Anxiety and depression predicted quality of life among patients with heart failure

Examining the influence of anxiety and depression on medication adherence among patients diagnosed with acute myocardial infarction

BACKGROUND

Effective medication adherence is vital for managing acute myocardial infarction (AMI) and enhancing patient well-being. This study aimed to evaluate medication adherence levels and associated factors among AMI patients using standardized assessment tools.

METHODS

Employing a cross-sectional descriptive design, the study involved 210 patients diagnosed with acute myocardial infarction. Participants completed the General Medication Adherence Scale (GMAS), Hospital Anxiety and Depression Scale (HADS), and provided socio-demographic details.

RESULTS

The study revealed partial adherence to medications among AMI patients, with mean scores of 24.89 (± 3.64) out of 33. Notably, good adherence was observed in non-adherence due to patient behavior (mean ± SD = 11.8 ± 2.3 out of 15) and additional disease burden (mean ± SD = 8.65 ± 2.21 out of 12), while partial adherence was noted in non-adherence due to financial constraints (mean ± SD = 4.44 ± 1.34 out of 6). Patients reported mild anxiety (mean ± SD = 8.38 ± 2.81) and no depressive symptoms (mean ± SD = 7.43 ± 2.42). Multiple linear regression analysis indicated that employed status, younger age, shorter duration of MI, lower anxiety, and depression levels were associated with higher medication adherence. However, factors such as monthly income, gender, educational level, and marital status did not predict medication adherence.

CONCLUSION

The study highlights the significance of addressing anxiety and depression levels and considering socio-demographic factors when designing interventions to enhance medication adherence among AMI patients. Further research is needed to explore additional determinants of medication adherence and develop tailored interventions to improve patient outcomes post-AMI.

A quasi-experimental study to assess the effect of Benson's relaxation on anxiety and depression among patients with heart failure in Jordan

BACKGROUND

Despite advancements in treatment, heart failure (HF) remains a leading cause of death. Anxiety and depression (A&D) are highly prevalent among patients with HF, negatively impacting their mortality, and morbidity. The Benson relaxation technique (BRT) is a non-pharmacological approach that is easy to learn, use, and apply for reducing A&D. This study aimed to investigate the effectiveness of the BRT in reducing A&D among patients with HF in Jordan.

METHODS

This quasi-experimental pre and post-design study involved a consecutive sample of 204 participants with a confirmed diagnosis of HF. Data were collected from four hospitals in Jordan.

RESULTS

A total of 204 patients participated in this study, with 138 males and 66 females. The mean A&D scores for the sample at baseline were 11.09±2.60 and 10.80±2.30, respectively. In the intervention group, there was a statistically significant difference between pre-intervention anxiety and post-intervention anxiety levels (P<0.001), as well as between pre-intervention depression and post-intervention depression levels (P<0.001). In contrast, the control group showed no statistically significant differences between pre-intervention and post-intervention A&D levels (P=0.83 and P=0.34) respectively.

CONCLUSIONS

BRT can be used as an adjunctive intervention for patients with HF to reduce A&D. Healthcare professionals should consider incorporating BRT into treatment plans, while nursing departments can lead its implementation.

Islamic Spiritual Care, Depression, and Quality of Life Among Patients With Heart Disease: A Systematic Review

Objectives: This study sought to identify the potential effect of Islamic-Spiritual care and how it is delivered in treating depression and improving the quality of life (QoL) of patients with heart disease. Methods: This systematic review is reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched using relevant keywords through PubMed, CINAHL, Scopus, Springer Link, and Academic Search Complete. Articles with an experimental or cohort design were included, without date restrictions. The quality of evidence was assessed using the Joanna Briggs Institute critical appraisal checklist, and data synthesis used thematic analysis. Results: The analysis included 6 of the 47 identified studies. All studies were conducted in Iran, and a small number had a low risk of bias. The intervention was given through an Islamic teaching strategy, indicating the potential to reduce depression and improve QoL. Moreover, the learning core consists of belief and surrender in God's providence, strengthened meaning and life's purposes, worship, and skills to overcome obstacles. Conclusions: The interventions had the potential to treat depression and improve the QoL. However, a further study considering the risks of bias and involving a larger patient population with other Muslim backgrounds is necessary.

Exploring the Relationship of Anxiety and Depressive Symptoms and Impulsiveness with the Quality of Life of Older Patients with Cardiovascular Disease: A Cross-Sectional Study

BACKGROUND

This study aimed to evaluate the relationship of selected clinical (i.e., body mass index, BMI) and psychological factors (i.e., anxiety, depression, and impulsiveness) with the quality of life (QoL) of elderly patients with cardiovascular disease (CVD) in a single clinical center in Italy.

METHODS

A total of 238 patients of older age (≥65 years) with CVD who voluntarily attended a single clinical center for weight loss and cardiac rehabilitation were sequentially recruited and tested upon admission to the hospital based on pre-established inclusion criteria.

RESULTS

The findings indicated that anxiety and depressive symptoms were moderately associated with lower QoL. Additionally, there were noteworthy but minor negative connections between impulsivity and QoL. Furthermore, BMI was inversely associated with the perceived QoL of the participants, and when incorporated into the regression analysis, BMI alone significantly accounted for 11.8% of the variability in QoL. This percentage increased to 18.4% with the inclusion of impulsiveness in the model and further to 34.3% with the addition of anxiety and depressive symptoms. However, after introducing anxiety and depression, the association between impulsivity and QoL ceased to be statistically significant.

CONCLUSIONS

Integrating the routine assessment and treatment of psychological factors into the care of older patients with CVD is important for optimizing their overall health outcomes and improving their QoL.

Health-related quality of life of people with heart failure in low- and middle-income countries: a systematic review and meta-analysis

PURPOSE

Heart failure is a global health concern and associated with poor health-related quality of life and increased mortality. There is a disproportionate burden on patients and health systems in low- and middle-income countries. This systematic review and meta-analysis estimates the health-related quality of life of people with heart failure in low- and middle-income countries.

METHODS

A systematic literature search was conducted to identify relevant studies from January 2012 to November 2022 using the following databases: MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, Scopus and JBI EBP database. Study screening, quality appraisal and data extraction were conducted using JBI methodology. A random-effects model was used to perform the meta-analysis. Heterogeneity was assessed using the I2 statistic. All statistical analyses were done in STATA version 17.

RESULTS

A total of 33 studies with 5612 participants were included in this review. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Short-Form-36 questionnaire (SF-36) were the most used instruments across 19 and 8 studies, respectively. The pooled mean MLHFQ and SF-36 scores using the random-effects model were 46.08 (95% CI 35.06, 57.10) and 41.23 (95% CI 36.63, 45.83), respectively. In a subgroup analysis using both instruments, the highest health-related quality-of-life scores occurred in studies with inpatient participants.

CONCLUSION

The overall health-related quality of life of people with heart failure in low- and middle-income countries is poor. Strategies should be strategically developed to improve the health-related quality of life of people with heart failure in these countries.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022377781.

Perceived Control, Functional Status, Depressive Symptoms, and Anxiety: Mediating and Moderating Influences on Health-Related Quality of Life in Patients With Heart Failure

BACKGROUND

Health-related quality of life (HRQoL) is poor in patients with heart failure. Psychological (ie, depressive symptoms [DS], anxiety, and perceived control) and physical (ie, functional status) factors are associated with HRQoL. The dynamic relationships among these variables and their impact on HRQoL remain unclear, limiting the ability to design effective interventions.

PURPOSE

Our aim was to evaluate a moderated mediation model, in which the association between perceived control and HRQoL was hypothesized to be mediated by DS and anxiety in the presence of a moderator, functional status.

METHODS

Patients (N = 426) with heart failure completed the Control Attitudes Scale-Revised to measure perceived control, Duke Activity Status Index for functional status, Patient Health Questionnaire-9 for DS, Brief Symptom Inventory for anxiety, and Minnesota Living with Heart Failure Questionnaire for HRQoL. We performed a moderated parallel mediation analysis.

RESULTS

Higher levels of perceived control were associated with better HRQoL through lower levels of anxiety and DS in the presence of functional status (index of moderated mediation for DS, b = 0.029; 95% confidence interval, 0.016-0.045; for anxiety: b = 0.009, 95% confidence interval, 0.002-0.018). The effect of perceived control on psychological symptoms was stronger at low and moderate functional statuses; however, this effect diminished with increasing functional status.

CONCLUSION

Functional status moderated the indirect effects of perceived control on HRQoL through DS and anxiety in patients with heart failure. Efforts to improve HRQoL by targeting perceived control may be more effective when considering DS and anxiety in patients with low to moderate levels of functional status.

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software.

RESULTS

The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18).

CONCLUSIONS

This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Gut microbiota connects the brain and the heart: potential mechanisms and clinical implications

Nowadays, high morbidity and mortality of cardiovascular diseases (CVDs) and high comorbidity rate of neuropsychiatric disorders contribute to global burden of health and economics. Consequently, a discipline concerning abnormal connections between the brain and the heart and the resulting disease states, known as psychocardiology, has garnered interest among researchers. However, identifying a common pathway that physicians can modulate remains a challenge. Gut microbiota, a constituent part of the human intestinal ecosystem, is likely involved in mutual mechanism CVDs and neuropsychiatric disorder share, which could be a potential target of interventions in psychocardiology. This review aimed to discuss complex interactions from the perspectives of microbial and intestinal dysfunction, behavioral factors, and pathophysiological changes and to present possible approaches to regulating gut microbiota, both of which are future directions in psychocardiology.

The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure

Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.

Symptom Burden and Quality of Life Among Patients With Heart Failure

Introduction

Heart failure is a debilitating condition that is associated with several burdensome symptoms that impede patients' quality of life. However, patients' experience of distressing symptoms and their impacts on their quality of life is not studied in Jordan.

Objectives

To assess the severity of distressing symptoms and to assess the relationships between these symptoms and the quality of life among patients with heart failure in Jordan.

Methods

A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Heart failure patients (n  =  167) who visited the outpatient clinics in three hospitals in Amman between July and November 2021 were included. The Edmonton Symptom Assessment System and Short-Form 36 tool were used.

Results

Participants were more likely males with a mean age of 55.2 years (SD  =  13.7). The most distressing symptoms among patients with heart failure were tiredness (M  =  4.56, SD  =  3.24), worse well-being (M  =  4.34, SD  =  2.52), and drowsiness (M  =  3.5, SD  =  3.06), respectively. Symptoms burden were negatively associated with the physical and the mental components summary of the quality of life. Pain, tiredness, nausea, loss of appetite, anxiety, and poor well-being were significant predictors of the physical components. The predictors of the mental components were tiredness, nausea, loss of appetite, and anxiety.

Conclusions

This study revealed that patients with heart failure facing significant symptom burden. The patients showed inadequate quality of life in both physical and mental components that were inversely associated with symptom burden. Given the debilitating effects of symptom burden on heart failure patients' quality of life, therefore, symptom assessment and management have to be a priority.

Health-related quality of life and its influencing factors among people with heart failure in Ethiopia: using the revised Wilson and Cleary model

Heart failure is a challenging public health problem associated with poor health-related quality of life (HRQoL). Data on the quality of life of people with heart failure are limited in Ethiopia. This study aimed to assess the HRQoL and its influencing factors in people with heart failure in Ethiopia. A hospital-based, cross-sectional study design was conducted in the cardiac outpatient clinics of two tertiary-level hospitals in Addis Ababa, Ethiopia. Data were collected from people with heart failure who met the inclusion criteria using an interviewer-administered questionnaire. The HRQoL was measured using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). A multiple linear regression model was fitted to identify factors that influenced HRQoL. All statistical analyses were conducted using STATA version 17 software. A total of 383 people with heart failure participated in the study. The mean age of the participants was 55 years. The MLHFQ score was 48.03±19.73, and 54% of participants had poor HRQoL. Multiple linear regression analysis revealed that age (β= 0.12, 95% CI 0.11, 0.28), diabetes mellitus comorbidity (β= 4.47, 95% CI 1.41, 7.54), social support score (β= - 1.48, 95% CI - 1.93, - 1.03), and depression score (β = 1.74, 95% CI 1.52, 1.96) were significant factors influencing overall HRQoL (p < 0.05). This study found that people in Ethiopia with heart failure had poor HRQoL, influenced by several factors. The findings can help health professionals identify appropriate interventions to improve the HRQoL of people with heart failure.

Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes?

Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.

Quality of life among patients with supraventricular tachycardia post radiofrequency cardiac ablation in Jordan

BACKGROUND

Supraventricular tachycardia (SVT) is a common arrhythmia with associated symptoms such as palpitation, dizziness, and fatigue. It significantly affects patients' quality of life (QoL). Radiofrequency cardiac ablation (RFCA) is a highly effective treatment to eliminate arrhythmia and improve patients' QoL. The purpose of this study was to assess the level of QoL among patients with SVT and examine the difference in QoL before and after RFCA.

METHODS

One group pre-posttest design with a convenience sample of 112 patients was used. QoL was assessed by 36-Item Short Form (SF-36). Data were collected at admission through face-to-face interviews and 1-month post-discharge through phone interviews.

RESULTS

There was a significant difference between QoL before (33.7±17.0) and 1 month after (62.5±18.5) the RFCA. Post-RFCA patients diagnosed with atrioventricular nodal reentrant tachycardia had higher QoL than other types of SVT. Moreover, there were significant negative relationships between QoL and the number and duration of episodes pre- and post-RFCA. There were no significant differences in QoL based on: age, sex, working status, marital status, smoking, coronary artery disease, diabetes mellitus, and hypertension.

CONCLUSIONS

After RFCA, the QoL of patients with ST improved for both physical and mental component subscales.

A Multicenter Cross-Sectional Study on Assessment of Depression in Cardiac Patients

Introduction

Cardiovascular diseases (CVDs) are considered the primary cause of mortality in Saudi Arabia and it is one of the major health concerns in the country. Depression can complicate, halt or even exacerbate the process of managing CVDs, making it harder to optimize the patient's condition. The main aim of this study is to assess the depression in cardiac patients.

Methods

A cross-sectional observational study was conducted in 257 patients diagnosed with cardiovascular diseases. The study was conducted in two governmental hospitals in Tabuk, Saudi Arabia, from December 2021 to April 2022. Depression was assessed using the Arabic version of the CESD-R questionnaire.

Results

The mean age of the participants was 44.49 ± 12.99 years. Majority of patients were in the age group of 40-49 years (n = 92, 35.8%). More than half (53.3%) of the samples were female. The prevalence of depression among cardiac patients was 53.3%.

Conclusion

The prevalence of depression was high among cardiac patients. It is strongly advised that routine examination and management of depression in cardiac patients be included in their regimens.

The Prevalence of Depression and Anxiety in Heart Failure Patients in Saudi Arabia: An Original Study

Background Depression is a severe comorbidity that is often detected in patients with chronic diseases. Poor prognosis may eventuate high mortality risk. Up to 30% of heart failure patients have been documented with depression and the majority upholds depression-related symptoms that may have serious clinical implications, such as hospital readmissions and fatalities. To mitigate depression-induced harms among heart failure patients, studies are being conducted to determine the prevalence, risk factors, and interventions. Objectives The current investigation is envisioned to examine the prevalence of depression and anxiety among the Saudi heart failure population. Also, it will help to explore the risk factors that will subsequently facilitate the analysis of preventive measures. Methodology The cross-sectional epidemiologic research was conducted at King Khalid University, Hospital with the recruitment of 205 participants. Each participant underwent a 30-question screening for depression, anxiety, and related risk factors. The "Hospital, Anxiety, and Depression Scale" (HADS score) was used to score subjects for the assessment of both comorbidities. The data points were subsequently analyzed by descriptive statistics and regression analysis. Results Among 205 participants, 137 (66.82%) were male and 68 (33.17%) were female with a mean age of 59.71 years. Our sample reflects a prevalence of 52.7% depression and 56.9% anxiety in Saudi heart failure patients. High depression scores were positively related to age, female gender, hospital readmissions, and pre-existing comorbidities in heart failure patients. Conclusion The study manifested high depression scores among the Saudi heart failure cohort compared to the previous survey. In addition, a substantial interrelationship of depression and categorical variables has been identified that accentuates predominating risks that can potentially promote depression and anxiety in heart failure patients.

Consequences of Psychological Aspects: From Jordanian Heart Failure Patients' Beliefs

Introduction

Psychological aspects are common in patients with heart failure (HF). Psychological aspects have negative consequences in patients with HF.

Objective

This study was conducted to gain a deeper understanding of the consequences of psychological aspects in Jordanian patients with HF.

Methods

This study is a qualitative study conducted with the participation of 24 patients with HF. Data were collected using semi-structured interviews.

Results

The main theme of the findings can be expressed as "Consequences of psychological aspects of HF." The following four sub-themes emerged from the data: social isolation, disturbance of feelings, being non-compliant, and growing burden on the health care system.

Conclusion

The findings revealed the need for informing healthcare providers about the negative consequences of psychological aspects and develop clinical guidelines to evaluate psychological aspects to support these patients.

Heart failure and depression: A perspective from bibliometric analysis

Background

Depression commonly occurs in heart failure patients, and negatively influences quality of life and disease prognosis. This study explored heart failure and depression-related research from a bibliometric perspective.

Methods

Relevant publications were searched on June 24, 2022. The Bibliometrix package in R was used to conduct quantitative analyses including the trends in publications, and related countries, articles, authors and keywords. VOSviewer software was used to conduct the visualization map on co-word, co-author, and institution co-authorship analyses. CiteSpace software was used to illustrate the top keywords with citation burst.

Results

A total of 8,221 publications in the heart failure and depression-related research field were published between 1983 and 2022. In this field, the United States had the most publications (N = 3,013; 36.65%) and highest total citation (N = 149, 376), followed by China, Germany, Italy and Japan. Author Moser and Duke University were the most productive author and institution, respectively. Circulation is the most influential journal. Apart from "heart failure" and "depression," "quality of life," "mortality" and "myocardial infarction" were the most frequently used keywords in this research area; whereas more recently, "self care" and "anxiety" have been used more frequently.

Conclusion

This bibliometric analysis showed a rapid growth of research related to heart failure and depression from 1989 to 2021, which was mostly led by North America and Europe. Future directions in this research area include issues concerning self-care and anxiety about heart failure. As most of the existing literature were published in English, publications in other languages should be examined in the future.

Prevalence of depression and its association with health-related quality of life in people with heart failure in low- and middle-income countries: A systematic review and meta-analysis

INTRODUCTION

Heart failure is a growing public health concern around the world. People with heart failure have a high symptom burden, such as depression, which affects health-related quality of life (HRQoL). The objective of this systematic review and meta-analysis was to estimate the pooled prevalence of depression and evaluate its association with HRQoL among people with heart failure in low- and middle-income countries (LMICs).

METHODS

This systematic review was conducted in accordance with the JBI methodology. Electronic databases such as MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, Scopus and JBI EBP were searched to identify relevant studies published from January 2012 to August 2022. The methodological quality of each article was assessed using relevant JBI critical appraisal instruments. A random-effects model was employed to estimate the pooled prevalence of depression. Heterogeneity across the studies was investigated using Cochrane's Q test and I2 statistic. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines 2020 were followed for reporting the results. All statistical analyses were performed using STATA version 17 software.

RESULTS

After screening, a total of 21 eligible articles with 5074 participants with heart failure were included in this review. The pooled prevalence of depression among people with heart failure in LMICs was 51.5% (95% CI = 39.7, 63.3%, I2 = 99.00%). Subgroup analysis revealed, the highest prevalence in studies whose participants were in-patients, and from the Middle East and North Africa, and studies utilizing Becks Depression Inventory (BDI). Depression was positively associated with HRQoL.

CONCLUSION

This review revealed that almost half of all people with heart failure in low- and middle-income countries have comorbid depression. People with heart failure and depressive symptoms had poor HRQoL. Therefore, early screening of depression is critical for improving HRQoL in this population. Systematic review registration: PROSPERO CRD42022361759.

Neutrophilic granulocyte percentage is associated with anxiety in Chinese hospitalized heart failure patients

BACKGROUND

In patients with heart failure, anxiety disorder is common and associated with adverse prognosis. This study intended to find more confounding factors of Chinese heart failure patients.

METHODS

We enrolled 284 hospitalized heart failure patients, whose New York Heart Association (NYHA) classed as II-IV and left ventricular ejection fraction (LVEF) ≤ 45%. All the patients were scaled in Hamilton Rating Scale for Anxiety (14-items) (HAM-A14). Ordinal logistic regression analysis was performed to examine the association of correlated factors with anxiety disorder.

RESULTS

There were 184 patients had anxiety accounting for 64.8% of all 284 hospitalized heart failure patients. The neutrophilic granulocyte percentage, urea nitrogen, total bilirubin and brain natriuretic peptide were positively associated with HAM-A14 score, meanwhile, the hemoglobin, red blood cells counts, albumin and LVEF were negatively associated with HAM-A14 score (All P < 0.05). After the adjustments of sex, hemoglobin, urea nitrogen, total bilirubin, albumin and brain natriuretic peptide, the neutrophilic granulocyte percentage was significantly associated with anxiety (OR = 43.265, P = 0.012). The neutrophilic granulocyte percentage was 0.616 ± 0.111, 0.640 ± 0.102, 0.681 ± 0.106 and 0.683 ± 0.113 in heart failure patients with no anxiety, possible anxiety, confirmed anxiety and obvious anxiety, respectively.

CONCLUSIONS

Neutrophilic granulocyte percentage as well as the traditional risk factors such as sex, urea nitrogen and brain natriuretic peptide is associated with anxiety in hospitalized heart failure patients.

Should inclusion have an expiry date? Older people's attitudes on intellectual disabilities

BACKGROUND

Older people with intellectual disabilities represent a new and neglected population in need of services, yet it may be problematic to include them in generic services without having a clear idea of how elderly people from the general population feel towards them. To the best of our knowledge, this topic has not been addressed quantitatively.

METHOD

Seventy-three participants over 63 years of age (23 females and 50 males) from the general population without an intellectual disability completed two valid measures: the CLAS-MR and the WHOQOL-OLD.

RESULTS

Level of education and quality of life were positively associated with attitudes towards people with intellectual disabilities. Age was negatively associated with knowledge regarding intellectual disability.

CONCLUSIONS

When preparing for the inclusion of older people with intellectual disabilities in generic services, attention should be given to members' level of education, quality of life, and knowledge regarding intellectual disabilities. Sensitivity should be applied to potential tendencies to shelter people with intellectual disabilities.

Predictive Model for Quality of Life in Patients With Heart Failure

BACKGROUND

Although many studies have been conducted to examine predictors of quality of life (QoL), little information exists on the real-world application of Rector's conceptual model for QoL related to heart failure (HF).

OBJECTIVES

In this study, we aimed to examine a hypothetical model of QoL based on Rector's conceptual model for QoL in relation to HF and the existing literature on patients with HF.

METHODS

Using a cross-sectional survey, 165 patients with HF were recruited from an outpatient clinic in Korea. Data were collected based on Rector's model constructs, such as cardiac function, symptoms, functional limitation, depression, distress, and QoL. Left ventricular ejection fraction for cardiac function was measured using echocardiography.

RESULTS

Functional limitation, depression, and distress, but not symptoms, had a direct effect on QoL (all Ps < .001). Cardiac function and symptoms directly affected functional limitation (β = 0.186, P = .004, and β = -0.488, P = < .001, respectively), whereas cardiac function, symptoms, and depression affected QoL through functional limitation and distress.

CONCLUSIONS

These results confirm that the Rector's model is suitable for predicting QoL in patients with HF. These findings have potential to guide and inform intervention programs designed to alleviate symptoms in patients with HF, enhance their physical functioning, and moderate their psychological distress with the ultimate goal of improving their QoL.

Family functioning and health-related quality of life of inpatients with coronary heart disease: a cross-sectional study in Lanzhou city, China

Background

A key outcome in coronary heart disease (CHD) is Health Related Quality of Life (HRQoL), and family functioning is important in the management of CHD. But few studies have examined both together, and little is known about them among inpatients with CHD in less developed areas of China. Therefore, this study aimed to assess the HRQoL and family functioning status of inpatients with CHD in Lanzhou from Northwest China, and identify the factors that affect their HRQoL.

Methods

A cross‑sectional study was conducted in 224 CHD inpatients at one major hospital. Sociodemographic data and disease information of CHD inpatients were collected by face-to-face using a structured questionnaire and data were also obtained from patient medical records. HRQoL was measured using the Sickness Impact Profile (SIP). Family functioning was measured using the family APGAR index. Multiple binary logistic regression analysis (MBLRA) was used to explore potential risk factors associated with HRQoL, and Pearson’s correlations were used to assess the relationship between family functioning and HRQoL.

Results

The overall, physical and psychosocial SIP scores were 25.03 ± 8.52, 18.61 ± 9.90 and 28.08 ± 9.64, respectively. The total family APGAR score was 6.11 ± 2.45. MBLRA found older age, poorer cardiac function and more severe disease were associated with poorer HRQoL, while better family functioning, higher monthly income, and urban living were associated with better HRQoL. Family functioning was weakly to moderately correlated with total and psychosocial HRQoL.

Conclusions

Older and less affluent inpatients with lower educational level, less family support and more severe CHD have poorest quality of life, and health care providers should consider interventions to support them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-022-02844-x.

The Role of Perceived Social Support on Quality of Life in People with Cardiovascular Diseases

Background

Cardiovascular Diseases (CVDs) are one of the major causes of hospitalization and mortality worldwide. Strengthening perceived social support and quality of life can reduce these problems. This study aimed to describe the role of perceived social support on cardiovascular patients' quality of life.

Methods

This cross-sectional study was conducted from September 2020 to February 2021. We selected 150 cardiovascular patients through convenience sampling. The questionnaires included: the Persian version of the WHOQOL-BREF, Perceived Social Support, and demographic variables. Hierarchical linear regression was used to explore the association between perceived social support and quality of life. Data were analyzed by SPSS version 21.0 software. A P-value less than 0.05 is considered statistically significant.

Results

The demographic variables could predict 12.2% of the variance of quality of life in the first step. In the second step, after adjusting control variables and dimensions of social support, the predictability increased to 29% of the variance with the addition of variables. All dimensions of social support, excluding tangible assets support, were significant predictors of quality of life and monthly income status. Self-esteem support (β= 0.387) was the strongest predictor of quality of life in cardiovascular patients.

Conclusions

Patients with higher perceived social support have a better quality of life than the other patients. Perceived social support is one of the strategies that can be utilized to improve quality of life and overcome disease in cardiovascular patients.

Effectiveness of a family customised online FOCUS programme aimed on building resiliency in dyad relationship to support dyadic illness management in persons with heart failure and their informal caregiver: a randomised clinical trial protocol

INTRODUCTION

Living with heart failure (HF), is a shared journey and arduous work for patients and their informal family caregivers. Given the key role and limited evidence of dyad illness management in improving dyad health in the context of HF, we developed a customisable, relationship focused, family online dynamic disease management programme-FOCUS programme-to improve dyad health for HF patients and their informal caregivers in China.

METHODS AND ANALYSIS

Based on the Theory of Dyadic Illness Management and the Systemic Transactional Model of Stress and Coping, the family customised online FOCUS programme has five modules: (1) family participatory; (2) open communication; (3) coping effectiveness; (4) uncertainty reduction and 5) shared dyad life stories. HF family dyads will be recruited in the cardiology wards of four university-affiliated hospitals in China. The dyads (N=142) will be randomly allocated to the intervention group that will receive the family customised online FOCUS programme, and the attention control group that will not receive elements of the FOCUS programme. Dyadic coping, HF somatic perception, self-care, anxiety and depression for patients and family caregivers and all-cause mortality and hospital admission for patients will be measured at baseline, 4 weeks (after the discharge, T1), 12 weeks (after the discharge, T2) and 24 weeks (after the discharge, T3). Statistical analysis will be performed using SPSS V. 22.0 software.

ETHICS AND DISSEMINATION

The study protocol was approved by the ethics committees of Tianjin Medical University (Reference number TMUHEC2019002) that covers all the centres enrolled in this study. The findings of this study will be published in scientific journals and will be presented at scientific conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100053168.

Relationship of spiritual wellbeing with life expectancy and quality of life for patients living with heart failure

Aim: Spirituality is a crucial dimension in human health. However, it is often overlooked in patients with heart failure (HF) in Iran. Thus, the purpose of this study was to determine the relationship between spiritual wellbeing, life expectancy and quality-of-life (QOL) in patients with HF. Methods: This cross-sectional study was performed with 150 HF patients, who were enrolled through convenience sampling. Data were collected using a questionnaire comprising four parts: the Minnesota Living with Heart Failure Questionnaire, Schneider's life expectancy instrument, Ellison's and Paulotzin's (1982) Spiritual Well-Being Scale, and a demographic checklist. SPSS software was used for data analysis. Results: In this study, mean and standard deviation of QOL, life expectancy and spiritual wellbeing were 41.82±19.17, 30.20±4.58 and 87.80±5.28 respectively. There was a significant relationship between spiritual wellbeing and quality of life (r=-0.633, P<0.001) and also life expectancy (r=0.544, P<0.001). Quality of life and life expectancy were significantly higher in men than in women. Linear regression tests showed that the existential and religious dimensions of spirituality could influence 44.9% of the QOL variance (F=54.54, P<0.001) and increased values of existential spirituality would improve QOL by an average of 3.45 units. Improving life expectancy also raised QOL by 14.0% (F=21.26, P<0.001). This study also demonstrated that life expectancy is impacted by spiritual health, with a variance of 34.2%, in which the role of existential-spiritual health is of particular significance (t=7.10, P<0.001). Conclusion: The results revealed that spiritual wellbeing, especially the existential type, enhances life expectancy and quality-of-life among HF patients. Therefore, it is recommended that healthcare professionals design a comprehensive and supportive care model for the promotion of spiritual wellbeing in HF patients.

The association of general practitioners' awareness of depression and anxiety with change in quality of life in heart failure patients: results of the prospective observational RECODE-HF cohort study

BACKGROUND

Depression and anxiety are more prevalent in patients with heart failure (HF) than in the general population and reduce quality of life (QoL); therefore, clinical guidelines recommend screening HF patients for depression/anxiety.

OBJECTIVE

We investigated, whether the general practitioners' (GPs) awareness of patients' symptoms of depression and/or anxiety (psychosocial distress) was associated with a change in QoL.

METHODS

In this prospective observational study, we recruited 3,129 primary care HF patients in Germany. Patients completed baseline and 12-month follow-up questionnaires. Their GPs were interviewed. We identified 666 patients with psychosocial distress and compared 2 groups by analysis of covariance: 235 patients with psychosocial distress whose GP was aware of the psychosocial distress and 431 patients with psychosocial distress whose GP was unaware of such distress. Primary outcome was the change in QoL, assessed by the EQ-5D visual analogue scale.

RESULTS

Patients with psychosocial distress showed lower baseline QoL than those without (45.9 vs 64.1; P < 0.001). Within the patients with psychosocial distress, the GPs' awareness of psychosocial distress was not associated with improvement of QoL (F = 1.285; P = 0.258) or remission of psychosocial distress (odds ratio = 0.887; P = 0.608).

CONCLUSION

We found no association between the GPs' awareness of psychosocial distress and change in QoL. Although data for effective treatments of depression in HF are currently insufficient, psychosocial distress strongly impairs the QoL in HF patients. These findings might influence the development of clinical practice guidelines in HF.

Assess and address: Screening and management of depression in patients with chronic heart failure

BACKGROUND

About one in three patients with heart failure (HF) have depression. Comorbid HF and depression are associated with poor outcomes and increased health care burden. Clinical guidelines recommend routine depression screening in patients with HF.

LOCAL PROBLEM

Depression screening was not being systematically implemented in an outpatient cardiology clinic.

METHODS

To create a sustainable process for a cardiology clinic to screen adults with chronic HF for depression, identify patients who have an elevated depression screening score and initiate an evidence-based treatment algorithm for patients with depressive symptoms.

INTERVENTION

A nurse practitioner (NP)-led process improvement project administered the Patient Health Questionnaire (PHQ-9) tool to patients with HF. The score was reviewed by the NP and, if elevated, addressed with assessment and plan. Compliance was measured by the percentage of patients screened. Clinical impact was measured by percentage of patients with an elevated score with a documented treatment plan.

RESULTS

Postimplementation results for four Plan-Do-Study-Act cycles were 38%, 68%, 72%, and 66%, respectively, with a total 63% of patients screened during the entire project. Twenty unique patients (13.2%) had elevated PHQ-9 scores; all had a documented treatment plan.

CONCLUSIONS

We demonstrated how a screening protocol and an accompanying treatment algorithm can be successfully implemented in an outpatient cardiology clinic. Elements of success included a standardized screening protocol, a clinical support algorithm for treatment/referral, an optimized electronic medical record, and a follow-up system for patients with significant depressive symptoms. Stakeholder engagement throughout the project informed iterative changes and provided direction for sustainability.

Psycho-Cardiological Disease: A Bibliometric Review From 2001 to 2021

The aim of this study was to gain insight into the progress and dynamics of psycho-cardiological disease research and track its hot spots. We have analyzed psycho-cardiological disease-related literature extracted from the Web of Science (WOS) Core Collection from 2001 to 2021 with the help of Cite Space. As a result, we have included 5,032 records. Then, we have analyzed connected networks for the country, author, subject category, keywords, and cited reference. We have summarized the findings in four aspects. First, the annual quantitative distribution of publications is on the rise, although there is a slight drop. Second, in terms of country analysis, the United States, England, Australia, Germany, and Italy are the main research forces in psycho-cardiological diseases. At the same time, several academic entities represented by Andrew Steptoe and Roland von Känel, MD, have been formed based on the early consciousness of physical and mental health in these countries. Besides, China is also more concerned about it due to the rapid population aging process and the largest population. Third, the psycho-cardiological disease is multidisciplinary, including psychology, psychiatry, clinical medicine, such as cardiovascular system and neurology, public environmental and occupational health, and pharmacology. Finally, the results of keyword analysis and co-cited references indicate the hot spots and frontiers in psycho-cardiological disease. The hot spots in psycho-cardiological disease include three aspects. The first aspect includes psychosocial factors, such as depression, lack of social support, and low economic and social status; the second aspect includes priority populations, such as Alzheimer's disease dementia caregivers, elderly, and patients with cancer, and the third aspect includes interventions, such as exercise therapy and diet. In addition, there are three future research frontiers. The first is a psycho-cardiological disease in patients with COVID-19; the second is cardiac rehabilitation, especially exercise therapy and health behavior evaluation; and the final is evidence-based medical evaluation, such as systematic reviews and meta-analyses.

Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study

BACKGROUND

Coronary artery bypass graft surgery (CABG) is an intervention directed toward improving the Quality of Life (QoL) for patients with coronary artery disease. Depression can affect QoL negatively among this population. Perceived control (PC) decreased the effect of anxiety on QoL, however, this effect has not been well-studies regarding depression. Therefore, the purpose of this study was to check the effect of depression on QoL among CABG patients and to determine if preoperative PC moderates this effect.

METHODS

This was a prospective observational cohort study conducted on a consecutive sample of 200 patients from three hospitals in Amman, Jordan. Depression Anxiety and Stress Scale, Short-Form Health Survey-36, and Arabic version of the Control Attitude Scale-Revised were used to measure depressive symptoms, QoL and PC respectively. Data were analyzed using t test and step wise multiple regression followed by simple slope analysis.

RESULTS

Postoperative Physical Component Summary (PCS) was better than preoperative PCS (mean ± SD: 38.2 ± 9.4 vs. 36.6 ± 9.5, P < 0.001). Postoperative Mental Component Summary (MCS) was better than preoperative MCS (mean ± SD: 44.3 ± 11.5 vs. 41.4 ± 11.4, P < 0.001). Preoperative depression was higher than postoperative depression; (mean ± SD: 12.8 ± 6.8 vs.11.1 ± 6.7, P < 0.01). Simple slope analysis was significant (simple slope = 0.41, t = 6.1, P < 0.001), indicating the moderating effect of PC.

CONCLUSION

Patients undergoing CABG surgery had poor QoL and high levels of depression. Perceived control moderated this relationship and improve QoL. Assessing depression levels and implantation of interventions to enhance perceived control levels prior to operation might improve QoL.

Quality of life of cardiac outpatients with and without psychiatric disorders: a cross-sectional study

Background

The study aims to measure the quality of life (QOL) for cardiac outpatients with psychiatric disorders (CPP) in comparison to cardiac outpatients without psychiatric disorders (CPOP). A semi-structured interview was performed for consecutive cardiac outpatients. Psychiatric diagnoses were confirmed using the mini-international neuropsychiatric interview (MINI). The QOL was measured by the World Health Organization quality of life (WHOQOL-BREF).

Results

Out of the 343 enrolled patients, 93 (27.1%) patients were found to have psychiatric disorders. The WHO-BREF score of QOL was 4.25 ± 0.85. The CPP were found to have statistically significant lower scores in QOL than CPOP in all the WHOQOL-BREF domains. Particularly, the domain of psychological health showed the highest difference between the two groups (76.9 vs. 87.8, P < 0.001), whereas the environment domain showed the lowest difference between them (80.2 vs. 87.9, P < 0.001). Within each QOL domain, patients with congestive heart failure and psychiatric disorders showed the lowest QOL in both the physical domain (51.4 vs. 71.3, P < 0.02) and the social domain (64.7 vs. 81.9, P < 0.05), while patients with vulvular heart disease and psychiatric disorders showed the lowest QOL in the psychological domain (74.6 vs. 85.7, P < 0.001) and patients with arrhythmias and psychiatric disorders in the environment domain (80 vs. 86.2, P < 0.02).

Conclusions

The QOL of CPP were found to have poorer QOL than CPOP. The magnitude of difference in QOL was the highest in the psychological health domain and the lowest in the environment domain.

The effect of persistent anxiety and depressive symptoms on quality of life among patients with heart failure

BACKGROUND

Anxiety and depressive symptoms interfere with physical and psychological status, worsening symptoms and quality of life (QoL) among patients with heart failure (HF). This study assesses the impact of persistent anxiety and depressive symptoms on QoL among patients with HF in Jordan.

METHODS

This was a prospective observational study of a consecutive sample with a confirmed diagnosis of HF, recruited from four hospitals in Jordan during the period 1-31 March 2020. QoL was measured using the Arabic version of the Short Form 36 Health Survey, while anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Data were analyzed using descriptive statistics and stepwise multiple regression.

RESULTS

Of 127 patients who participated in the study, 72 (56.7%) were persistently anxious and 60 (47.3%) were persistently depressed. In multiple regression models, persistent anxiety, persistent depression, and higher levels of New York Heart Association functional class were independent predictors for both Physical Component Summary (of which history of DM was another predictor) and Mental Component Summary. The model explained 78.4% of the variance for PCS, P < 0.05. These predictors reduced QoL/(PCS) by 0.261, 0.398, 0.09, and 0.325 units respectively. Mental Component Summary (MCS) regression model explained 76.1% of the variance, P < 0.001. These predictors reduced QoL/(MCS) by 0.286, 0.346, and 0.359 units respectively.

CONCLUSIONS

Persistent anxiety and depressive symptoms were associated with poor QoL among patients with HF. It is highly recommended to assess psychological health for the patients with HF, especially anxiety and depression, and to include this dimension in treatment protocols.

Depression and anxiety among individuals with medical conditions during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh

BACKGROUND

Coronavirus disease 2019 (COVID-19) disproportionately impacts individuals with medical conditions, including with respect to their mental health. The present study investigated depression and anxiety and their correlates among individuals with medical conditions in Bangladesh.

METHODS

Subjects were recruited to participate in an internet-based survey. Data were collected from November 2020 to January 2021 using convenience sampling by a semi-structured questionnaire through online platforms. Multiple regression analyses were performed to determine associations applying Bonferroni correction (p < 0.004). The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) measured depression and anxiety, respectively.

RESULTS

Nine-hundred-and-seventy-one participants (50.1% male; mean age = 42.29 ± 15.86 years; age range = 18-80 years) with medical conditions were included in final analyses. The most frequently reported conditions were diabetes, hypertension, obesity, heart disease, asthma, and anemia. Estimates of moderate to severe depression and anxiety were 38.9% and 35.2%, respectively. The mean depression and anxiety scores were significantly higher among participants who reported having hypertension, obesity, heart disease, asthma, anemia, cancer and chronic obstructive pulmonary disease (COPD). Using Bonferroni correction (p < 0.004), depression was associated with being female and a student, having poorer quality of life, poorer health status and greater numbers of co-morbidities, not engaging in physical exercise and tobacco smoking. Anxiety was associated with being female and a student, having lower socioeconomic status, poorer quality of life, poorer health status and greater numbers of co-morbidities, less sleep and tobacco smoking.

CONCLUSIONS

Depression and anxiety are prevalent among individuals with medical conditions and correlate with sociodemographic, quality-of-life and smoking measures. Interventions targeting vulnerable groups should be employed and investigated.

Mindfulness, Anxiety Symptoms, and Quality of Life in Heart Failure

BACKGROUND

An estimated 6.5 million American adults live with heart failure (HF). Elevated anxiety symptoms may worsen HF symptoms and contribute to decreases in overall quality of life (QOL). Mindfulness has been associated with better psychological health with lower levels of anxiety symptoms. Mindfulness may be a modifiable target for reducing anxiety symptoms and increasing QOL in patients with HF.

OBJECTIVE

The objective of this study is to examine the relationships among anxiety symptoms, dispositional mindfulness, and QOL in patients with symptomatic HF.

METHODS

In this cross-sectional study, we conducted a secondary analysis of baseline data from 70 participants. We performed descriptive statistics, bivariate Pearson correlations, and multiple linear regression.

RESULTS

The sample included 70 individuals with a mean age of 65 ± 10.5 years, 89% male, mean left ejection fraction of 45.7 ± 13.6, mean total QOL of 36.9 ± 21.7, mean total mindfulness of 82.2 ± 12.8, and mean anxiety of 4.8 ± 2.9. In multiple regression analyses, total mindfulness was significantly associated with lower anxiety (β = -0.491, P < .01), greater observational mindfulness was significantly associated with lower anxiety (β = -0.377, P < .01), and greater nonreactivity to inner experience was significantly associated with lower anxiety (β = -0.320, P < .05). Lower anxiety was associated with greater total QOL (β = 0.488, P < .01), greater physical QOL (β = 0.381, P < .01), and greater emotional QOL (β = 0.639, P < .01).

CONCLUSIONS

Mindfulness may be a way of improving both anxiety symptoms and QOL in this population.

Posttraumatic stress disorder predicts poor health-related quality of life in cardiac patients in Palestine

Background

The longitudinal association of posttraumatic stress disorder (PTSD) with health-related quality of life (HRQL) in cardiac patients’ remains poorly studied, particularly in conflict-affected settings.

Materials and methods

For this cohort study, we used baseline and one-year follow-up data collected from patients 30 to 80 years old consecutively admitted with a cardiac diagnosis to four major hospitals in Nablus, Palestine. All subjects were screened for PTSD and HRQL using the PTSD Checklist Specific and the HeartQoL questionnaire. We used a generalized structural equation model (GSEM) to examine the independent predictive association of PTSD at baseline with HRQL at follow-up. We also examined the mediating roles of depression, anxiety, and stress at baseline.

Results

The prevalence of moderate-to-high PTSD symptoms among 1022 patients at baseline was 27∙0%. Patients with PTSD symptoms reported an approximate 20∙0% lower HRQL at follow-up. The PTSD and HRQL relationship was largely mediated by depressive and anxiety symptoms. It was not materially altered by adjustment for socio-demographic, clinical, and lifestyle factors.

Discussion

Our findings suggest that individuals with a combination of PTSD and depression, or anxiety are potentially faced with poor HRQL as a longer-term outcome of their cardiac disease. In Palestine, psychological disorders are often stigmatized; however, integration of mental health care with cardiac care may offer an entry door for addressing psychological problems in the population. Further studies need to assess the effective mental health interventions for improving quality of life in cardiac patients.

The Association Between Depressive Symptoms and Length of Hospital Stay Following Coronary Artery Bypass Graft is Moderated by Perceived Control

PURPOSE

Depressive symptoms can negatively influence patient outcomes after coronary artery bypass graft surgery (CABG). Preoperative depressive symptoms can be associated with a longer hospitalization. Perceived control moderates the effect of anxiety on length of stay (LOS) among CABG patients, but its effect on depressive symptoms and LOS is not well studied. This study tests whether perceived control moderates the relationship between depressive symptoms and LOS among patients following CABG.

PATIENTS AND METHODS

This prospective cohort study was conducted on 220 participants recruited from three hospitals in Jordan. Participants' depressive symptom levels were measured using the depression subscale of the Hospital Anxiety and Depression Scale. Perceived control was measured by the Arabic version of the Control Attitude Scale-Revised. Length of stay was obtained from medical records. Data were analyzed using multiple regression and simple slope analysis.

RESULTS

Females had higher levels of depressive symptoms (mean [SD]: 16.7 [5.2] vs 11.6 [5.6], P<0.05), and longer LOS (mean [SD]: 17.5 [12.7] vs 10.3 [9.0], P<0.001) compared to male patients. Being female increased the length of stay by 0.18 days. Every one-unit increase in preoperative depressive symptoms increased LOS by 0.37 days. Perceived control has a protective effect; every one unit increase in perceived control decreased LOS by 0.28 days. Moreover, perceived control moderates the relationship between depressive symptoms and LOS.

CONCLUSION

This study suggests that depressive symptoms and perceived control play an important role in the recovery among post-CABG patients. Application of policies to assess depressive symptoms and improve perceived control prior to CABG by health care providers might decrease morbidity and mortality.

Association between depressive symptoms and quality of life in outpatients and inpatients with heart failure

OBJECTIVE

To analyze sociodemographic and clinical characteristics, depressive symptoms and quality of life of patients with heart failure and associate quality of life with depressive symptoms.

METHOD

A cross-sectional study conducted with outpatients and inpatients. Sociodemographic data were collected and questionnaires were applied to assess quality of life (Minnesota Living with Heart Failure Questionnaire) and depressive symptoms (Beck Depression Inventory).

RESULTS

The sample consisted of 113 patients. Outpatients were retired (p=0.004), with better education (p=0.034) and higher ventricular ejection fraction (p=0.001). The inpatient group had greater depressive symptoms (18.1±10 vs 14.6±1.3; p=0.036) and lower quality of life (74.1±18.7 vs 40.5±3.4; p<0.001) than the outpatient group. Outpatients with depressive symptom scores from 18 points had worse quality of life scores in 17 of the 21 questions.

CONCLUSION

Inpatients had worse depressive symptoms and quality of life, which was more affected in the physical dimension in those with moderate/severe depressive symptoms. Outpatients with more severe depressive symptoms had worse quality of life in all dimensions.

Identification of factors associated with social dysfunction in patients with heart failure

AIMS

Social dysfunction is adversely associated with individuals' physical and mental quality of life. However, little is known about the status of social dysfunction and its associated factors in patients with heart failure. Our study aimed to reveal the prevalence of social dysfunction, and the associations between fatigue, dyspnoea, anxiety, depression, social connectedness, and social dysfunction in patients with heart failure.

METHODS AND RESULTS

We assessed the social dysfunction, fatigue, dyspnoea, anxiety, depression, and social connectedness using self-report questionnaires among 291 patients (64.13 ± 11.84 years, 53.3% male) with heart failure. Two stepwise forward logistic regression models were employed to identify the factors associated with social dysfunction, and the area under receiver operating characteristic curve was used to calculate the variance of the associated factors accounting for social dysfunction. Of the 291 patients, 76.6% reported social dysfunction. The logistic regression model after adjusting co-variables showed that fatigue [odds ratio (OR) 4.233, 95% confidence interval (CI) 1.778-10.081], dyspnoea (OR 0.866, 95% CI 0.756-0.991), depression (OR 1.173, 95% CI 1.037-1.328) were positively associated with social dysfunction, whereas social connectedness (OR 0.394, 95% CI 0.203-0.764) was negatively associated with social dysfunction. Four factors explained 84.5% of the variance of social dysfunction in patients with heart failure.

CONCLUSIONS

Social dysfunction is prevalent in patients with heart failure, and fatigue, dyspnoea, depression, and social connectedness are the associated factors. The findings indicate that the key to helping heart failure patients return to social life may be to attenuate fatigue, dyspnoea, and depression and to improve social connectedness.

The Relationship Between Uncertainty in Illness and Quality of Life in Patients With Heart Failure: Multiple Mediating Effects of Perceived Stress and Coping Strategies

BACKGROUND

Previous investigators have demonstrated that uncertainty in illness is associated with quality of life (QoL) in patients with chronic illness. However, little is known about the mechanism underlying the relationship in patients with heart failure.

OBJECTIVE

The aim of this study was to examine the multiple mediating effects of perceived stress and coping strategies on the relationship between uncertainty in illness and QoL in patients with heart failure.

METHODS

We conducted a cross-sectional study in 302 patients with heart failure recruited at a general hospital in China from October 2016 to September 2017. Uncertainty in illness, perceived stress, coping strategies, and QoL were assessed using self-reported questionnaires. The multiple mediation model was tested using the PROCESS macro for SPSS.

RESULTS

Of the 302 patients, 51.7% had poor physical QoL and 45.7% had poor mental QoL (physical component summary or mental component summary score of <50 points). Uncertainty in illness had a significantly negative indirect effect on mental QoL through perceived stress and acceptance-resignation (indirect effect, -0.02; 95% confidence interval, -0.04 to -0.01). Uncertainty in illness also had a significantly negative indirect effect on mental QoL via perceived stress only (indirect effect, -0.18; 95% confidence interval, -0.26 to -0.09).

CONCLUSIONS

Poor QoL is prevalent in patients with heart failure. Perceived stress and acceptance-resignation are important mediating factors between uncertainty in illness and mental QoL in patients with heart failure. Interventions aimed at reducing perceived stress and acceptance-resignation coping may be beneficial for improving mental QoL in patients with heart failure.

Quality of life among caregivers of children with epilepsy: A cross-sectional study at Eastern Nepal

Objective

To assess the quality of life among caregivers of children with epilepsy in a tertiary care center of eastern Nepal.

Methods

A cross-sectional study was conducted among primary caregivers of children with epilepsy, who accompanied their child in child neurology clinic. Consecutive sampling was done, and 106 respondents were interviewed. Data were collected using World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale and analyzed using Statistical Package for the Social Sciences. Descriptive and Inferential statistics were applied.

Results

Mean WHOQOL-BREF score was 82.25 {standard deviation (SD) ±12. 11}. Transformed scores (0-100) for each domain were 57.98 ± 14.55 in physical, 55.87 ± 13.16 in psychological, 53.12 ± 13.42 in social, and 52.52 ± 13.04 in environmental domain. Mean score for overall perception of quality of life (QOL) was 2.71 ± 0.79 and was 3.12 ± 0.75 for overall perception of health. Living below poverty line (P = .03) and poor seizure control status of children (P = .46) were significantly associated with lower total QOL score. Living below poverty line was significantly associated with low social relationship (P = .003) and environment domain (<0.001) scores.

Significance

Epilepsy has a multifaceted impact on the lives of affected people. Caring children with epilepsy is associated with enormous psychosocial effects on parents and family members. Caregivers' QOL may affect the treatment and outcome of epilepsy in children. Given the consideration to scarcity of this kind of literature in Nepalese context, this study was conducted.

Pain in adolescent chronic fatigue following Epstein-Barr virus infection

Objectives Acute Epstein-Barr virus (EBV) infection is a trigger of Chronic Fatigue (CF) and Chronic Fatigue Syndrome (CFS). The aim of this cross-sectional study was to investigate pain symptoms and pressure pain thresholds in fatigued and non-fatigued adolescents six months after acute EBV-infection, and in healthy controls. This study is part of the CEBA-project (CF following acute EBV infection in adolescents). Methods A total of 195 adolescents (12-20 years old) that had undergone an acute EBV infection six months prior to assessment were divided into fatigued (EBV CF+) and non-fatigued (EBV CF-) cases based on questionnaire score. The EBV CF+ cases were further sub-divided according to case definitions of CFS. In addition, a group of seventy healthy controls was included. Symptoms were mapped with questionnaires. Pressure pain thresholds were measured through pressure algometry. One way ANOVA were used for between-group analyses. Linear regression analyses were used to explore associations between Pediatric Quality of Life (dependent variable), pain symptoms and other variables within the EBV (CF+) group. Results The EBV CF+ group had significantly higher scores for pain symptoms as compared with the EBV CF- group and healthy controls, but pressure pain threshold did not differ significantly. The number of pain symptoms as well as pain severity were strongly and independently associated with quality of life. Conclusions CF and CFS following acute EBV-infection in adolescents is characterized by high pain symptom burden, which in turn is associated with a decline in quality of life. Pain in CF and CFS is of considerable clinical importance, and should be a focal point for further investigation and intervention in these patient groups.

Association of depression and anxiety with adherence in primary care patients with heart failure-cross-sectional results of the observational RECODE-HF cohort study

BACKGROUND

Psychological distress has a negative impact on the prognosis and quality of life for patients with heart failure. We investigated the association between psychological distress and the patients' adherence to medical treatment (medication adherence) and self-care advice (lifestyle adherence) in heart failure. We further examined whether there are different factors associated with low medication compared to low lifestyle adherence.

METHOD

This secondary analysis of the RECODE-HF cohort study analyzed baseline data of 3099 primary care heart failure patients aged 74 ± 10 years, 44.5 % female. Using multivariable regression, factors relating to medication and lifestyle adherence were investigated in order to estimate the extent to which these factors confound the association between psychological distress and adherence.

RESULTS

Psychological distress was significantly associated with poorer medication adherence but not with lifestyle adherence after controlling for confounders. We identified different factors associated with medication compared to lifestyle adherence. A higher body mass index, a less developed social network, living alone, fewer chronic co-morbidities and unawareness of the heart failure diagnosis were only related to lower lifestyle adherence. Higher education was associated with poorer medication adherence. Male sex, younger age, lower self-efficacy and less familiar relation with the general practitioner were common factors associated with both lower medication and lifestyle adherence.

CONCLUSION

Promising factors for increasing medication adherence (reduction of psychological distress) and lifestyle adherence (explaining the patient his/her heart failure diagnosis more than once and increase in the patients' self-efficacy), which were found in this cross-sectional study, must be further investigated in longitudinal studies.

Anxiety and Depression among Patients Admitted to Intensive Care

BACKGROUND

Critically ill patients in intensive care units frequently experience high levels of anxiety and depression. These symptoms affect the patient's treatment plan and response to treatment.

AIMS AND OBJECTIVES

To identify the prevalence of anxiety and depression among patients admitted to intensive care units in Jordan and their correlation with quality of life.

DESIGN

A descriptive cross-sectional survey design was used.

METHODS

The sample for this study consisted of 108 patients admitted to intensive care units in seven governmental hospitals in Jordan. Three instruments were used to collect the data: the demographic data sheet, Hospital Anxiety and Depression Scale, and the World Health Organization Quality of Life tool.

RESULTS

More than half of the participants were female (56.5%), and the mean age was 44.6 years (SD 18.2); 84.3% had anxiety with a mean total score of 12.1 (SD 4.3), and 79.6% of the patients had depression with a mean total score of 11.5 (SD 4.5). A significant negative correlation was found between the mean total anxiety score (r = -0.541, P < .001), depression (r = -0.616, P < .001), and the mean total quality of life score.

CONCLUSIONS

Management programmes for anxiety and depression are highly recommended for intensive care units patients. Such programmes should focus on teaching health care providers correct assessment and management techniques. In addition, developing and implementing a psychiatric consultation support system for these patients might contribute to better management of anxiety and depression.

RELEVANCE TO CLINICAL PRACTICE

This study reveals high prevalence of anxiety and depression among critically ill patient in ICUs. So, regular assessment of anxiety and depression should be conducted by healthcare provider. This requires using a valid and reliable assessment tool. Early correct assessment would result in optimal management for anxiety and depression through patient referral to psychiatric care and the use of pharmacological and non-pharmacological interventions. Guidelines to assess and manage anxiety and depression should be adapted and implemented into clinical practice within the intensive care units. Regular psychiatric consultation for patients admitted to ICU might be helpful in detecting and managing anxiety and depression symptoms.

Quality of life among patients with cardiac disease: the impact of comorbid depression

BACKGROUND

Patients with cardiac disease with or without depression may also have major physical and mental problems. This study assesses and compares the quality of life (QOL) of patients with cardiac disease with and without depression and accompanying comorbidities.

METHODS

A cross-sectional study was conducted with a convenience sample of 388 patients with cardiac disease. The 12-item Short-Form (SF-12)-patient was used to measure physical component scale (PCS) and mental component scale (MCS) QOL, and the Patient Health Questionnaire (PHQ-9) was used to measure depression. The Charlson Comorbidity Index was used to estimate 10-year survival probability. Descriptive statistics, analysis of covariance (ANCOVA), chi-square tests, and binary logistic regression were used for analysis.

RESULTS

The prevalence of minimal to mild depression was 65.7% [(95% CI (60.8, 70.4)] and that of moderate to severe depression was 34.3% [95% CI (29.6, 39.2)]. There was no significant association between the level of PHQ-categorised depression and age (p = 0.171), sex (p = 0.079), or ethnicity (p = 0.407). The overall mean PCS and MCS QOL was 32.5 [95% CI (24.4, 40.64)] and 45.4 [95% CI (44.4, 46.4)], respectively, with no significant correlation between PCS and MCS [r (Pearson's) = 0.011; p = 0.830)]. There were QOL differences among the five PHQ categories (PCS: p = 0.028; MCS: p ≤ 0.001) with both MCS and PCS decreasing with increasing depression. ANCOVA (with number of comorbidities as the covariate) showed a significant age × ethnicity interaction for PCS (p = 0.044) and MCS (p = 0.039), respectively. Young Indo-Trinidadians had significantly lower PCS than did Afro-Trinidadians, while the converse was true for MCS. Depression, age, and number of comorbidities were predictors of PCS, while depression, age, and sex were predictors of MCS.

CONCLUSIONS

Increasing severity of depression worsened both PCS and MCS QOL. Age and level of clinical depression predicted QOL, with number of comorbidities predicting only PCS and sex predicting only MCS. Efforts must be made to treat depression in all age groups of patients with cardiac disease.

Hospitalized patients with heart failure: the impact of anxiety, fatigue, and therapy adherence on quality of life

Introduction

Heart failure (HF) is a major global health problem associated with increased morbidity and mortality and reduced quality of life (QoL). The aim of the study was to assess the impact of anxiety, fatigue and adherence to therapeutic guidelines on HF patients' QoL.

Material and methods

A hundred and twenty hospitalized HF patients were enrolled in the study. Data collection was performed by completion of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek), the Zung Self-Rating Anxiety Scale (SAS) and a questionnaire that measured adherence to therapeutic guidelines.

Results

Data analysis showed moderate levels of anxiety and high levels of adherence to therapeutic guidelines as well as moderate to large effects of HF on patients' fatigue and QoL. A statistically significant positive linear association was observed between anxiety and QoL (rho > 0.6) as well as fatigue and QoL (rho > 0.3). An increase in the anxiety or fatigue score indicated an increase also in the QoL score, meaning that the more anxiety and fatigue a patient felt the worse the QoL also was. Moreover, a statistically significant negative linear association was observed between adherence to therapeutic guidelines and QoL (rho < -0.2). An increase in adherence score indicated a decrease in QoL score, meaning that the more adherent a patient was the better was the QoL.

Conclusions

The present findings suggest that QoL may be improved when adherence to therapy is increased and fatigue and anxiety are alleviated.

Validation of the Arabic Version of the Minnesota Living with Heart Failure Questionnaire

BACKGROUND

The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is commonly used to measure quality of life (QOL) in patients with heart failure (HF). We examined the psychometric properties and cultural validity of an Arabic version of the MLHFQ.

METHODS

An observational cross-sectional study was conducted with 210 adult HF outpatients. Patients were interviewed with the Arabic MLHFQ and the Patient Health Questionnaire (PHQ-9). Cronbach's alpha coefficient and confirmatory factor analysis were conducted. Patients with different NYHA classes and HF-hospitalization histories were compared on QOL to test known-group validity.

RESULTS

The confirmatory factor analysis yielded 3 factors: physical, emotional, and social. Three items (4, 8, and 15) had low loadings. The overall Cronbach's alpha coefficient was 0.92. There were significant differences in MLHFQ by PHQ-9 categories, NYHA class, and HF-hospitalization history.

CONCLUSIONS

This Arabic version of MLHFQ is valid and reliable and can be used in Arabic-speaking Lebanese HF populations.

The role of beta-adrenolytic drugs in treating anxiety disorders

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

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

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

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

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