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Fillies B, Stapel B, Lemke LH, Löffler F, Bauersachs J, Kahl KG, Westhoff-Bleck M. Remission from depression is associated with improved quality of life and preserved exercise capacity in adults with congenital heart disease. Front Cardiovasc Med 2024; 11:1418342. [PMID: 39022619 PMCID: PMC11251921 DOI: 10.3389/fcvm.2024.1418342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Aims Improved long-term survival has widened the treatment goals for adults with congenital heart disease (ACHD) by addressing parameters that impact mental well-being and exercise capacity. Depression, a frequent co-morbidity in ACHD, is linked to both. Whether successful treatment of depression also affects cardiac parameters is a matter of debate. Methods This prospective, cross-sectional, longitudinal study included N = 150 ACHD (mean age 35.2 ± 11.3 years, 57% male) at baseline (t0) and N = 114 at follow-up (mean follow-up: 4.8 ± 0.6 years; t1). Patients were interviewed using a structured clinical interview, and severity of depression was assessed using the Montgomery-Asperg Depression Scale (MADRS). Additional testing was performed using self-rating questionnaires concerning depression, anxiety and quality of life (QoL). Exercise capacity (VO2max) was assessed by symptom limited exercise testing. Results Of N = 33 patients diagnosed with depression at t0, N = 18 patients remitted and N = 15 were non-remitters. Remitters displayed significantly decreased anxiety (P = 0.013), improved global QoL (P = 0.002), and preserved VO2max (P = 0.958) at t1 compared to t0. This was associated with favourable health behaviour at t1 and stable body-mass-index. Contrarily, non-remitters reported further increased anxiety (P = 0.021) and no significant improvement in QoL (P = 0.405). VO2max declined significantly (P = 0.006) and body-mass-index increased (P = 0.004). Never-depressed patients showed no significant changes in anxiety (P = 0.415) or QoL (P = 0.211). VO2max decreased significantly (P < 0.001). Conclusion In ACHD, remission from depression is associated with better physical functioning, mental health, and QoL. The assessment and treatment of depression in ACHD emerges as an important clinical goal that should be included in a comprehensive multimodal treatment plan.
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Affiliation(s)
- Brit Fillies
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Lars H. Lemke
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Stapel B, Winter L, Heitland I, Löffler F, Bauersachs J, Westhoff-Bleck M, Kahl KG. Impact of congenital heart disease on personality disorders in adulthood. Eur J Prev Cardiol 2024:zwae030. [PMID: 38268119 DOI: 10.1093/eurjpc/zwae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND AIMS Adults with congenital heart disease (ACHD) constitute an ever-growing patient population characterized by high risks for cardiovascular- and mental disorders. Personality disorders (PDs) are associated with adverse physical and mental health. Studies assessing PD prevalence in ACHD are lacking. METHODS PD point prevalence was assessed in 210 ACHD by Structured Clinical Interview for Axis-II Personality Disorders (SCID-II) and compared to meta-analytical data from the general population. Depression and anxiety were measured by self-report (Hospital Anxiety and Depression Scale, HADS) and clinician-rating (Montgomery-Åsberg depression rating scale, MADRS). Childhood maltreatment was assessed with the Childhood Trauma Questionnaire and quality-of-life (QOL) with the World Health Organization QOL Scale. RESULTS PD prevalence was markedly higher in ACHD compared to general population (28.1% vs. 7.7%). Particularly borderline (4.8% vs. 0.9%) and cluster C (i.e. anxious or fearful; 17.1% vs. 3.0%) PDs were overrepresented. PD diagnosis was associated with a surgery age ≤12 years (χ²(1)=7.861, φ=.195, p=.005) and higher childhood trauma levels (U=2583.5, Z=-3.585, p<.001). ACHD with PD reported higher anxiety (HADS-A: U=2116.0, Z=-5.723, p<.001) and depression (HADS-D: U=2254.5, Z=-5.392, p<.001; MADRS: U=2645.0, Z=-4.554, p<.001) levels and lower QOL (U=2538.5, Z=-4.723, p<.001). CONCLUSIONS PDs, particularly borderline- and cluster C, are significantly more frequent in ACHD compared to general population and associated with depression, anxiety and decreased QOL. Data from the general population suggest an association with adverse cardiometabolic and mental health. To ensure guideline-based treatment, clinicians should be aware of the increased PD risk in ACHD.
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Affiliation(s)
- Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Kovacs AH, Luyckx K, Thomet C, Budts W, Enomoto J, Sluman MA, Lu CW, Jackson JL, Khairy P, Cook SC, Chidambarathanu S, Alday L, Estensen ME, Dellborg M, Berghammer M, Johansson B, Mackie AS, Menahem S, Caruana M, Veldtman G, Soufi A, Jameson SM, Callus E, Kutty S, Oechslin E, Van Bulck L, Moons P. Anxiety and Depression in Adults With Congenital Heart Disease. J Am Coll Cardiol 2024; 83:430-441. [PMID: 38233017 DOI: 10.1016/j.jacc.2023.10.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND A comprehensive understanding of adult congenital heart disease outcomes must include psychological functioning. Our multisite study offered the opportunity to explore depression and anxiety symptoms within a global sample. OBJECTIVES In this substudy of the APPROACH-IS (Assessment of Patterns of Patient-Reported Outcomes in Adults With Congenital Heart Disease-International Study), the authors we investigated the prevalence of elevated depression and anxiety symptoms, explored associated sociodemographic and medical factors, and examined how quality of life (QOL) and health status (HS) differ according to the degree of psychological symptoms. METHODS Participants completed the Hospital Anxiety and Depression Scale, which includes subscales for symptoms of anxiety (HADS-A) and depression (HADS-D). Subscale scores of 8 or higher indicate clinically elevated symptoms and can be further categorized as mild, moderate, or severe. Participants also completed analogue scales on a scale of 0 to 100 for QOL and HS. Analysis of variance was performed to investigate whether QOL and HS differed by symptom category. RESULTS Of 3,815 participants from 15 countries (age 34.8 ± 12.9 years; 52.7% female), 1,148 (30.1%) had elevated symptoms in one or both subscales: elevated HADS-A only (18.3%), elevated HADS-D only (2.9%), or elevations on both subscales (8.9%). Percentages varied among countries. Both QOL and HS decreased in accordance with increasing HADS-A and HADS-D symptom categories (P < 0.001). CONCLUSIONS In this global sample of adults with congenital heart disease, almost one-third reported elevated symptoms of depression and/or anxiety, which in turn were associated with lower QOL and HS. We strongly advocate for the implementation of strategies to recognize and manage psychological distress in clinical settings. (Patient-Reported Outcomes in Adults With Congenital Heart Disease [APPROACH-IS]; NCT02150603).
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Affiliation(s)
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven-University of Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Corina Thomet
- Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Junko Enomoto
- Department of Education, Toyo University, Tokyo, Japan
| | - Maayke A Sluman
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jamie L Jackson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Stephen C Cook
- IU Health Adult Congenital Heart Disease Program, IU School of Medicine, Indianapolis, Indiana, USA
| | - Shanthi Chidambarathanu
- Pediatric Cardiology, Frontier Lifeline Hospital (Dr K. M. Cherian Heart Foundation), Chennai, India
| | - Luis Alday
- Division of Cardiology, Hospital de Niños, Córdoba, Argentina
| | - Mette-Elise Estensen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Mikael Dellborg
- Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Malin Berghammer
- Department of Health Sciences, University West, Trollhättan, Sweden; The Queen Silva Children's Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Samuel Menahem
- Department of Paediatrics and School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maryanne Caruana
- Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta
| | - Gruschen Veldtman
- Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexandra Soufi
- Department of Cardiac Rehabilitation, Médipôle Hôpital Mutualiste, Lyon-Villeurbanne, France
| | - Susan M Jameson
- Adult Congenital Heart Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, California, USA
| | - Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Shelby Kutty
- Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Centre for Person-Centered Care (GPCC), University of Gothenburg, Gothenburg, Sweden; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Marshall WH, Rajpal S, Mah ML, Armstrong AK, Salavitabar A, Hickey J, Metzger R, Sisk T, Daniels CJ. Early Experience and Lessons Learned Using Implanted Hemodynamic Monitoring in Patients With Fontan Circulation. J Am Heart Assoc 2023; 12:e031836. [PMID: 38063189 PMCID: PMC10863767 DOI: 10.1161/jaha.123.031836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Data on the use of implanted hemodynamic monitoring (IHM) in patients with Fontan circulation are limited. This study reports our experience using the CardioMEMS HF system in adults with Fontan circulation. METHODS AND RESULTS This single-center, retrospective study evaluated heart failure hospitalizations, procedural complications, and device-related complications in patients with Fontan circulation referred for IHM placement (2015-2022). The association of pulmonary artery pressure (by most recent catheterization and median IHM pressure within 30 days of placement) with both death and follow-up Model for End-Stage Liver Disease Excluding International Normalized Ratio score were evaluated. Of 18 patients referred for IHM placement, 17 were successful (median age, 30 [range 21-48] years, 6 women). Procedural complications (access site hematomas, pulmonary artery staining) occurred in 3 patients, without device-related procedural complications. In follow-up (median, 35 [range, 6-83] months), 1 patient developed a pulmonary embolism (possibly device-related). Heart failure hospitalizations/year were similar before and after IHM (median, 1 [interquartile range, 0-1.0] versus 0.6 [0-2.3]; P=0.268), though only 46% of heart failure hospitalizations had associated IHM transmissions. IHM pressures were associated with Model for End-Stage Liver Disease Excluding International Normalized Ratio scores (R2=0.588, P<0.001), though catheterization pressures were not (R2=0.140, P=0.139). The long-term mortality rate was 53% in this cohort. On unadjusted survival analysis, IHM pressures ≥18 mm Hg were associated with mortality (log rank P=0.041), which was not reproduced with catheterization pressures (log rank P=0.764). CONCLUSIONS In patients with Fontan circulation, IHM did not reduce heart failure hospitalizations, though patient adherence to transmission was low. Device-related complications were low. IHM pressures may better represent real-life conditions compared with catheterization given associations with mortality and Model for End-Stage Liver Disease Excluding International Normalized Ratio score.
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Affiliation(s)
- William H. Marshall
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Saurabh Rajpal
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - May Ling Mah
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | | | | | - Jenne Hickey
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Rachel Metzger
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Tracey Sisk
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
| | - Curt J. Daniels
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical CenterColumbusOH
- Nationwide Children’s Hospital, The Heart CenterColumbusOH
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Stapel B, Scharn N, Halling T, Akkermann S, Heitland I, Westhoff-Bleck M, Kahl KG. Impact of relationship status on psychological parameters in adults with congenital heart disease. Front Psychiatry 2023; 14:1260664. [PMID: 38045616 PMCID: PMC10690776 DOI: 10.3389/fpsyt.2023.1260664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Objective Adult congenital heart disease (ACHD) is a growing disease entity, posing questions concerning psychosocial outcomes across the lifespan. Spousal relationships were shown to benefit cardiovascular and mental health in the general population. We assessed the association of relationship status with anxiety and depression in ACHD patients and determined whether patients considered disease-related concerns potential mediators of relationship problems. Methods N = 390 ACHD patients were included. Self-report questionnaires were used to assess relationship status, ACHD-related relationship problems, socio-demographic variables, and depression and anxiety scores. Further, clinical parameters concerning the heart condition were determined. Results N = 278 (71%) patients were currently in a relationship, while N = 112 (29%) were not in a relationship. Groups did not significantly differ regarding age, sex, and cardiovascular parameters. Two-way MANCOVA with relationship status and sex as independent variables, controlling for age, NYHA class, and NT-proBNP, showed an association of relationship status with depression, while sex was associated with anxiety. N = 97 (25%) patients reported disease-related adverse effects on a current or prior relationship. In detail, worries about body image (N = 57, 61%), own fears (N = 51, 54%), problems arising from wish to have children (N = 33, 35%), fears regarding a joint future (N = 29, 31%), partner's fears or lack of understanding (N = 28, 30%), and sexual problems (N = 21, 22%) were cited. Conclusion Relationships status was associated with depression, while sex was associated with anxiety in ACHD patients. Relationship status as well as potential relationship problems, and the importance of social support for mental and physical well-being, should be considered when treating ACHD patients.
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Affiliation(s)
- Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nicole Scharn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Tim Halling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Steffen Akkermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Storer B, Kershaw KA, Braund TA, Chakouch C, Coleshill MJ, Haffar S, Harvey S, Newby JM, Sicouri G, Murphy M. Global Prevalence of Anxiety in Adult Cardiology Outpatients: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101877. [PMID: 37336306 DOI: 10.1016/j.cpcardiol.2023.101877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Anxiety and anxiety disorders are associated with adverse cardiovascular outcomes, and reduced quality of life. Despite this, no comprehensive study on the global prevalence of anxiety symptoms and disorders among adult cardiology outpatients exists. This systematic review and meta-analysis aims to provide cardiologists with a precise estimate of the prevalence of anxiety in their outpatient clinics. PubMed, Embase, Cochrane and PsycINFO databases and Google Scholar were searched from database inception to January 23, 2023. Data characteristics were extracted independently by 2 investigators. Ninety-three studies, n = 36,687 participants across 31 countries, were included. Global prevalence of anxiety symptoms/disorders was 28.9% (95%CI 25.7-32.4; 8927/36, 687; I2 = 97.33; n = 93). The highest rates were found in patients presenting with hypertension, 43.6%. Subgroup analyses revealed higher prevalence estimates when using self-report screening compared to gold-standard diagnostic interview. When using diagnostic interview, the highest rates were reported in outpatients with undifferentiated chest pain/palpitations, 19·0%. Panic disorder was the most frequent diagnosis 15.3%, and rates were significantly higher in patients with undifferentiated chest pain/palpitations compared to ischemic heart disease. Higher rates of anxiety were found in studies of outpatients from developing countries, and female outpatients tended to have higher rates compared to males. Anxiety occurred frequently among cardiology outpatients and at a higher rate than estimated in the general population. Given the impact anxiety has on patient outcomes, it is important that effective identification and management strategies be developed to support cardiologists in identifying and treating these conditions in their clinics.
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Affiliation(s)
- Ben Storer
- The Black Dog Institute, Sydney, Australia
| | | | - Taylor A Braund
- The Black Dog Institute, Sydney, Australia; Psychiatry and Mental Health Department, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | | | | | - Sam Haffar
- The Black Dog Institute, Sydney, Australia
| | - Samuel Harvey
- The Black Dog Institute, Sydney, Australia; Psychiatry and Mental Health Department, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Jill M Newby
- The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Gemma Sicouri
- The Black Dog Institute, Sydney, Australia; School of Psychology, Faculty of Science, University of New South Wales, Sydney, Australia
| | - Michael Murphy
- The Black Dog Institute, Sydney, Australia; Psychiatry and Mental Health Department, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.
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Analysis of Early Warning Diagnostic Indexes and Influencing Factors of Anxiety and Depression in Patients with Arrhythmia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2061340. [PMID: 36285161 PMCID: PMC9588353 DOI: 10.1155/2022/2061340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
Objective Arrhythmia patients complicated with psychological problems are very common in clinics. The imbalance of autonomic nervous regulation of the heart caused by anxiety and depression will further promote the occurrence and development of arrhythmia. For nonorganic heart disease, β receptor blockers combined with antianxiety drugs have a good effect. Therefore, it is necessary to analyze the influencing factors of anxiety and depression in patients with arrhythmias. Methods We included 150 patients with arrhythmia and divided them into observation groups (80 patients with anxiety and depression) and control groups (70 patients without anxiety and depression). All patients were monitored by Holter, and the detection of arrhythmia was compared between the two groups. We took the general situation and quality of life of the investigated patients as independent variables and the anxiety and depression status of the patients as dependent variables. Results The detection rates of atrioventricular premature beats, ventricular premature beats, atrial fibrillation, short bursts of atrial tachycardia, and atrioventricular block in the observation group were all higher than those in the control group by dynamic electrocardiogram. Multivariate logistic stepwise regression analysis showed that age, years of education, obsessive-compulsive score, somatization score and alcohol consumption were the main influencing factors for anxiety and depression. Conclusions The detection rate of arrhythmia in patients with anxiety/depression status was higher than in those without abnormal psychophylaxis. We should need to pay close attention to the risk factors of age, education years, obsessive-compulsive score, somatization score, and alcohol consumption, so as to prevent and timely detect anxiety and depression symptoms in patients with arrhythmias.
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Gebhardt P, Caldarone F, Westhoff-Bleck M, Olsson KM, Hoeper MM, Park DH, Stapel B, Breitner MH, Werth O, Heitland I, Kahl KG. Metacognitive Short-Term Intervention in Patients With Mental Disorders Following Cardiovascular Events. Front Psychiatry 2022; 13:812807. [PMID: 35444582 PMCID: PMC9013742 DOI: 10.3389/fpsyt.2022.812807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mental disorders are common among patients with severe cardiovascular diseases (CVD). Yet, there is a lack of easily accessible evidence-based treatments. Recent research indicates elevated prevalence of dysfunctional metacognitions in patients with mental disorders following cardiovascular events. As metacognitive therapy (MCT) is an established treatment to modify metacognitions, we tested if a brief metacognitive intervention via videotelephony is effective in this patient group. Methods A brief MCT treatment was tailored to CVD patients and designed as a face-to-face internet-based intervention. Five patients with CVDs and comorbid mental disorders underwent a psychocardiological examination and diagnostic approach. Each patient participated in eight 50 min sessions via encrypted video messenger service. Metacognitions, depression and anxiety symptoms and quality of life were assessed by self-report measures pre- and post-treatment. Patients rated dysfunctional thought processes, current psychological impairment, and treatment satisfaction after each session. Intended follow-up measures were not reported due to missing data. Results For most patients, the brief metacognitive intervention was associated with a decrease in dysfunctional metacognitions and a reduction of symptoms of anxiety and depression post-treatment. Psychological and physiological quality of life improved. Patients reported high satisfaction with the tailored treatment. Conclusion Our results suggest that a brief internet-based metacognitive treatment may be a promising tool for patients with CVDs and comorbid mental disorders. Feasibility and acceptance of the intervention was rated high by the patients. Further research is necessary to support the preliminary findings and to adapt and evaluate the intervention in a controlled clinical trial setting.
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Affiliation(s)
- Philippa Gebhardt
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Flora Caldarone
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Karen M. Olsson
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL/BREATH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Marius M. Hoeper
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL/BREATH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Da-Hee Park
- Department of Respiratory Medicine, Hannover Medical School, Member of the German Center for Lung Research (DZL/BREATH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Britta Stapel
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Michael H. Breitner
- Information Systems Institute, Leibniz University Hannover, Hannover, Germany
| | - Oliver Werth
- Information Systems Institute, Leibniz University Hannover, Hannover, Germany
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Khajali Z, Sayyadi A, Ansari Z, Aliramezany M. Quality of life in adult patients with congenital heart disease: Results of a double-center study. Front Psychiatry 2022; 13:1062386. [PMID: 36713905 PMCID: PMC9878379 DOI: 10.3389/fpsyt.2022.1062386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Prevalence of congenital heart disease (CHD) has increased in recent years, and patients with CHD have to deal with sequelae of the multiple medical and surgical treatments that can affect different aspects of their life which could be reflected in their quality of life (QoL). In Iran, to the best of our knowledge, QoL of adult patients with CHD has not been investigated, so this study aimed to investigate the QoL of adult patients with CHD referred to two Iranian outpatient settings. METHODS In 2022, a double center, cross-sectional study was performed on adult patients with CHD receiving out-patient care at Besat Clinic in Kerman, Iran, and Clinic of Shahid Rajaee Hospital in Tehran, Iran. Inclusion criteria were documented diagnosis of CHD based on guidelines, ejection fraction of above 45% and age of 18-55 years. We recruited a sample of 120 individuals using a simple random sampling method. At the day of referring to the adult congenital heart diseases clinic, after ensuring their written consent to participate in the study, we asked patients to fill in two questionnaires of demographic questionnaire and Persian version of the Ferrans and Powers Quality of Life Index. Data were analyzed using descriptive statistics and chi square via SPSS-22. RESULTS A total of 101 patients with a mean age of 31.05 years participated in the study. Demographic and socio-economic factors had no significant relationship with the patients' QoL. But factors related to the disease were significantly different among QoL groups (P-value > 0.05). DISCUSSION Adults with CHD had a low QoL, which is not related to their demographic and socio-economic factors. That is, the existence of the disease alone and its accompanying complications can affect the QoL of these people. Hence, the mental health of adult patients with CHD should be monitored during their routine cardiac care.
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Affiliation(s)
- Zahra Khajali
- Shaheed Rajaei Cardiovascular Medical and Research Center, Tehran, Iran
| | - Amin Sayyadi
- Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Ansari
- Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maryam Aliramezany
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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Schmitz C, Wedegärtner SM, Langheim E, Kleinschmidt J, Köllner V. Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept. Front Psychiatry 2022; 13:836750. [PMID: 35615455 PMCID: PMC9124936 DOI: 10.3389/fpsyt.2022.836750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Heart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation. METHODS A prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach. RESULTS Exercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found. CONCLUSIONS HFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.
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Affiliation(s)
- Christoph Schmitz
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Behavioral Psychotherapy, Technological University Dresden, Dresden, Germany
| | - Sonja Maria Wedegärtner
- Department of Cardiology, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Eike Langheim
- Department of Cardiology, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Judit Kleinschmidt
- Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
| | - Volker Köllner
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Behavioral Therapy and Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, Teltow, Germany
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Lebherz C, Frick M, Panse J, Wienstroer P, Brehmer K, Kerst G, Marx N, Mathiak K, Hövels-Gürich H. Anxiety and Depression in Adults With Congenital Heart Disease. Front Pediatr 2022; 10:906385. [PMID: 35799689 PMCID: PMC9253420 DOI: 10.3389/fped.2022.906385] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Anxiety and depression can worsen outcome in patients with heart disease. We elucidate the prevalence of anxiety and depression in a cohort of adults with congenital heart disease (ACHD). MATERIALS AND METHODS Prospective screening for anxiety or depression was performed in 204 consecutive patients of the outpatient clinic of our tertiary care center using the Hospital Anxiety and Depression Scale (HADS) questionnaire and the distress thermometer (DT) as a potential ultra-short screening test. Functional data were assessed at liberty of the responsible physician. HADS scores ≥ 8 were considered doubtful and scores ≥ 11 as confirmed cases of anxiety or depression, respectively. HADS results were compared with a historical group of 100 patients with non-Hodgkin Lymphoma (NHL) as well as German reference values from the literature. RESULTS Patients from the ACHD cohort were 28 ± 10 years old (mean ± SD, 54% male), 34% had a simple, 51% a moderate, including 52 patients with transposition of the great arteries after arterial switch operation, and 15% a heart defect of severe complexity. Prevalence of depression in ACHD was comparable to the German normal population (5.9% ACHD vs. 5.4% control). In contrast, prevalence of anxiety was higher than expected from reference values (12.7% ACHD vs. 5.6% control). There was a positive association between psychological distress and NYHA class [anxiety: OR 2.67 (95% CI, 1.50-4.76) p = 0.001; depression: OR 2.93 (95% CI, 1.60-5.35) p = 0.0005], but not with age, gender, or heart defect severity. Percentages of patients with ACHD with anxiety were significantly higher than in a cohort of patients with indolent non-Hodgkin lymphoma (NHL) but comparable to those with aggressive NHL (HADS-A ≥ 11: ACHD 12.7%, indolent NHL 2.2%, aggressive NHL 13.2%; p = 0.037 ACHD vs. indolent NHL; p = 0.929 ACHD vs. aggressive NHL). The distress thermometer screening test had only a fair discriminatory ability (AUC 0.708; p = 0.002) and is therefore of limited usability. CONCLUSION Adults with congenital heart disease exhibit an increased risk for anxiety disorders independently of the severity of the underlying heart defect. Anxiety prevalence was comparable to a historical cohort of patients with aggressive NHL underlining the importance of a routine screening for psychosocial distress in adults with congenital heart disease.
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Affiliation(s)
- Corinna Lebherz
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Frick
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf (CIO-ABCD), Aachen, Germany
| | - Philipp Wienstroer
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Katrin Brehmer
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany.,Department of Cardiology, DIAK Hospital, Schwäbisch Hall, Germany
| | - Gunter Kerst
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Nikolaus Marx
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, Aachen, Germany
| | - Hedwig Hövels-Gürich
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
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