilot RCT and at baseline and 6-monthly interviews for up to 36 months for the cohort study, using standard questionnaires.ResultsPersonalised care was acceptable to patients and proved feasible. The reporting of chest pain in the intervention group was half that of the control group at 6 months, and this reduction was maintained at 1 year. There was also a small improvement in self-efficacy measures in the intervention group at 12 months. Anxiety was more prevalent than depression in our CHD cohort over the 3 years. Nearly half of the cohort complained of chest pain at outset, with two-thirds of these being suggestive of angina. Baseline exertional chest pain (suggestive of angina), anxiety and depression were independent predictors of adverse cardiac outcome. Psychosocial factors predicted the continued reporting of exertional chest pain across the 3 years of follow-up. Costs were slightly lower for the PC group but QALYs were also lower. Neither difference was statistically significant.ConclusionsChest pain, anxiety, depression and social problems are common in patients on CHD registers in primary care and predict adverse cardiac outcomes. Together they pose a complex management problem for GPs and PNs. Our pilot trial of PC suggests a promising approach for treatment of these patients. Generalisation is limited because of the selection bias in recruitment of the practices and the subsequent participation rate of the CHD register patients, and the fact that the research took place in south London boroughs. Future work should explicitly explore methods for effective implementation of the intervention, including staff training needs and changes to practice.Trial registrationCurrent Controlled Trials ISRCTN21615909.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- André Tylee
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elizabeth A Barley
- Florence Nightingale School of Nursing and Midwifery, King’s College London, London, UK
| | - Paul Walters
- Weymouth and Portland Community Mental Health Team, Dorset HealthCare University NHS Foundation Trust and Bournemouth University, Dorset, UK
| | - Evanthia Achilla
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rohan Borschmann
- Centre of Adolescent Health, The Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Morven Leese
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul McCrone
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jorge Palacios
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alison Smith
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rosemary Simmonds
- Academic Unit of Primary Health Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Diana Rose
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Joanna Murray
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Harm van Marwijk
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | - Paul Williams
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony Mann
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Kamenski G, Bendova J, Fink W, Sönnichsen A, Spiegel W, Zehetmayer S. Does COPD have a clinically relevant impact on hearing loss? A retrospective matched cohort study with selection of patients diagnosed with COPD. BMJ Open 2015; 5:e008247. [PMID: 26586319 PMCID: PMC4654383 DOI: 10.1136/bmjopen-2015-008247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) as a multisystemic disease has a measurable and biologically explainable impact on the auditory function detectable in the laboratory. This study tries to clarify if COPD is also a significant and clinically relevant risk factor for hearing impairment detectable in the general practice setting. DESIGN Retrospective matched cohort study with selection of patients diagnosed with COPD. SETTING 12 general practices in Lower Austria. PARTICIPANTS Consecutive patients >35 years with a diagnosis of COPD who consulted 1 of 12 single-handed GPs in 2009 and 2010 were asked to participate. Those who agreed were individually 1:1 matched with controls according to age, sex, hypertension, diabetes, coronary heart disease and chronic heart failure. MAIN OUTCOME MEASURES Sensorineural hearing impairment as assessed by pure tone audiometry, answers of three questions concerning a self-perceived hearing problem, application of the whispered voice test and the score of the Hearing Inventory for the Elderly, Screening Version (HHIE-S). RESULTS 194 patients (97 pairs of 194 cases and controls) with a mean age of 65.5 (SD 10.2) were tested. Univariate conditional logistic regression resulted in significant differences in the mean bone conduction hearing loss and in the total score of HHIE-S, in the multiple conditional regression model, only smoking (p<0.0001) remained significant. CONCLUSIONS The results of this study do not support the hypothesis that there is an association between COPD and hearing impairment which, if found, would have allowed better management of patients with COPD.
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Affiliation(s)
- Gustav Kamenski
- Department of General Practice, Centre for Public Health, Medical University Vienna, Vienna, Austria
| | - Jana Bendova
- Department of General Medicine, Surgery for adults Velky Biel, Velky Biel, Slovakia
| | - Waltraud Fink
- Karl Landsteiner Institute for Systematics in General Medicine, Angern, Austria
| | - Andreas Sönnichsen
- General Practice and Family Medicine, Institute of General Practice and Family Medicine, Witten/Herdecke University, Witten, Germany
| | - Wolfgang Spiegel
- Centre for Public Health, Medical University Vienna, Vienna, Austria
| | - Sonja Zehetmayer
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
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Bates DW. Health Information Technology and Care Coordination: The Next Big Opportunity for Informatics? Yearb Med Inform 2015. [PMID: 26123913 DOI: 10.15265/iy-2015-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The costs of care in the U.S. are very high, in part because canre is relatively uncoordinated. To begin to address this and other issues, health care reform was passed, including the notion of accountable care. Under acountable care arrangements, providers are at risk for the costs of the care they provide to groups of patients. Evaluation of costs has made it clear that a large proportion of these costs are in the post-acute setting, and also that many specific problems such as adverse events and unnecessary readmissions occur following transitions. However, the electronic health records of today do not provide a great deal of assistance with the coordination of care, and even the best organizations have relatively primitive systems with respect to care coordination, even though communication is absolutely central to better coordination of care and health information technology (HIT) is a powerful lever for improving communication. This paper identifies specific gaps in care coordination today, presents a framework for better coordinating care using HIT, then describes how specific technologies can be leveraged. Also discussed are the need to build and test specific interventions to improve HIT-related care coordination tools, and the key policy steps needed to accomplish this.
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Affiliation(s)
- D W Bates
- David Bates, Division of General Internal Medicine, 1620 Tremont St., Boston, MA 02115, United States of America, E-mail:
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Insufficient glucocorticoid signaling and elevated inflammation in coronary heart disease patients with comorbid depression. Brain Behav Immun 2015; 48:8-18. [PMID: 25683698 DOI: 10.1016/j.bbi.2015.02.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/19/2015] [Accepted: 02/03/2015] [Indexed: 12/23/2022] Open
Abstract
Coronary heart disease (CHD) and depression are very common and often co-existing disorders. In addition to psychological and social morbidity, depression exacerbates adverse cardiac outcomes in CHD patients. Inflammation has been proposed as one of the mechanisms involved in the association between these two debilitating diseases. Therefore, the present study aimed to evaluate inflammatory responses as well as to investigate the pathophysiological mechanisms underlying the putative inflammatory activation in CHD patients with and without depression, by assessing the function of two important biological factors regulating inflammation, the hypothalamus-pituitary-adrenal (HPA) axis and the glucocorticoid receptor (GR). Eighty-three CHD patients with (n=28) and without (n=55) comorbid depression were recruited from primary care services in South London. Depression status was assessed by means of Clinical Interview Schedule Revised for diagnosis of depression, and Beck Depression Inventory for the presence of depressive symptoms. Serum C-reactive protein (CRP), plasma vascular endothelial growth factor (VEGF), and plasma and salivary cortisol were measured using commercially available ELISA kits. Gene expression of GR and interleukin-6 (IL-6) were conducted via qPCR. GR sensitivity was evaluated in vitro in isolated peripheral blood mononuclear cells using the dexamethasone inhibition of lipopolysaccharide-stimulated IL-6 levels. Serum levels of kynurenine pathway metabolites were measured using high performance liquid chromatography. Our results show that CHD patients with depression had higher levels of CRP, IL-6 gene expression, and VEGF compared with CHD non-depressed, as well as lower plasma and saliva cortisol levels. The CHD depressed group also exhibited a reduction in GR expression and sensitivity. Finally, tryptophan levels were significantly lower in patients with depression, who also showed an increased kynurenine/tryptophan ratio. In conclusion, CHD patients with depression had elevated levels of inflammation in the context of HPA axis hypoactivity, GR resistance, and increased activation of the kynurenine pathway. Reduced cortisol bioavailability and attenuated glucocorticoid responsiveness due to decreased expression and sensitivity of GR may lead to insufficient glucocorticoid signaling and thus elevation of inflammation in these patients.
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Barley EA, Clifton A, Lee G, Norman IJ, O'Callaghan D, Tierney K, Richards D. The Space From Heart Disease Intervention for People With Cardiovascular Disease and Distress: A Mixed-Methods Study. JMIR Res Protoc 2015; 4:e81. [PMID: 26133739 PMCID: PMC4526970 DOI: 10.2196/resprot.4280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/14/2015] [Accepted: 04/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background Poor self-management of symptoms and psychological distress leads to worse outcomes and excess health service use in cardiovascular disease (CVD). Online-delivered therapy is effective, but generic interventions lack relevance for people with specific long-term conditions, such as cardiovascular disease. Objective To develop a comprehensive online CVD-specific intervention to improve both self-management and well-being, and to test acceptability and feasibility. Methods Informed by the Medical Research Council (MRC) guidance for the development of complex interventions, we adapted an existing evidence-based generic intervention for depression and anxiety for people with CVD. Content was informed by a literature review of existing resources and trial evidence, and the findings of a focus group study. Think-aloud usability testing was conducted to identify improvements to design and content. Acceptability and feasibility were tested in a cross-sectional study. Results Focus group participants (n=10) agreed that no existing resource met all their needs. Improvements such as "collapse and expand" features were added based on findings that participants’ information needs varied, and specific information, such as detecting heart attacks and when to seek help, was added. Think-aloud testing (n=2) led to changes in font size and design changes around navigation. All participants of the cross-sectional study (10/10, 100%) were able to access and use the intervention. Reported satisfaction was good, although the intervention was perceived to lack relevance for people without comorbid psychological distress. Conclusions We have developed an evidence-based, theory-informed, user-led online intervention for improving self-management and well-being in CVD. The use of multiple evaluation tests informed improvements to content and usability. Preliminary acceptability and feasibility has been demonstrated. The Space from Heart Disease intervention is now ready to be tested for effectiveness. This work has also identified that people with CVD symptoms and comorbid distress would be the most appropriate sample for a future randomized controlled trial to evaluate its effectiveness.
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Affiliation(s)
- Elizabeth Alexandra Barley
- Post Graduate Research Department, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, United Kingdom.
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Bates DW. Health Information Technology and Care Coordination: The Next Big Opportunity for Informatics? Yearb Med Inform 2015; 10:11-4. [PMID: 26123913 DOI: 10.15265/iy-2015-020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The costs of care in the U.S. are very high, in part because canre is relatively uncoordinated. To begin to address this and other issues, health care reform was passed, including the notion of accountable care. Under acountable care arrangements, providers are at risk for the costs of the care they provide to groups of patients. Evaluation of costs has made it clear that a large proportion of these costs are in the post-acute setting, and also that many specific problems such as adverse events and unnecessary readmissions occur following transitions. However, the electronic health records of today do not provide a great deal of assistance with the coordination of care, and even the best organizations have relatively primitive systems with respect to care coordination, even though communication is absolutely central to better coordination of care and health information technology (HIT) is a powerful lever for improving communication. This paper identifies specific gaps in care coordination today, presents a framework for better coordinating care using HIT, then describes how specific technologies can be leveraged. Also discussed are the need to build and test specific interventions to improve HIT-related care coordination tools, and the key policy steps needed to accomplish this.
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Affiliation(s)
- D W Bates
- David Bates, Division of General Internal Medicine, 1620 Tremont St., Boston, MA 02115, United States of America, E-mail:
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Barley EA, Walters P, Haddad M, Phillips R, Achilla E, McCrone P, Van Marwijk H, Mann A, Tylee A. The UPBEAT nurse-delivered personalized care intervention for people with coronary heart disease who report current chest pain and depression: a randomised controlled pilot study. PLoS One 2014; 9:e98704. [PMID: 24901956 PMCID: PMC4047012 DOI: 10.1371/journal.pone.0098704] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/01/2014] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Depression is common in people with coronary heart disease (CHD) and associated with worse outcome. This study explored the acceptability and feasibility of procedures for a trial and for an intervention, including its potential costs, to inform a definitive randomized controlled trial (RCT) of a nurse-led personalised care intervention for primary care CHD patients with current chest pain and probable depression. METHODS Multi-centre, outcome assessor-blinded, randomized parallel group study. CHD patients reporting chest pain and scoring 8 or more on the HADS were randomized to personalized care (PC) or treatment as usual (TAU) for 6 months and followed for 1 year. Primary outcome was acceptability and feasibility of procedures; secondary outcomes included mood, chest pain, functional status, well being and psychological process variables. RESULT 1001 people from 17 General Practice CHD registers in South London consented to be contacted; out of 126 who were potentially eligible, 81 (35% female, mean age = 65 SD11 years) were randomized. PC participants (n = 41) identified wide ranging problems to work on with nurse-case managers. Good acceptability and feasibility was indicated by low attrition (9%), high engagement and minimal nurse time used (mean/SD = 78/19 mins assessment, 125/91 mins telephone follow up). Both groups improved on all outcomes. The largest between group difference was in the proportion no longer reporting chest pain (PC 37% vs TAU 18%; mixed effects model OR 2.21 95% CI 0.69, 7.03). Some evidence was seen that self efficacy (mean scale increase of 2.5 vs 0.9) and illness perceptions (mean scale increase of 7.8 vs 2.5) had improved in PC vs TAU participants at 1 year. PC appeared to be more cost effective up to a QALY threshold of approximately £3,000. CONCLUSIONS Trial and intervention procedures appeared to be feasible and acceptable. PC allowed patients to work on unaddressed problems and appears cheaper than TAU. TRIAL REGISTRATION Controlled-Trials.com ISRCTN21615909.
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Affiliation(s)
- Elizabeth A. Barley
- Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, King's College London, London, United Kingdom
| | - Paul Walters
- Dorset HealthCare University NHS Foundation Trust, Weymouth and Portland Community Mental Health Team, Mental Health Centre, Weymouth, Dorset, United Kingdom
| | - Mark Haddad
- School of Health Sciences, City University London, London, United Kingdom
| | - Rachel Phillips
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Evanthia Achilla
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Paul McCrone
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Harm Van Marwijk
- Department of General Practice & Elderly Care Medicine and the EMGO Institute for Health and Care Research of VU University Medical Centre, Amsterdam, The Netherlands
| | - Anthony Mann
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Andre Tylee
- Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
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