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Al-Maskari A, Al-Zaabi G, AL-Mamari HA, Al-mawali M, Nadar SK. Psychological impact of first admission with cardiovascular disease in a tertiary hospital in Oman. J Taibah Univ Med Sci 2024; 19:28-34. [PMID: 37868102 PMCID: PMC10585295 DOI: 10.1016/j.jtumed.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 10/24/2023] Open
Abstract
Background and objectives Cardiovascular diseases (CVD) are associated with substantial psychological effects that can adversely influence long term prognosis. The aim of this study was to determine the psychological effect of the first hospital admission for acute coronary syndrome (ACS) or congestive heart failure (CHF) in an adult Omani population. Methods This cross-sectional questionnaire based study used the Hospital Anxiety and Depression Scale. Patients were recruited from the in-patient cardiology and medical wards of our institution. Patients with a prior hospital admission for CHF and ACS were excluded. The questionnaire was administered between days 3 and 7 after admission once patients were clinically stable. Results The study included 116 patients (mean age 60.3 + 13.8 years; 78 (67.8%) men), comprising 52 patients with ACS and 64 patients with CHF. Based on the scores, a total of 45 (38.8%) patients had moderate to severe anxiety, and 32 (27.6%) had moderate to severe depression. Patients with severe anxiety tended to be younger, and no other factors predicted anxiety or depression. The proportion of patients with severe depression was higher among patients with CHF (31.4%), and no other differences were observed between patients with ACS or CHF. Conclusion A substantial proportion of patients admitted to our institution in Oman with CVD had severe anxiety and depression. Treating physicians and caregivers should be more open to identifying these patients, and steps should be taken to address their psychological wellbeing along with the medical management of their illness.
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Affiliation(s)
- Ahmed Al-Maskari
- Department of Nursing, Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ghanima Al-Zaabi
- Department of Nursing, Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hafsa A. AL-Mamari
- Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Manar Al-mawali
- Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Sunil K. Nadar
- Department of Cardiology, Sultan Qaboos University Hospital, Muscat Oman
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Priorello LJ, Arbona C. Illness intrusiveness, health locus of control, and anxiety symptoms among veterans with congestive heart failure. Health Psychol Open 2024; 11:20551029241250311. [PMID: 38726462 PMCID: PMC11080764 DOI: 10.1177/20551029241250311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Disease severity, illness intrusiveness, and health locus of control (HLC) each contribute to psychosocial wellbeing in patients with congestive heart failure (CHF). To better understand the relationships between these variables regarding anxiety symptoms, we analyzed data from 116 adult male veterans with comorbid CHF and anxiety. Results suggested that illness intrusiveness significantly mediated the relation of CHF severity to anxiety symptom severity, and that the illness intrusiveness domains of physical well-being/diet, work/finances, and other aspects of life (religious/spirituality, community/civic, self-improvement/expression) were also significant mediators of that relationship. The relation of illness intrusiveness to anxiety was not moderated by internal HLC. Findings highlight the importance of assessing and treating various aspects of illness intrusiveness to manage anxiety symptoms in CHF patients.
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Kaur T, Sharma K, Groban L. Subanesthetic Ketamine Infusion Reducing Symptoms of Depression in a Patient With End-Stage Heart Failure Enrolled in Hospice Care: A Case Report. J Palliat Med 2023; 26:1435-1438. [PMID: 37327367 DOI: 10.1089/jpm.2022.0430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
Background: The development of major depressive disorder in patients at end of life often goes undiagnosed, as it is difficult to distinguish from preparatory grief and/or hypoactive delirium in this unique patient population. If this preliminary barrier of appropriate diagnosis is overcome, it can be quite difficult to properly select and adjust pharmacological therapy. Many well-established antidepressants take four to five weeks for maximal effectiveness (which may be far too long of a titration period for patients at end of life), have various contraindications to patients' comorbid chronic conditions (particularly patients with cardiovascular disease), or may simply be ineffective. Case: We present a case report of severe treatment-resistant depression in an end-stage heart failure patient enrolled in hospice care. Discussion: We discuss the potential use of a single low-dose intravenous racemic ketamine infusion to reduce end-of-life suffering related to depression, despite the theoretical contraindication of ketamine use in such patients, in part, due to its sympathomimetic secondary effect.
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Affiliation(s)
- Tejaspreet Kaur
- Hospice and Palliative Medicine Department, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Zilber Family Hospice of Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Kavita Sharma
- Hospice and Palliative Medicine Department, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Zilber Family Hospice of Advocate Aurora Health, Milwaukee, Wisconsin, USA
| | - Leanne Groban
- Hospice and Palliative Medicine Department, Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Zilber Family Hospice of Advocate Aurora Health, Milwaukee, Wisconsin, USA
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Liu TC, Yoo SM, Sim MS, Motwani Y, Viswanathan N, Wenger NS. Perceived Cognitive Deficits in Patients With Symptomatic SARS-CoV-2 and Their Association With Post-COVID-19 Condition. JAMA Netw Open 2023; 6:e2311974. [PMID: 37145596 DOI: 10.1001/jamanetworkopen.2023.11974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Importance Neuropsychiatric symptoms are common in acute SARS-CoV-2 infection and in post-COVID-19 condition (PCC; colloquially known as long COVID), but the association between early presenting neuropsychiatric symptoms and PCC is unknown. Objective To describe the characteristics of patients with perceived cognitive deficits within the first 4 weeks of SARS-CoV-2 infection and the association of those deficits with PCC symptoms. Design, Setting, and Participants This prospective cohort study was conducted from April 2020 to February 2021, with follow-up of 60 to 90 days. The cohort consisted of adults enrolled in the University of California, Los Angeles, SARS-CoV-2 Ambulatory Program who had a laboratory-confirmed symptomatic SARS-CoV-2 infection and were either hospitalized in a University of California, Los Angeles, hospital or one of 20 local health care facilities, or were outpatients referred by a primary care clinician. Data analysis was performed from March 2022 to February 2023. Exposure Laboratory-confirmed SARS-CoV-2 infection. Main Outcomes and Measures Patients responded to surveys that included questions about perceived cognitive deficits modified from the Perceived Deficits Questionnaire, Fifth Edition, (ie, trouble being organized, trouble concentrating, and forgetfulness) and symptoms of PCC at 30, 60, and 90 days after hospital discharge or initial laboratory-confirmed infection of SARS-CoV-2. Perceived cognitive deficits were scored on a scale from 0 to 4. Development of PCC was determined by patient self-report of persistent symptoms 60 or 90 days after initial SARS-CoV-2 infection or hospital discharge. Results Of 1296 patients enrolled in the program, 766 (59.1%) (mean [SD] age, 60.0 [16.7] years; 399 men [52.1%]; 317 Hispanic/Latinx patients [41.4%]) completed the perceived cognitive deficit items at 30 days after hospital discharge or outpatient diagnosis. Of the 766 patients, 276 (36.1%) perceived a cognitive deficit, with 164 (21.4%) having a mean score of greater than 0 to 1.5 and 112 patients (14.6 %) having a mean score greater than 1.5. Prior cognitive difficulties (odds ratio [OR], 1.46; 95% CI, 1.16-1.83) and diagnosis of depressive disorder (OR, 1.51; 95% CI, 1.23-1.86) were associated with report of a perceived cognitive deficit. Patients reporting perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection were more likely to report symptoms of PCC than those without perceived cognitive deficits (118 of 276 patients [42.8%] vs 105 of 490 patients [21.4%]; χ21, 38.9; P < .001). Adjusting for demographic and clinical factors, perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 were associated with PCC symptoms (patients with a cognitive deficit score of >0 to 1.5: OR, 2.42; 95% CI, 1.62-3.60; patients with cognitive deficit score >1.5: OR, 2.97; 95% CI, 1.86-4.75) compared to patients who reported no perceived cognitive deficits. Conclusions and Relevance These findings suggest that patient-reported perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection are associated with PCC symptoms and that there may be an affective component to PCC in some patients. The underlying reasons for PCC merit additional exploration.
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Affiliation(s)
- Teresa C Liu
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Sun M Yoo
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Myung S Sim
- Department of Medicine Statistics Core, University of California, Los Angeles
| | - Yash Motwani
- Department of Medicine Statistics Core, University of California, Los Angeles
| | - Nisha Viswanathan
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Neil S Wenger
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
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Manolis TA, Manolis AA, Melita H, Manolis AS. Neuropsychiatric disorders in patients with heart failure: not to be ignored. Heart Fail Rev 2022:10.1007/s10741-022-10290-2. [DOI: 10.1007/s10741-022-10290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
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Anxiety in heart failure patients and its association with socio-demographic and clinical characteristics: a cross-sectional study. Porto Biomed J 2022; 7:e177. [PMID: 36186120 PMCID: PMC9521754 DOI: 10.1097/j.pbj.0000000000000177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022] Open
Abstract
Anxiety is one of the most frequent psychiatric disorders in heart failure (HF) patients. However, it is often neglected in clinical practice and studies about the particular relationship with the New York Heart Association (NYHA) classes for HF are scarce. In this context, this study aims to analyze the presence of anxiety symptoms in HF outpatients and also its association with sociodemographic and clinical characteristics of these patients.
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Ratcliff CG, Massarweh NN, Sansgiry S, Dindo L, Cully JA. Impact of Psychiatric Diagnoses and Treatment on Postoperative Outcomes Among Patients Undergoing Surgery for Colorectal Cancer. Psychiatr Serv 2021; 72:391-398. [PMID: 33557593 DOI: 10.1176/appi.ps.201900559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychiatric diagnoses may be a risk factor for poor colorectal cancer (CRC) surgery outcomes. The authors investigated the risk of psychiatric diagnoses and benefit of mental health treatment for surgery outcomes among CRC patients. METHODS This retrospective cohort study of patients undergoing CRC surgery in the 2000-2014 period identified documentation of psychiatric diagnosis and mental health treatment (no treatment, medication only, psychotherapy only, or both medication and psychotherapy) 30 days before surgery. Associations between psychiatric diagnoses, mental health treatment, and postoperative outcomes (postoperative complications, length of stay [LOS], and 90-day readmission rate) were evaluated with multivariable generalized estimating equations. RESULTS Among 58,961 patients undergoing CRC surgery, 9,029 (15.3%) had psychiatric diagnoses, 4,601 (51.0%) of whom received preoperative mental health treatment (90.0% psychiatric medication, 6.7% psychotherapy, and 3.0% medication and psychotherapy). Patients with psychiatric diagnoses had an increased risk for postoperative complications (odds ratio [OR]=1.09, 95% confidence interval [CI]=1.03-1.15) and 90-day readmission (OR=1.11, 95% CI=1.06-1.17) compared with patients without psychiatric diagnoses. Patients with psychiatric diagnoses who received no mental health treatment or only medication had a 7%-17% increased risk for postoperative complications and 90-day readmission compared with patients without psychiatric diagnoses. Patients who received medication only also had a 4% increase in LOS relative to patients without psychiatric diagnoses. Patients with psychiatric diagnoses receiving only psychotherapy and patients without psychiatric diagnoses had similar postoperative outcomes. CONCLUSIONS Preoperative psychiatric diagnoses were associated with worse postoperative outcomes. Surgical quality-improvement efforts should focus on identifying patients with preoperative psychiatric diagnoses and addressing these conditions presurgery.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Nader N Massarweh
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Shubhada Sansgiry
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Lilian Dindo
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
| | - Jeffrey A Cully
- Department of Psychology, Sam Houston State University, Huntsville, Texas (Ratcliff); Department of Psychiatry and Behavioral Sciences (Ratcliff, Cully), Department of Surgery (Massarweh), and Department of Medicine (Sansgiry, Dindo), Baylor College of Medicine, Houston; Health Policy, Quality, and Informatics Program (Massarweh), Methodology and Analytics Core (Sansgiry), and Behavioral Health Program (Dindo, Cully), U.S. Department of Veterans Affairs (VA) Health Services Research VA Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston; VA South Central Mental Illness Research, Education, and Clinical Center (MIRECC), Houston (Ratcliff, Massarweh, Sansgiry, Dindo, Cully)
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Electronic Mental Health Screening in a Pediatric Heart Failure and Transplant Clinic. J Clin Psychol Med Settings 2021; 28:815-825. [PMID: 33772706 DOI: 10.1007/s10880-021-09770-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Adults with heart failure and transplant are at increased risk for psychiatric comorbidities. The prevalence and impact of psychiatric comorbidities have not been well studied in pediatric heart failure and transplant. This quality improvement project sought to evaluate the feasibility of utilizing electronic mental health screening measures during pediatric heart failure and transplant clinics and to explore the prevalence and severity of self-reported depressive, anxiety, and suicidal ideation symptoms. Patients aged 11 years and older who presented to a pediatric heart failure and transplant clinic were administered the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Medical chart review and a survey were used to examine additional variables of interest. There were no significant differences in moderate and severe mental health symptoms between gender, medical diagnoses, or those with recent hospitalizations. Pediatric patients with heart failure or transplant reported higher prevalence of anxiety and depressive symptoms, and similar suicidal ideation compared to the general adolescent population. Moreover, rates of depression and anxiety symptoms as well as suicidal ideation were comparable to pediatric patients with diabetes, lupus, inflammatory bowel disease, and cystic fibrosis. Results suggest electronic mental health screening is feasible for use during outpatient cardiology clinic visits and provides valuable mental health information.
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Liu Q, Wang W, Gu X, Deng F, Wang X, Lin H, Guo X, Wu S. Association between particulate matter air pollution and risk of depression and suicide: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:9029-9049. [PMID: 33481201 DOI: 10.1007/s11356-021-12357-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
An increasing number of studies examined the potential effects of ambient particulate matter (PM: PM2.5 and PM10-PMs with diameters not greater than 2.5 and 10 μm, respectively) pollution on the risk of depression and suicide; however, the results have been inconclusive. This study aimed to determine the overall relationship between PM exposure and depression/suicide based on current evidence. We conducted a systematic review and meta-analysis of current available studies. Thirty articles (20 for depression and 10 for suicide) with data from 1,447,313 participants were included in the meta-analysis. For a 10 μg/m3 increase in short-term exposure to PM2.5, we found a 2% (p < 0.001) increased the risk of depression and a 2% (p = 0.001) increased risk of suicide. A 10 μg/m3 increase in long-term exposure to PM2.5 was associated with a more apparent increase of 18% (p = 0.005) in depression risk. In addition, a 10 μg/m3 increase in short-term exposure to PM10 was associated with a 2% (p = 0.003) increase in depression risk and a 1% (p = 0.002) increase in suicide risk. Subgroup analyses showed that associations between PM and depression were more apparent in people over 65 years and from developed regions. Besides, the study design and study quality might also have an impact on their associations. The meta-analysis found that an increase in ambient PM concentration was strongly associated with an increased risk of depression and suicide, and the associations for depression appeared stronger for smaller particles (PM2.5) and at a long-term time pattern.
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Affiliation(s)
- Qisijing Liu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Wanzhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Xuelin Gu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Furong Deng
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Xueqin Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hualiang Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinbiao Guo
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, China.
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Oud FMM, Spies PE, Braam RL, van Munster BC. Recognition of cognitive impairment and depressive symptoms in older patients with heart failure. Neth Heart J 2020; 29:377-382. [PMID: 33320302 PMCID: PMC8271051 DOI: 10.1007/s12471-020-01527-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Cognitive impairment and depression in patients with heart failure (HF) are common comorbidities and are associated with increased morbidity, readmissions and mortality. Timely recognition of cognitive impairment and depression is important for providing optimal care. The aim of our study was to determine if these disorders were recognised by clinicians and, secondly, if they were associated with hospital admissions and mortality within 6 months' follow-up. METHODS Patients (aged ≥65 years) diagnosed with HF were included from the cardiology outpatient clinic of Gelre Hospitals. Cognitive status was evaluated with the Montreal Cognitive Assessment test (score ≤22). Depressive symptoms were assessed with the Geriatric Depression Scale (score >5). Patient characteristics were collected from electronic patient files. The clinician was blinded to the tests and asked to assess cognitive status and mood. RESULTS We included 157 patients. Their median age was 79 years (65-92); 98 (62%) were male. The majority had New York Heart Association functional class II. Cognitive impairment was present in 56 (36%) patients. Depressive symptoms were present in 21 (13%) patients. In 27 of 56 patients (48%) cognitive impairment was not recognised by clinicians. Depressive symptoms were not recognised in 11 of 21 patients (52%). During 6 months' follow-up 24 (15%) patients were readmitted for HF-related reasons and 18 (11%) patients died. There was no difference in readmission and mortality rate between patients with or without cognitive impairment and patients with or without depressive symptoms. CONCLUSION Cognitive impairment and depressive symptoms were infrequently recognised during outpatient clinic visits.
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Affiliation(s)
- F M M Oud
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands. .,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands.
| | - P E Spies
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - R L Braam
- Department of Cardiology, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands
| | - B C van Munster
- Department of Geriatrics, Gelre Hospitals, Apeldoorn & Zutphen, The Netherlands.,Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Bose CN, Saboonchi F, Persson H, Björling G, Elfström ML. Adaptation of Coping Effectiveness Training for Patients With Heart Failure and Patient-Reported Experience of the Intervention. J Patient Exp 2020; 7:1054-1061. [PMID: 33457545 PMCID: PMC7786735 DOI: 10.1177/2374373520916012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although patients with chronic heart failure (CHF) often experience psychological distress, psychosocial aspects are not an integral part of their treatment and care. The aim is to describe the adaptation of Coping Effectiveness Training for patients with CHF and the participants' reported experiences. The intervention workbook and manual were translated into Swedish and adapted for patients with CHF. Patient-reported experience from 33 of 35 participants, that had completed the psychosocial intervention, was measured with an evaluation form consisting of closed and open-ended questions. Most participants thought they benefited from the intervention, were pleased with the structure and did not want to add anything to the program. The benefits experienced were learning how to cope with the illness and meeting other people to share and discuss experiences. There was a variation concerning the group process of how much direction should be given during the discussions. Overall, unique data from patient-reported experience measure showed that the participants were satisfied with the psychosocial intervention, applied for the first time to patients with CHF.
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Affiliation(s)
- Catarina Nahlén Bose
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Saboonchi
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Administration, Karolinska Institutet, Stockholm, Sweden
| | - Hans Persson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, Stockholm, Sweden
| | - Gunilla Björling
- Department of Health Sciences, The Swedish Red Cross University College, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Faculty of Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Magnus L Elfström
- Mälardalen University, School of Health, Care and Social Welfare, Eskilstuna, Sweden
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Pachana NA, Byrne GJ. The Geriatric Anxiety Inventory: International Use and Future Directions. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2011.00052.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Eisele M, Harder M, Rakebrandt A, Boczor S, Marx G, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. Association of depression and anxiety with adherence in primary care patients with heart failure-cross-sectional results of the observational RECODE-HF cohort study. Fam Pract 2020; 37:695-702. [PMID: 32358596 DOI: 10.1093/fampra/cmaa042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Malte Harder
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Gabriella Marx
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck
| | - Stefan Störk
- University and University Hospital Würzburg, Comprehensive Heart Failure Center Würzburg, Am Schwarzenberg, Würzburg
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg
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Ratcliff CG, Deavers F, Tullos EA, Christensen MR, Ricardo MM, Dindo L, Cully JA. Brief Behavioral Intervention for Distressed Patients Undergoing Cancer Surgery: A Case Series. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Cheng X, Zhu M, Liu Q, Feng Z, Meng Y. <p>Effectiveness of Metoprolol in Improving Cardiac and Motor Functions in Patients with Chronic Heart Failure: A Prospective Study</p>. Drug Des Devel Ther 2020; 14:3485-3494. [PMID: 32921985 PMCID: PMC7457782 DOI: 10.2147/dddt.s263026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- XiaoLiang Cheng
- Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Min Zhu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Qing Liu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Zhenxia Feng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People’s Republic of China
- Correspondence: Yong Meng Email
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Lee AA, Aikens JE, Janevic MR, Rosland AM, Piette JD. Functional support and burden among out-of-home supporters of heart failure patients with and without depression. Health Psychol 2020; 39:29-36. [PMID: 31535879 PMCID: PMC6901712 DOI: 10.1037/hea0000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Over 20% of patients with heart failure (HF) experience clinical depression, which is associated with higher rates of mortality, morbidity, and hospitalization. Support from family members or friends (whom we refer to as care partners [CPs]) can lower the risk of these outcomes. We examined whether HF patients with depression received assistance from CPs living outside of their homes. Further, we examined whether patient depression was associated with support-related strain among out-of-home CPs. METHOD We analyzed baseline survey data from 348 HF patients with reduced ejection fraction and their CPs. Patients with scores on the Center for Epidemiological Studies Depression Scale-10 (Kohout, Berkman, Evans, & Cornoni-Huntley, 1993) of ≥10 were classified as having clinically significant depressive symptoms (i.e., depression). Outcomes included CP-reported hr per week helping with health care and talking with patients via telephone and scores on the Modified Caregiver Strain Index. Negative binomial regression models examined differences in the amount of in-person and telephone support for patients with and without depression, controlling for patients' comorbidities, living alone, CP geographic distance, and CP emotional closeness to the patient. RESULTS CPs provided more in-person support to HF patients with depression (M = 3.64 hr) compared with those without depression (M = 2.60 hr per week, incident rate ratio [IRR] = 1.40, p = .019). CPs provided more telephone support to patients with depression (M = 3.02 hr) compared with those without depression (M = 2.09 hr per week, IRR = 1.42, p < .001). Patient depression had no effect on caregiver burden (IRR = 1.00, p = .843). CONCLUSION Patients with clinically significant depressive symptoms receive more in-person assistance and telephonic support from CPs. Despite that additional contact, caregiver burden was not greater among the supporters of depressed patients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Aaron A Lee
- Veterans Affairs Center for Clinical Management Research
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School
| | - Mary R Janevic
- Department of Health Behavior & Health Education, University of Michigan School of Public Health
| | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh Medical School
| | - John D Piette
- Veterans Affairs Center for Clinical Management Research
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Wu L, Zhang Q, Shu Q, Zhang R, Meng Y. Sex-dependent changes in physical, mental, and quality of life outcomes in metoprolol-treated Chinese chronic heart failure patients. Medicine (Baltimore) 2019; 98:e18331. [PMID: 31852127 PMCID: PMC6922588 DOI: 10.1097/md.0000000000018331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study assessed sex differences in cardiac and motor functions, quality of life (QoL), and mental status in Chinese chronic heart failure (CHF) patients after metoprolol treatment.This single-center prospective study, conducted from February 2013 to April 2016, included CHF patients (men and women) with resting heart rate (HR) >80 beats/min using metoprolol continuous release tablets. Metoprolol-induced changes in cardiac and motor functions, QoL, and mental status at 1, 3, 6, 9, and 12 months from baseline, within and between the sexes, were analyzed. Descriptive data were represented as counts, percentages, and mean ± standard deviation. Differences at various follow-up periods were compared using repeated measures one-way analysis of variance, followed by post hoc Dunnett's multiple comparison test. Statistical significance was considered at P < .05.Compared with men, women reported significantly higher systolic blood pressure (SBP) (122.28 ± 6.76 vs 125.47 ± 6.67 mm Hg, P < .05) and Veterans Specific Activity Questionnaire score (8.16 ± 0.98 vs 8.47 ± 0.89, P = .05) at 12 months. Men reported higher Hospital Anxiety and Depression Scale scores for depression than women at 1 month (10.27 vs 8.83, P < .05) and for anxiety at 12 months (8.4 vs 7.72, P < .05). Metoprolol significantly decreased HR and Minnesota Living with Heart Failure Questionnaire score in men (64.5 ± 3.13 and 53.7 ± 8.00) and women (65.38 ± 3.32 and 53.85 ± 8.42, respectively). Ejection fraction (%, men: 50.00 ± 4.45, women: 50.72 ± 4.09), cardiac index (L/min/m, men: 2.70 ± 0.25, women: 2.78 ± 0.23), 6-minute walk test distance (m, men: 414.41 ± 20.84, women: 420.34 ± 20.35), and short form-8 questionnaire scores (men: 52.05 ± 1.94, women: 52.19 ± 2.58) increased significantly in both the sexes (P < .001 for all) at 12 months. Copenhagen Burnout Inventory score significantly increased in men (mean score 62.43, P < .05).Metoprolol treatment improves cardiac and motor functions, QoL, and anxiety scores but causes greater depression and burnout in men and women. Sex was seen to affect mental status of CHF patients the most.
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Abstract
We examined the accuracy of the anxiety not otherwise specified (anxiety NOS) diagnosis in 61 patients, using data from older Veterans screened for a large trial of cognitive behavioral therapy for late-life generalized anxiety disorder. We compared the anxiety NOS diagnoses based on the electronic medical record to diagnoses obtained via a gold standard structured diagnostic interview conducted for this trial. We found concordance of the anxiety NOS diagnosis in only 2 participants (3%). Most patients (77%) met diagnostic criteria for a specific Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorder, including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and/or social anxiety disorder, on the basis of a structured diagnostic interview. The erroneous diagnosis of anxiety NOS is a barrier to patients receiving appropriate evidence-based care for specific anxiety-related and trauma-related disorders. Undertreated anxiety can result in poorer health outcomes, overutilization of medical services, and increased health care costs. Accurate diagnosis of anxiety disorders is foundational to evidence-based treatment; thus, it is imperative that patients presenting with anxiety symptoms receive proper diagnostic assessment to facilitate access to the appropriate evidence-based mental health services.
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Gu X, Liu Q, Deng F, Wang X, Lin H, Guo X, Wu S. Association between particulate matter air pollution and risk of depression and suicide: systematic review and meta-analysis. Br J Psychiatry 2019; 215:456-467. [PMID: 30719959 DOI: 10.1192/bjp.2018.295] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Some recent studies examined the effect of ambient particulate matter (PM) pollution on depression and suicide. However, the results have been inconclusive.AimsTo determine the overall relationship between PM exposure and depression/suicide in the general population. METHOD We conducted a systematic review and meta-analysis of case-crossover and cohort studies to assess the association between PM2.5 (particles with an aerodynamic diameter of 2.5 µm or less) or PM10 (particles with an aerodynamic diameter between 2.5 and 10 µm) exposure and depression/suicide. RESULTS A total of 14 articles (7 for depression and 7 for suicide) with data from 684 859 participants were included in the meta-analysis. With a 10 µg/m3 increase in PM2.5 we found a 19% (odds ratio [95% CI] 1.19 [1.07, 1.33]) increased risk of depression and a marginally increased risk of suicide (odds ratio [95% CI] 1.05 [0.99, 1.11]) in the general population. We did not observe any significant associations between increasing exposure to PM10 and depression/suicide. Sensitivity and subgroup analyses were used to determine the robustness of results. The strongest estimated effect of depression associated with PM2.5 appeared in a long-term lag pattern (odds ratio [95% CI] 1.25 [1.07, 1.45], P < 0.01) and cumulative lag pattern (odds ratio [95% CI] 1.26 [1.07, 1.48], P < 0.01). CONCLUSIONS The meta-analysis suggested that an increase in ambient PM2.5 concentration was strongly associated with increased depression risk in the general population, and the association appeared stronger at long-term lag and cumulative lag patterns, suggesting a potential cumulative exposure effect over time.Declaration of interestNone.
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Affiliation(s)
- Xuelin Gu
- MSc Student, Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,China
| | - Qisijing Liu
- PhD Student, Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,China
| | - Furong Deng
- Professor,Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,China
| | - Xueqin Wang
- Associate Professor,Peking University Sixth Hospital, Peking University Institute of Mental Health,Key Laboratory of Mental Health,Ministry of Health (Peking University),National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital),China
| | - Hualiang Lin
- Associate Professor,Department of Medical Statistics and Epidemiology,School of Public Health,Sun Yat-sen University,China
| | - Xinbiao Guo
- Professor,Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University,China
| | - Shaowei Wu
- Associate Professor,Department of Occupational and Environmental Health Sciences,School of Public Health,Peking University;Key Laboratory of Molecular Cardiovascular Sciences,Peking University,Ministry of Education,China
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Mohamed NF, Ghazali SR, Yaacob NA, Rahim AAA, Maskon O. Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire. Sultan Qaboos Univ Med J 2019; 18:e494-e500. [PMID: 30988969 DOI: 10.18295/squmj.2018.18.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient's quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting. Methods This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument's construct validity. Cronbach's alpha coefficients were used to determine internal consistency. Results A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors-psychological, physical-social and spiritual wellbeing-resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450-0.718 for psychological wellbeing (12 items), 0.394-0.740 for physical-social wellbeing (14 items) and 0.449-0.727 for spiritual wellbeing (seven items). The overall Cronbach's alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively. Conclusion The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF.
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Affiliation(s)
- Nor F Mohamed
- Department of Psychology & Counselling, Faculty of Human Development, Sultan Idris Education University, Tanjung Malim, Malaysia
| | - Siti R Ghazali
- Department of Psychological Medicine, University Malaysia Sarawak, Sarawak, Malaysia
| | - Nor A Yaacob
- Department of Community Medicine, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Aizai A A Rahim
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Oteh Maskon
- Department of Cardiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Shu Q, Wu L, Zhang R, Zhang Q, Huang J, Meng Y. Age-dependent changes in cardiac performance, motor function, QoL, and mental status in metoprolol-treated chronic heart failure patients. Sci Rep 2019; 9:453. [PMID: 30679746 PMCID: PMC6345765 DOI: 10.1038/s41598-018-37520-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023] Open
Abstract
No previous study reports the effect of age on cardiac performance, motor function and quality of life (QoL) in Chinese chronic heart failure (CHF) patients. This single-center, prospective study enrolled CHF patients with resting heart rate (RHR) > 80 bpm, who were treated with metoprolol and were followed up at 1, 3, 6, and 12 months. Changes in cardiac, motor, and QoL parameters between patients aged ≥60 years and those aged <60 years were compared at all time points. P < 0.05 was considered significant. A total of 154 patients were enrolled (median age: 66.39 years; 116 aged ≥60 years, 38 aged <60 years; 95% New York Heart Association class III-IV). RHR decreased significantly in both patient groups (P < 0.0001 for both groups). Patients aged ≥60 years had a significant improvement in both ejection fraction (EF) at 6 and 12 months and in cardiac index (CI) at 3, 6, and 12 months. However, no major difference was observed in motor function in both groups. Significantly higher SF-8 scores showed greater improvement in QoL in the <60 age group at 12 months (P = 0.0008). Metoprolol demonstrated improvement in cardiac performance, motor function, QoL, and anxiety with increase in depression and burnout in both genders; however, the findings were independent of age.
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Affiliation(s)
- Qiuhong Shu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Liyong Wu
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Ran Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Qian Zhang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Jingjing Huang
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China
| | - Yong Meng
- Department of Cardiology, The Second Affiliated Hospital of Kunming Medical University, No. 374, Dianmian Road, Kunming, Yunnan, 650101, China.
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Anxiety and Depression among Patients with Coronary Artery Disease Attending at a Cardiac Center, Kathmandu, Nepal. Nurs Res Pract 2019; 2018:4181952. [PMID: 30595917 PMCID: PMC6286769 DOI: 10.1155/2018/4181952] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/07/2018] [Accepted: 10/28/2018] [Indexed: 11/17/2022] Open
Abstract
Psychiatric morbidity such as anxiety and depression is common among patients with coronary artery disease (CAD). The coexistence of psychiatric morbidity negatively affects the outcome of treatment and increases the overall burden of disease in CAD patients. The objective of the study was to identify the level of anxiety and depression among patients with CAD. Descriptive, cross-sectional research design and purposive sampling were used and a total of 168 patients having coronary artery disease were selected purposively for the study from the patients attending cardiac outpatient department of Sahid Gangalaal National Heart Center, Kathmandu, Nepal. Data was collected on 2017 by using pretested semistructured interview schedule, Hospital Anxiety and Depression Scale. The findings showed that 27.4% of the respondents had anxiety caseness and 23.8% of the respondents had depression caseness. Bivariate analysis showed that patient's level of anxiety was significantly associated with sex, family income, occupation status, and self-esteem. Higher level of anxiety (42.4%) was found in female than male patients. Likewise, level of depression was significantly associated with education status, occupation status, presence of comorbidities, physical exercise, and self-esteem of the patients. There was significant positive relationship between anxiety and depression score. Thus anxiety and depression were common among patients with CAD. Hence, anxiety and depression in CAD patients need be monitored regularly, provide regular counseling services, and refer the patients for the treatment when needed.
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Asgari S, Roohani M, Amini K, Faghihzadeh S. Investigating Death Anxiety and its Relationship with Some Demographic Variables in Patients with Heart Failure in Zanjan 2018. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2018. [DOI: 10.29252/pcnm.8.2.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Teng HC, Yeh ML, Wang MH. Walking with controlled breathing improves exercise tolerance, anxiety, and quality of life in heart failure patients: A randomized controlled trial. Eur J Cardiovasc Nurs 2018; 17:717-727. [PMID: 29775076 DOI: 10.1177/1474515118778453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with heart failure experience not only impaired physical condition, but also their physical activity, moods, and quality of life may be diminished. AIMS The purpose of this study was to investigate the effects of 12-week walking with breathing program on physical activity tolerance considering time-dependent physiological factors and time-independent interoceptive awareness, as well as psychosocial factors. METHODS This randomized controlled trial recruited 90 heart failure patients and randomly assigned them. The walking with breathing group received the walking and breathing intervention for 12 weeks but the control group did not. Outcomes included activity tolerance measured by 6-minute walk distance, moods assessed by the Hospital Anxiety and Depression Scale, quality of life determined by the EuroQol 5-Dimensions, oxygen saturation by pulse oximetry, and interoceptive awareness by the Multidimensional Assessment of Interoceptive Awareness scale. Data were collected before the intervention at baseline and at Weeks 2, 4 and 12. RESULTS The results of the generalized estimating equation showed the 6-minute walk distance in the walking with breathing group was significantly different across time ( p<0.001) compared with the control group at baseline. Oxygen saturation by pulse oximetry ( p=0.04) and Trusting on the Multidimensional Assessment of Interoceptive Awareness scale ( p=0.001) significantly and positively correlated with results of the 6-minute walk distance. There were significant between-group differences at Week 12 in anxiety ( p=0.03) and quality of life ( p=0.02) but not depression ( p=0.06). CONCLUSIONS Walking with breathing improved heart failure patients' tolerance of physical activity, probably because of improved oxygen saturation and trusting interoceptive awareness. Walking with breathing also improved patients' anxiety and quality of life.
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Affiliation(s)
- Hsiu-Chin Teng
- 1 Department of Nursing, Cheng Hsin General Hospital, ROC
| | - Mei-Ling Yeh
- 2 Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei University of Nursing and Health Sciences, ROC
| | - Mei-Hua Wang
- 3 School of Nursing, National Taipei University of Nursing and Health Sciences, ROC
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Eisele M, Boczor S, Rakebrandt A, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. General practitioners' awareness of depressive symptomatology is not associated with quality of life in heart failure patients - cross-sectional results of the observational RECODE-HF Study. BMC FAMILY PRACTICE 2017; 18:100. [PMID: 29221442 PMCID: PMC5723041 DOI: 10.1186/s12875-017-0670-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression is a common comorbidity in patients with chronic heart failure (HF) and linked to a wider range of symptoms which, in turn, are linked to a decreased health-related quality of life (HRQOL). Treatment of depression might improve HRQOL but detecting depression is difficult due to the symptom overlap between HF and depression. Therefore, clinical guidelines recommend to routinely screen for depression in HF patients. No studies have so far investigated the treatment after getting aware of a depressive symptomatology and its correlation with HRQOL in primary care HF patients. Therefore, we examined the factors linked to depression treatment and those linked to HRQOL in HF patients. We hypothesized that GPs' awareness of depressive symptomatology was associated with depression treatment and HRQOL in HF patients. METHODS For this observational study, HF patients were recruited in primary care practices and filled out a questionnaire including PHQ-9 and HADS. A total of 574 patients screened positive for depressive symptomatology. Their GPs were interviewed by phone regarding the patients' comorbidities and potential depression treatment. Descriptive and regression analysis were performed. RESULTS GPs reported various types of depression treatments (including dialogue/counselling by the GP him/herself in 31.8% of the patients). The reported rates differed considerably between GP-reported initiated treatment and patient-reported utilised treatment regarding psychotherapy (16.4% vs. 9.5%) and pharmacotherapy (61.2% vs. 30.3%). The GPs' awareness of depressive symptomatology was significantly associated with the likelihood of receiving pharmacotherapy (OR 2.8; p < 0.001) but not psychotherapy. The patient's HRQOL was not significantly associated with the GPs' awareness of depression. CONCLUSION GPs should be aware of the gap between GP-initiated and patient-utilised depression treatments in patients with chronic HF, which might lead to an undersupply of depression treatment. It remains to be investigated why GPs' awareness of depressive symptomatology is not linked to patients' HRQOL. We hypothesize that GPs are aware of cases with reduced HRQOL (which improves under depression treatment) and unaware of cases whose depression do not significantly impair HRQOL, resulting in comparable levels of HRQOL in both groups. This hypothesis needs to be further investigated.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078 Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center, and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099 Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Recognition of anxiety, depression, and PTSD in patients with COPD and CHF: Who gets missed? Gen Hosp Psychiatry 2017; 47:61-67. [PMID: 28807139 DOI: 10.1016/j.genhosppsych.2017.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study sought to identify patient factors associated with mental health (MH) recognition and treatment in medically ill Veterans. METHOD Retrospective data from patient electronic medical records (EMR) and self-report data were reviewed for 180 Veterans with cardiopulmonary conditions who met diagnostic criteria for anxiety, depression, or posttraumatic stress disorder on the Mini-International Neuropsychiatric Interview. Multivariate logistic regression examined the association of medical record MH recognition and MH service use with patient factors, including anxiety and depression severity, self-efficacy, locus of control, coping, illness intrusiveness, and health-related quality of life (QOL). RESULTS Seventy veterans (39%) had an MH diagnosis documented in their EMR, and 101 (56%) received at least one MH service (≥1 MH encounter or psychiatric medications). Greater depression (p=0.047) and adaptive coping (p=0.012) were associated with increased likelihood of EMR documentation of MH diagnoses. EMR MH diagnosis (p<0.001), higher internal locus of control (p=0.037), and poorer physical health-related QOL (p=0.014) were associated with greater likelihood of MH service use. DISCUSSION Veterans with cardiopulmonary conditions experiencing MH problems are under-recognized. Improved MH screening is needed, particularly for patients with poor adaptive coping skills, low internal locus of control, or poor physical health-related QOL.
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Eisele M, Rakebrandt A, Boczor S, Kazek A, Pohontsch N, Okolo-Kulak M, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. Factors associated with general practitioners' awareness of depression in primary care patients with heart failure: baseline-results from the observational RECODE-HF study. BMC FAMILY PRACTICE 2017; 18:71. [PMID: 28599626 PMCID: PMC5466751 DOI: 10.1186/s12875-017-0641-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/24/2017] [Indexed: 12/30/2022]
Abstract
Background Depression is more prevalent in patients with heart failure (HF) than in those without, but its detection is complicated by the symptom overlap between the two diseases. General practitioners (GPs) are the first point of contact for patients with HF. Therefore, this study aims to investigate GPs’ awareness of depression in their HF patients and factors associated with this awareness. Methods In this cross-sectional, observational study 3224 primary care patients with HF were screened for depressive symptomatology using an algorithm based on the Hospital Anxiety and Depression Scale, the 9-item subscale on Depression of the Patient Health Questionnaire, and selected items from the PROMIS Depression and Anxiety scales. The 272 GPs of all patients involved in the study were interviewed by telephone regarding their patients’ somatic and psychological comorbidities. The awareness rates of depressive symptomatology by the patients’ GPs are analyzed using descriptive statistics. Logistic regression analyses are applied to investigate the patient- and GP-based factors associated with the GPs’ awareness of depressive symptomatology. Results GPs were aware of their patients’ depressive symptomatology in 35% of all cases. Factors associated with the awareness of depressive symptomatology were: higher patient education levels, a history of depression known to the GP, GP-consultations due to emotional distress within the last 6 months, a higher frequency of GP-contacts within the last 6 months, a higher New York Heart Association (NYHA) classification and more severe depressive symptomatology. The GPs’ characteristics, including further education in psychology/psychiatry, were not associated with GP awareness. Conclusions Many aspects, including the definition of awareness and the practical issues in primary care, may contribute to the unexpectedly low awareness rates of depressive symptomatology in HF patients in primary care. Awareness rates might increase, if GPs encouraged their patients to talk about emotional distress, held detailed medical interviews including a patient’s history of depression and payed special attention to HF patients with low education levels. However, it remains to be investigated whether GPs’ judgement of depressive symptomatology is a better or worse indicator for the future prognosis and quality of life of HF patients than psychiatry based diagnostic criteria.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Agata Kazek
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nadine Pohontsch
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Magdalena Okolo-Kulak
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099, Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Pun VC, Manjourides J, Suh H. Association of Ambient Air Pollution with Depressive and Anxiety Symptoms in Older Adults: Results from the NSHAP Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:342-348. [PMID: 27517877 PMCID: PMC5332196 DOI: 10.1289/ehp494] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 06/01/2016] [Accepted: 07/19/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ambient fine particulate matter (PM2.5) is among the most prevalent sources of environmentally induced inflammation and oxidative stress, both of which are implicated in the pathogenesis of most mental disorders. Evidence, however, concerning the impact of PM2.5 on mental health is just emerging. OBJECTIVE We examined the association between PM2.5 and current level of depressive and anxiety symptoms using a nationally representative probability sample (n = 4,008) of older, community-dwelling individuals living across the United States (the National Social Life, Health and Aging project). METHODS Mental health was evaluated using validated, standardized questionnaires and clinically relevant cases were identified using well-established cutoffs; daily PM2.5 estimates were obtained using spatiotemporal models. We used generalized linear mixed models, adjusting for potential confounders, and explored effect modification. RESULTS An increase in PM2.5 was significantly associated with anxiety symptoms, with the largest increase for 180-days moving average (OR = 1.61; 95% CI: 1.35, 1.92) after adjusting for socioeconomic measures (SES); PM2.5 was positively associated with depressive symptoms, and significantly for 30-day moving average (OR = 1.16; 95% CI: 1.05, 1.29) upon SES adjustment. The observed associations were enhanced among individuals who had low SES and history of comorbidity. When considering mental health as chronic conditions, PM2.5 was significantly associated with incident depressive symptoms for all exposure windows examined, but with incident anxiety symptoms only for shorter exposure windows, which may be due to a drop in power resulting from the decreased between-subject variability in chronic PM2.5 exposure. CONCLUSION PM2.5 was associated with depressive and anxiety symptoms, with associations the strongest among individuals with lower SES or among those with certain health-related characteristics. Citation: Pun VC, Manjourides J, Suh H. 2017. Association of ambient air pollution with depressive and anxiety symptoms in older adults: results from the NSHAP study. Environ Health Perspect 125:342-348; http://dx.doi.org/10.1289/EHP494.
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Affiliation(s)
| | | | - Helen Suh
- Address correspondence to H. Suh, Department of Civil and Environmental Engineering, Tufts University, Medford, MA 02153 USA. Telephone: (617) 627-2941.
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Moser DK, Arslanian-Engoren C, Biddle MJ, Chung ML, Dekker RL, Hammash MH, Mudd-Martin G, Alhurani AS, Lennie TA. Psychological Aspects of Heart Failure. Curr Cardiol Rep 2016; 18:119. [DOI: 10.1007/s11886-016-0799-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gould CE, O'Hara R, Goldstein MK, Beaudreau SA. Multimorbidity is associated with anxiety in older adults in the Health and Retirement Study. Int J Geriatr Psychiatry 2016; 31:1105-15. [PMID: 27441851 PMCID: PMC5312684 DOI: 10.1002/gps.4532] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The present study determined whether the number of medical conditions was associated with increased occurrence of anxiety and whether triads of medical conditions were associated with anxiety in a nationally representative sample of older Americans. We determined whether multimorbidity findings were unique to anxiety as compared with depressive symptoms. METHODS A sample of 4219 participants (65 years or older) completed anxiety and depression measures in the Health and Retirement Study 2006 wave. The logistic regression models' outcome was elevated anxiety (≥12 on five-item Beck Anxiety Inventory) or depressive symptoms (≥12 on eight-item Center for Epidemiological Studies Depression Scale). The predictor variable was a tally of seven self-report of doctor-diagnosed conditions: arthritis, cancer, diabetes, heart conditions, high blood pressure, lung disease, and stroke. Analyses were adjusted for age, gender, and depressive or anxiety symptoms. Associations among elevated anxiety or depressive symptoms and 35 triads of medical conditions were examined using Bonferroni corrected chi-square analyses. RESULTS Three or more medical conditions conferred a 2.30-fold increase in elevated anxiety (95% confidence interval: 1.44-4.01). Twenty triads were associated with elevated anxiety as compared with 13 associated with depressive symptoms. Six of seven medical conditions, with the exception being stroke, were present in the majority of triads. CONCLUSION Number of medical conditions and specific conditions are associated with increased occurrence of elevated anxiety. Compared with elevated depressive symptoms, anxiety is associated with greater multimorbidity. As anxiety and depression cause significant morbidity, it may be beneficial to consider these mental health symptoms when evaluating older adults with multimorbidity. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- Christine E. Gould
- VA Palo Alto Health Care System, Geriatric Research Education and Clinical Center (GRECC), Palo Alto, CA, United States,Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States,Corresponding Author: Christine E. Gould, PhD, Veterans Affairs Palo Alto Health Care System, GRECC (182B), 3801 Miranda Ave., Palo Alto, CA 94304.
| | - Ruth O'Hara
- Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States,VA Palo Alto Health Care System, Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto, CA, United States,School of Psychology, University of Queensland, Brisbane, Australia
| | - Mary K. Goldstein
- VA Palo Alto Health Care System, Geriatric Research Education and Clinical Center (GRECC), Palo Alto, CA, United States,Stanford University, Center for Primary Care and Outcomes Research (PCOR), Stanford, CA, United States
| | - Sherry A. Beaudreau
- Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, CA, United States,VA Palo Alto Health Care System, Mental Illness Research Education and Clinical Center (MIRECC), Palo Alto, CA, United States,School of Psychology, University of Queensland, Brisbane, Australia
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Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies. Int J Cardiol 2016; 224:170-177. [PMID: 27657469 DOI: 10.1016/j.ijcard.2016.09.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/07/2016] [Accepted: 09/15/2016] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) is a burgeoning chronic health condition affecting more than 20million people worldwide. Patients with HF have a significant (17.1%) 30-day readmission rate, which invites substantial penalty in payment to hospitals from Centers for Medicare and Medicaid Services, as per the newly introduced Hospital Readmissions Reduction Program. Depression is one of the important risk factors for readmission in HF patients. It has a significant prevalence in patients with HF and contributes to the overall poor quality of life in them. Several behavioral (smoking, obesity, lack of exercise and medication noncompliance) and pathophysiological factors (hypercortisolism, elevated inflammatory biomarkers, fibrinogen, and atherosclerosis) have been found responsible for the adverse outcome in patients with HF and concomitant depression. Hippocampal volume loss noted in patients with acute HF exacerbations may contribute to the development of depressive symptoms in them. Screening for depression in HF patients continues to be challenging due to a considerable overlap in symptoms. Published trials on the use of antidepressants and cognitive behavioral therapy (CBT) have shown variable outcomes. Newer modalities like internet-based CBT have been tried in small studies, with promising results. A recent meta-analysis observed the beneficial role of aerobic exercise training in patients with HFrEF. Future long-term prospective studies may contribute to the formulation of a detailed screening and management guideline for patients with HF and depression. Our review is aimed to summarize the intricate relationship between depression and heart failure, with respect to their epidemiology, pathophysiological aspects, and optimal management approach.
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Factors Associated With High Frequency of Suicidal Ideation in Medically Ill Veterans. J Psychiatr Pract 2016; 22:389-97. [PMID: 27648503 DOI: 10.1097/pra.0000000000000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Suicide is a leading cause of death, and rates are especially high among medically ill, older individuals. Health-related psychosocial correlates of suicidal ideation (SI) may be particularly important for medically ill older adults as they may clarify who may benefit from interventions to reduce SI. This study examined whether demographic, physical health, and/or health-related psychosocial factors were associated with high frequency of SI in older, medically ill Veterans experiencing elevated anxiety or depression. This cross-sectional study included 302 Veterans with (1) a cardiopulmonary condition and functional impairment and (2) elevated symptoms of depression and/or anxiety. Participants were classified as having either no, low, or high SI, based on self-reported ideation, from the Patient Health Questionnaire-9. SI was reported in 26.8% of the full sample and high SI was reported by 12.6% of participants. Logistic regression analyses predicting high versus no SI found the odds of high SI increased 4.7 times (95% confidence interval, 2.6-8.3) for each 1-unit increase in maladaptive coping and 4.1 times (95% confidence interval, 1.2-14.3) for each 1-unit increase in physical health severity/functional limitations. Older, medically ill Veterans with comorbid depression and/or anxiety frequently reported SI and were at greater risk of experiencing a high frequency of SI if they engaged in maladaptive coping strategies and/or had high levels of functional impairment. Effective interventions to reduce SI for this population should focus on reducing maladaptive coping and minimizing negative behavioral, cognitive, and emotional reactions to functional limitations.
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Jani BD, Mair FS, Roger VL, Weston SA, Jiang R, Chamberlain AM. Comorbid Depression and Heart Failure: A Community Cohort Study. PLoS One 2016; 11:e0158570. [PMID: 27362359 PMCID: PMC4928788 DOI: 10.1371/journal.pone.0158570] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 06/19/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To examine the association between depression and clinical outcomes in heart failure (HF) in a community cohort. Patients and Methods HF patients in Minnesota, United States completed depression screening using the 9-item Patient Health Questionnaire (PHQ-9) between 1st Oct 2007 and 1st Dec 2011; patients with PHQ-9≥5 were labelled “depressed”. We calculated the risk of death and first hospitalization within 2 years using Cox regression. Results were adjusted for 10 commonly used prognostic factors (age, sex, systolic blood pressure, estimated glomerular filtration rate, serum sodium, ejection fraction, blood urea nitrogen, brain natriuretic peptide, presence of diabetes and ischaemic aetiology). Area under the curve (AUC), integrated discrimination improvement (IDI) and net reclassification improvement (NRI) compared depression as a predictor against the aforementioned factors. Results 425 patients (mean age 74, 57.6% males) were included in the study; 179 (42.1%) had PHQ-9≥5. The adjusted hazard ratio of death was 2.02 (95% CI 1.34–3.04) and of hospitalization was 1.42 (95% CI 1.13–1.80) for those with compared to those without depression. Adding depression to the models did not appreciably change the AUC but led to statistically significant improvements in both the IDI (p = 0.001 and p = 0.005 for death and hospitalization, respectively) and NRI (for death and hospitalization, 35% (p = 0.002) and 27% (p = 0.007) were reclassified correctly, respectively). Conclusion Depression is frequent among community patients with HF and associated with increased risk of hospitalizations and death. Risk prediction for death and hospitalizations in HF patients can be improved by considering depression.
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Affiliation(s)
- Bhautesh Dinesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Véronique L. Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Susan A. Weston
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ruoxiang Jiang
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Alanna M. Chamberlain
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
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Celik E, Cay S, Sensoy B, Murat S, Oksuz F, Cankurt T, Ali Mendi M. Heart Failure Functional Class Associated with Depression Severity But Not Anxiety Severity. ACTA CARDIOLOGICA SINICA 2016; 32:55-61. [PMID: 27122931 DOI: 10.6515/acs20150509a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Depression and anxiety are common in heart failure (HF) patients and associated with adverse clinical outcomes. However, there are little or no published data that focuses on the relationship between these commonly observed situations and HF classes. The aim of this study was to evaluate the relationship between these psychiatric co-morbidities and HF symptom classes. As a second objective of our study, the associations between patient characteristics and depression severity were also assessed. METHODS Our study enrolled a total of 420 HF study participants. The severity of depressive and anxiety symptoms was evaluated by Beck's depression and anxiety. The measured total scores were used to grade depression severity and anxiety as minimal/mild and moderate/severe. RESULTS According to NYHA Functional Classification, 228 patients (51%) had class I symptoms, 101 (23%) had class II symptoms, 31 (7%) had class III symptoms, and class IV symptoms were noted in the remaining 60 patients (19%). The mean Beck's depression and anxiety scores were 12.4 ± 11.1 and 13.4 ± 9.0, respectively. While no association between HF symptom classes and anxiety severity was observed, a significant positive relation between HF symptom class and depression score was found. CONCLUSIONS The results of our study suggested that HF symptom class was positively associated with severity of depression. On the other hand, there was no association between HF symptom class and anxiety score in a wide population of heart failure patients. KEY WORDS Anxiety; Depression; Heart failure.
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Affiliation(s)
- Etem Celik
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Serkan Cay
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Baris Sensoy
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Sani Murat
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Fatih Oksuz
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Tayyar Cankurt
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
| | - Mehmet Ali Mendi
- Department of Cardiology, Yuksek Ihtisas Heart-Education and Research Hospital
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Chapa DW, Akintade B, Son H, Woltz P, Hunt D, Friedmann E, Hartung MK, Thomas SA. Pathophysiological Relationships Between Heart Failure and Depression and Anxiety. Crit Care Nurse 2014; 34:14-24; quiz 25. [DOI: 10.4037/ccn2014938] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals.
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Affiliation(s)
- Deborah W. Chapa
- Deborah Chapa is an assistant professor and coordinator of bachelor of nursing science to doctor of nursing practice at George Washington University, School of Nursing, Washington, DC. She is also an acute care nurse practitioner
| | - Bimbola Akintade
- Bimbola Akintade is an assistant professor in the trauma, critical care, emergency department and clinical nurse specialist nurse practitioner program at the University of Maryland, School of Nursing, and an acute care nurse practitioner at Washington Hospital Center, Baltimore, Maryland
| | - Heesook Son
- Heesook Son is an assistant professor at Chung-Ang University School of Nursing, Seoul, South Korea
| | - Patricia Woltz
- Patricia Woltz is director of nursing research at the University of Maryland Medical Center in Baltimore
| | - Dennis Hunt
- Dennis Hunt is an assistant professor, physical therapy and human performance, and director of the exercise science program at Florida Gulf Coast University, Fort Meyers, Florida
| | - Erika Friedmann
- Erika Friedmann is a professor at the University of Maryland, School of Nursing
| | - Mary Kay Hartung
- Mary Kay Hartung was a health sciences librarian at Florida Gulf Coast University. She is now retired
| | - Sue Ann Thomas
- Sue Ann Thomas is a professor emeritus of nursing at the University of Maryland School of Nursing
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Abstract
OBJECTIVE Depression has been associated with increased risk of heart failure (HF). Because anxiety is highly comorbid with depression, we sought to establish if anxiety, depression, or their co-occurrence is associated with incident HF. METHODS A retrospective cohort (N = 236,079) including Veteran's Administration patients (age, 50-80 years) free of cardiovascular disease (CVD) at baseline was followed up between 2001 and 2007. Cox proportional hazards models were computed to estimate the association between anxiety disorders alone, major depressive disorder (MDD) alone, and the combination of anxiety and MDD, with incident HF before and after adjusting for sociodemographics, CVD risk factors (Type 2 diabetes, hypertension, hyperlipidemia, obesity), nicotine dependence/personal history of tobacco use, substance use disorders (alcohol and illicit drug abuse/dependence), and psychotropic medication. RESULTS Compared with unaffected patients, those with anxiety only, MDD only, and both disorders were at increased risk for incident HF in age-adjusted models (hazard ratio [HR] = 1.19 [ 95% confidence interval {CI} = 1.10-1.28], HR = 1.21 [95% CI = 1.13-1.28], and HR = 1.24 [95% CI = 1.17-1.32], respectively). After controlling for psychotropics in a full model, the association between anxiety only, MDD only, and both disorders and incident HF increased (HRs = 1.46, 1.56, and 1.74, respectively). CONCLUSIONS Anxiety disorders, MDD, and co-occurring anxiety and MDD are associated with incident HF in this large cohort of Veteran's Administration patients free of CVD at baseline. This risk of HF is greater after accounting for protective effects of psychotropic medications. Prospective studies are needed to clarify the role of depression and anxiety and their pharmacological treatment in the etiology of HF.
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Eisele M, Blozik E, Störk S, Träder JM, Herrmann-Lingen C, Scherer M. Recognition of depression and anxiety and their association with quality of life, hospitalization and mortality in primary care patients with heart failure - study protocol of a longitudinal observation study. BMC FAMILY PRACTICE 2013; 14:180. [PMID: 24279590 PMCID: PMC4222561 DOI: 10.1186/1471-2296-14-180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/20/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND International disease management guidelines recommend the regular assessment of depression and anxiety in heart failure patients. Currently there is little data on the effect of screening for depression and anxiety on the quality of life and the prognosis of heart failure (HF). We will investigate the association between the recognition of current depression/anxiety by the general practitioner (GP) and the quality of life and the patients' prognosis. METHODS/DESIGN In this multicenter, prospective, observational study 3,950 patients with HF are recruited by general practices in Germany. The patients fill out questionnaires at baseline and 12-month follow-up. At baseline the GPs are interviewed regarding the somatic and psychological comorbidities of their patients. During the follow-up assessment, data on hospitalization and mortality are provided by the general practice. Based on baseline data, the patients are allocated into three observation groups: HF patients with depression and/or anxiety recognized by their GP (P+/+), those with depression and/or anxiety not recognized (P+/-) and patients without depression and/or anxiety (P-/-). We will perform multivariate regression models to investigate the influence of the recognition of depression and/or anxiety on quality of life at 12 month follow-up, as well as its influences on the prognosis (hospital admission, mortality). DISCUSSION We will display the frequency of GP-acknowledged depression and anxiety and the frequency of installed therapeutic strategies. We will also describe the frequency of depression and anxiety missed by the GP and the resulting treatment gap. Effects of correctly acknowledged and missed depression/anxiety on outcome, also in comparison to the outcome of subjects without depression/anxiety will be addressed. In case results suggest a treatment gap of depression/anxiety in patients with HF, the results of this study will provide methodological advice for the efficient planning of further interventional research.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Eva Blozik
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Straubmühlweg 2a, Würzburg 97078, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research, von-Siebold-Str. 5, Göttingen 37075, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany
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Huffman JC, Beach SR, Suarez L, Mastromauro CA, DuBois CM, Celano CM, Rollman BL, Januzzi JL. Design and baseline data from the Management of Sadness and Anxiety in Cardiology (MOSAIC) randomized controlled trial. Contemp Clin Trials 2013; 36:488-501. [PMID: 24090821 DOI: 10.1016/j.cct.2013.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/23/2013] [Accepted: 09/25/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression and anxiety in cardiac patients are independently associated with adverse cardiovascular outcomes, including mortality. Collaborative care (CC) programs, which use care managers to assess patients, coordinate care, and perform therapeutic interventions, have proven effective in managing depression in this population. However, no prior CC intervention has simultaneously managed depression and anxiety disorders, and there has been minimal study of CC in high-risk cardiac inpatients. MATERIALS AND METHODS The Management of Sadness and Anxiety in Cardiology (MOSAIC) study was a prospective randomized trial of a low-intensity CC intervention, compared to enhanced usual care, for patients hospitalized for acute coronary syndrome, heart failure, or arrhythmia, and diagnosed with depression, generalized anxiety disorder (GAD), or panic disorder (PD). The primary outcome measure for MOSAIC was mental health-related quality of life (HRQoL), measured using the Medical Outcomes Study Short Form-12. Additional outcomes included psychological, functional, and medical outcomes, including rehospitalizations. RESULTS A total of 183 eligible participants were enrolled (92 collaborative care, 91 enhanced usual care); 94% of depressed patients reported being depressed for >1month, and 53% of those with GAD reported clinically significant anxiety for >1year. One hundred thirty-three patients had depression, 118 had GAD, and 19 had PD; 74 participants (40%) had two or more of the disorders. CONCLUSION The MOSAIC trial will provide data regarding whether an intervention that concurrently manages these common psychiatric disorders results in meaningful improvements in HRQoL, psychiatric symptoms, and medical outcomes in cardiac patients at high risk for adverse outcomes.
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Affiliation(s)
- Jeff C Huffman
- Harvard Medical School, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.
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Feola M, Garnero S, Vallauri P, Salvatico L, Vado A, Leto L, Testa M. Relationship between Cognitive Function, Depression/Anxiety and Functional Parameters in Patients Admitted for Congestive Heart Failure. Open Cardiovasc Med J 2013; 7:54-60. [PMID: 24044027 PMCID: PMC3772569 DOI: 10.2174/1874192401307010054] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/18/2013] [Accepted: 07/18/2013] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED Cognitive impairment, anxiety and depression have been described in patients with congestive heart failure (CHF). We analyzed in-hospital CHF patients before discharge with neuropsychological tests attempting to correlate with prognostic parameters. METHODS All subjects underwent a mini mental state examination (MMSE), geriatric depression scale (GDS), anxiety and depression scale test (HADS). We evaluated NYHA class, brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and non-invasive cardiac output (CO). RESULTS Three-hundred and three CHF patients (age 71.6 ys) were analysed. The mean NYHA class was 2.9±0.8, LVEF was 43.4±15.8%; BNP plasma level and CO were calculated as 579.8±688.4 pg/ml and 3.9±1.1 l/min, respectively. In 9.6% a pathological MMSE score emerged; a depression of mood in 18.2% and anxiety in 23.4% of patients were observed. A significant correlation between MMSE and age (r=0.11 p=0.001), BNP (r=0.64 p=0.03) but not between MMSE and NYHA class and LVEF was observed. GDS and HADS were inversely correlated with NYHA class (r=0.38 p=0.04) and six-minute walking test (r=0.18 p=0.01) without an association with objective parameters in CHF (BNP, LVEF and cardiac output). At multivariate analysis only MMSE and BNP are inversely correlated significantly (p=0.019 OR=-0.64, CI=-042-0.86). CONCLUSIONS in-hospital CHF patients may manifest a reduction of MMSE and important anxiety/depression disorders. The results of the study suggest that the presence of cognitive impairment in older CHF patients with higher BNP plasma level should be considered. In admitted CHF patients anxiety and depression of mood are commonly reported and influenced the perception of the severity of illness.
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Affiliation(s)
- Mauro Feola
- Cardiovascular Rehabilitation-Heart Failure Unit Ospedale SS Trinita’ Fossano, Italy
| | - Sonia Garnero
- Cardiovascular Rehabilitation-Heart Failure Unit Ospedale SS Trinita’ Fossano, Italy
| | | | | | | | - Laura Leto
- School of Geriatry Universita’ degli Studi Torino, Italy
| | - Marzia Testa
- School of Geriatry Universita’ degli Studi Torino, Italy
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Rustad JK, Stern TA, Hebert KA, Musselman DL. Diagnosis and treatment of depression in patients with congestive heart failure: a review of the literature. Prim Care Companion CNS Disord 2013; 15:13r01511. [PMID: 24392265 DOI: 10.4088/pcc.13r01511] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/12/2013] [Indexed: 01/02/2023] Open
Abstract
CONTEXT Major depressive disorder (MDD) can be challenging to diagnose in patients with congestive heart failure, who often suffer from fatigue, insomnia, weight changes, and other neurovegetative symptoms that overlap with those of depression. Pathophysiologic mechanisms (eg, inflammation, autonomic nervous system dysfunction, cardiac arrhythmias, and altered platelet function) connect depression and congestive heart failure. OBJECTIVE We sought to review the prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure. DATA SOURCES A search of all English-language articles between January 2003 and January 2013 was conducted using the search terms congestive heart failure and depression. STUDY SELECTION We found 1,498 article abstracts and 19 articles (meta-analyses, systematic reviews, and original research articles) that were selected for inclusion, as they contained information about our focus on diagnosis, treatment, and pathophysiology of depression associated with congestive heart failure. The search was augmented with manual review of reference lists of articles from the initial search. Articles selected for review were determined by author consensus. DATA EXTRACTION The prevalence, diagnosis, neurobiology, and treatment of depression associated with congestive heart failure were reviewed. Particular attention was paid to the safety, efficacy, and tolerability of antidepressant medications commonly used to treat depression and how their side-effect profiles impact the pathophysiology of congestive heart failure. Drug-drug interactions between antidepressant medications and medications used to treat congestive heart failure were examined. RESULTS MDD is highly prevalent in patients with congestive heart failure. Moreover, the prevalence and severity of depression correlate with the degree of cardiac dysfunction and development of congestive heart failure. Depression increases the risk of congestive heart failure, particularly in those patients with coronary artery disease , and is associated with a poorer quality of life, increased use of health care resources, more frequent adverse clinical events and hospitalizations, and twice the risk of mortality. CONCLUSIONS At present, limited empirical data exist with regard to treatment of depression in the increasingly large population of patients with congestive heart failure. Evidence reveals that both psychotherapeutic treatment (eg, cognitive-behavioral therapy) and pharmacologic treatment (eg, use of the selective serotonin reuptake inhibitor sertraline) are safe and effective in reducing depression severity in patients with cardiovascular disease. Collaborative care programs featuring interventions that work to improve adherence to medical and psychiatric treatments improve both cardiovascular disease and depression outcomes. Depression rating scales such as the 9-item Patient Health Questionnaire should be used to monitor therapeutic efficacy.
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Affiliation(s)
- James K Rustad
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Theodore A Stern
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Kathy A Hebert
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
| | - Dominique L Musselman
- Department of Psychiatry and Behavioral Medicine, Morsani College of Medicine, University of South Florida, Tampa, and Department of Psychiatry, University of Central Florida College of Medicine, Orlando (Dr Rustad); Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston (Dr Stern); Departments of Medicine (Ms Hebert) and Psychiatry (Dr Musselman), University of Miami/Miller School of Medicine, Miami, Florida
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Feola M, Vallauri P, Salvatico L, Vado A, Testa M. Neuropsychological impact of implantable cardioverter defibrillator in congestive heart failure patients. Int J Cardiol 2013; 166:275-6. [DOI: 10.1016/j.ijcard.2012.09.150] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
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Bunevicius A, Staniute M, Brozaitiene J, Pop VJM, Neverauskas J, Bunevicius R. Screening for anxiety disorders in patients with coronary artery disease. Health Qual Life Outcomes 2013; 11:37. [PMID: 23497087 PMCID: PMC3601013 DOI: 10.1186/1477-7525-11-37] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 03/04/2013] [Indexed: 02/01/2023] Open
Abstract
Background Anxiety disorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxiety disorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxiety disorders in patients with CAD and diagnostic utility of self-rating scales for screening of anxiety disorders. Methods Five-hundred and twenty-three CAD patients not receiving psychotropic treatments at initiation of rehabilitation program completed self-rating scales (Hospital Anxiety and Depression Scale or HADS; Spielberger State-Anxiety Inventory or SSAI; and Spielberger Trait-Anxiety Inventory or STAI) and were interviewed for generalized anxiety disorder (GAD), social phobia, panic disorder and agoraphobia (Mini-International Neuropsychiatric Interview or MINI). Results Thirty-eight (7%) patients were diagnosed with anxiety disorder(s), including GAD (5%), social phobia (2%), agoraphobia (1%) and panic disorder (1%). Areas under the ROC curve of the HADS Anxiety subscale (HADS-A), STAI and SSAI for screening of any anxiety disorder were .81, .80 and .72, respectively. Optimal cut-off values for screening of any anxiety disorders were ≥8 for the HADS-A (sensitivity = 82%; specificity = 76%; and positive predictive value (PPV) = 21%); ≥45 for the STAI (sensitivity = 89%; specificity = 56%; and PPV = 14%); and ≥40 for the SSAI (sensitivity = 84%; specificity = 55%; PPV = 13%). In a subgroup of patients (n = 340) scoring below the optimal major depressive disorder screening cut-off value of HADS-Depression subscale (score <5), the HADS-A, STAI and SSAI had moderate-high sensitivity (range from 69% to 89%) and low PPVs (≤22%) for GAD and any anxiety disorders. Conclusions Anxiety disorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxiety disorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxiety disorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying anxiety disorders.
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Affiliation(s)
- Adomas Bunevicius
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
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44
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Muschalla B, Glatz J, Linden M. Heart-related anxieties in relation to general anxiety and severity of illness in cardiology patients. PSYCHOL HEALTH MED 2013; 19:83-92. [DOI: 10.1080/13548506.2013.774428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Identifying cognitive impairment in heart failure: A review of screening measures. Heart Lung 2013; 42:92-7. [DOI: 10.1016/j.hrtlng.2012.11.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 11/09/2012] [Accepted: 11/10/2012] [Indexed: 01/11/2023]
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Eastwood JA, Moser DK, Riegel BJ, Albert NM, Pressler S, Chung ML, Dunbar S, Wu JR, Lennie TA. Commonalities and differences in correlates of depressive symptoms in men and women with heart failure. Eur J Cardiovasc Nurs 2012; 11:356-65. [PMID: 22414584 PMCID: PMC4014068 DOI: 10.1177/1474515112438010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE (i) To compare the prevalence and severity of depressive symptoms between men and women enrolled in a large heart failure (HF) registry. (ii) To determine gender differences in predictors of depressive symptoms from demographic, behavioral, clinical, and psychosocial factors in HF patients. METHODS In 622 HF patients (70% male, 61 ± 13 years, 59% NYHA class III/IV), depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-9). Potential correlates were age, ethnicity, education, marital and financial status, smoking, exercise, body mass index (BMI), HF etiology, NYHA class, comorbidities, functional capacity, anxiety, and perceived control. To identify gender-specific correlates of depressive symptoms, separate logistic regression models were built by gender. RESULTS Correlates of depressive symptoms in men were financial status (p = 0.027), NYHA (p = 0.001); functional capacity (p < 0.001); health perception (p = 0.043); perceived control (p = 0.002) and anxiety (p < 0.001). Correlates of depressive symptoms in women were BMI (p = 0.003); perceived control (p = 0.013) and anxiety (p < 0.001). CONCLUSIONS In HF patients, lowering depressive symptoms may require gender-specific interventions focusing on weight management in women and improving perceived functional capacity in men. Both men and women with HF may benefit from anxiety reduction and increased control.
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Affiliation(s)
- Jo-Ann Eastwood
- University of California Los Angeles School of Nursing, USA.
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Cully JA, Armento MEA, Mott J, Nadorff MR, Naik AD, Stanley MA, Sorocco KH, Kunik ME, Petersen NJ, Kauth MR. Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design. Implement Sci 2012; 7:64. [PMID: 22784436 PMCID: PMC3503767 DOI: 10.1186/1748-5908-7-64] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. METHODS This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. CONCLUSIONS Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. TRIAL REGISTRATION NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT01149772.
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Affiliation(s)
- Jeffrey A Cully
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Maria E A Armento
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Juliette Mott
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Nadorff
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Aanand D Naik
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Melinda A Stanley
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Kristen H Sorocco
- Oklahoma Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Geriatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mark E Kunik
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Nancy J Petersen
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine/Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Michael R Kauth
- Houston VA HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (a virtual center), USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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Tully PJ, Cardinal T, Bennetts JS, Baker RA. Selective Serotonin Reuptake Inhibitors, Venlafaxine and Duloxetine are Associated With in Hospital Morbidity but Not Bleeding or Late Mortality After Coronary Artery Bypass Graft Surgery. Heart Lung Circ 2012; 21:206-14. [DOI: 10.1016/j.hlc.2011.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/14/2011] [Accepted: 12/18/2011] [Indexed: 12/21/2022]
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De Jong MJ, Chung ML, Wu JR, Riegel B, Rayens MK, Moser DK. Linkages between anxiety and outcomes in heart failure. Heart Lung 2011; 40:393-404. [PMID: 21453974 PMCID: PMC3149715 DOI: 10.1016/j.hrtlng.2011.02.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/29/2011] [Accepted: 02/06/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes. METHODS In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival. RESULTS In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival. CONCLUSION This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
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Affiliation(s)
- Marla J De Jong
- TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
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Cognitive-Behavioral Therapy: Innovations for Cardiopulmonary Patients With Depression and Anxiety. COGNITIVE AND BEHAVIORAL PRACTICE 2009. [DOI: 10.1016/j.cbpra.2009.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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