Effect of anxiety and depression on the fatigue of patients with a permanent pacemaker

The effect of right ventricle septal pacing versus apical pacing in dual-chamber pacemakers on patients' anxiety and depression: a one-year follow-up study

BACKGROUND

Anxiety and depression are potentially harmful outcomes of permanent cardiac pacemakers. Dual-chamber P.P.M. is frequently used to treat life threatening bradycardia. The study aims to estimate the effect of the right ventricular PM lead position on recipients' anxiety and depression before, 6 months, and 1 year after implantation.

RESULTS

A statistically significant correlation was discovered between the studied groups regarding HADS depression score after 6 months (p 0.013) and 1 year (p 0.013). A statistically non-significant difference was found among the studied groups at any point of time regarding baseline (p 0.063), after 6 months (p 0.054), or after 1 year (p 0.099). Significance was found between HADS anxiety score (p 0.015) or depression score after 1 year and the incidence of complications (p 0.001).

CONCLUSIONS

A strong relationship was found between the level of depression and the R.V. site of implantation, as patients with the apical group had higher levels of depression post-implantation. The septal position has less stress and depression on the patient's well-being than the apical one.

Moderating effect of negative emotion differentiation in chronic stress and fatigue among Chinese employees

Introduction

According to the reactivity hypothesis and the diathesis-stress model, repeated activation of the stress system has a negative effect on health, and this effect may differ because of individual characteristics. Thus, the present study explores the effect of chronic stress on fatigue and investigates its mechanism.

Methods

A questionnaire survey of 288 participants selected from the northwest part of China was conducted (13.89% females; ages ranged from 18 to 34 years, with M ± SD = 23.14 ± 3.79 years) on chronic stress, fatigue, depression, anxiety, and negative emotion differentiation. SPSS 28.0 was used to process descriptive statistics and correlation analysis and the PROCESS macro was used to analyze the moderated chained multi-mediation.

Results

Chronic stress was found to be positively correlated with fatigue, depression, and anxiety; depression and anxiety played a chained multi-mediating role between chronic stress and fatigue, and negative emotion differentiation played a moderating role in the chained multi-mediation model.

Discussion

Compared with depression, anxiety plays a more important role in the influence of chronic stress on fatigue. Therefore, it is necessary to pay more attention to anxiety symptoms and take appropriate intervention measures. Negative emotion differentiation plays a moderating role. Improving negative emotion differentiation through mindfulness and adaptive emotion regulation is an effective way to reduce the influence of chronic stress on fatigue.

Assessment of Psychological Implications and Quality of Life After Different Cardiac Device Implantation in Saudi Arabia

BACKGROUND

Cardiac device therapy is likely to affect different aspects of patients' psychological well-being, such as their quality of life. The aim of this study was to examine the mental health status, specifically the conditions of depression and anxiety regarding implantable cardiac device patients.

METHODS

A cross-sectional retrospective study was conducted in January 2022. This study was conducted at King Abdul-Aziz University Hospital in Jeddah, Saudi Arabia. All patients aged more than 18 years old who underwent heart device implantation for six months or more formed the study population. A total of 30 implantable cardioverter defibrillator (ICD) subtypes were used in our patients (45.8%), including cardiac resynchronization therapy device (CRT-D) in seven patients (14.6%) and one subcutaneous ICD (2.1%). A pacemaker was used in 18 patients (37.5%). Binary logistic regression analysis was conducted to identify the association between type of cardiac implantation device and the likelihood of having abnormal depression and anxiety score.

RESULTS

A total of 48 patients participated in this study. Hypertension was the most frequently associated risk factor in our sample (64.6%; n=31). In comparison between ICD users and pacemaker users in terms of the SF-36 general health survey, a marginally significant difference was noted in the role of limitations due to emotional health (63 ± 28.6) for ICD patients compared to pacemaker patients (81.8 ± 28.1), (p=0.050). However, pacemaker patients showed a significant favourable social functioning score (90.1 ± 17.7) compared to ICD patients (71.5 ± 19), (p=0.001). There is no significant difference noted regarding the other domains. Binary logistic regression analysis identified that patients who are using ICD were seven times more likely to have abnormal anxiety score (odds ratio: 7.00 (95% confidence interval: 1.36-35.9) (p=0.020).

CONCLUSION

This study identified a potential association between cardiac devices and the anxiety and quality of life of patients. Nonetheless, further investigation is warranted to assess the psychological and physiological effects of cardiac device therapy on patients, in addition to examining the effects of implantation and follow-up on cardiac function and cardiac symptoms.

Prevalence of depression and its association with quality of life in patients after pacemaker implantation during the COVID-19 pandemic: A network analysis

Background

This study was designed to investigate the prevalence and predictors of depression in patients after pacemaker implantation during the COVID-19 pandemic in addition to identifying specific depressive symptoms associated with quality of life (QOL) using network analysis (NA).

Methods

This cross-sectional, observational study was conducted in China between July 1, 2021, and May 17, 2022. Descriptive analysis was used to calculate depression prevalence. Univariate analyses were used to compare differences in demographic and clinical characteristics between depressed and non-depressed patients following pacemaker implantation. Binary logistic regression analysis was used to assess factors independently associated with depression. Network analysis “expected influence,” and flow function indexes were used to identify symptoms central to the depression network of the sample and depressive symptoms that were directly associated with QOL, respectively. Network stability was examined using a case-dropping bootstrap procedure.

Results

In total, 206 patients implanted with a pacemaker met the study entry criteria and completed the assessment. The overall prevalence of depression (PHQ-9 total score ≥ 5) was 39.92% [95% confidence interval (CI) = 29.37−42.47%]. A binary logistic regression analysis revealed that patients with depression were more likely to report a poor health status (p = 0.031), severe anxiety symptoms (p < 0.001), and fatigue (p < 0.001). In the network model for depression, “Sad mood,” “Poor Energy,” and “Guilt” were the most influential symptoms. “Fatigue” had the strongest negative association with QOL, followed by “Sad mood” and “Appetite”.

Conclusion

Depression is common among patients having undergone pacemaker implantation during the COVID-19 pandemic. Anxiety, central symptoms of depression (i.e., “Sad mood”, “Poor Energy”, and “Guilt”) and depressive symptoms linked to QOL (i.e., “Sad mood”, “Appetite”, and “Fatigue”) identified in this study are promising targets for interventions and preventive measures for depression in patients who have undergone pacemaker implants.

The Mediating Role of Depression and of State Anxiety οn the Relationship between Trait Anxiety and Fatigue in Nurses during the Pandemic Crisis

The coronavirus pandemic (COVID-19) is a global health crisis with a particular emotional and physical impact on health professionals, especially nurses. The aim of this study was to investigate the prevalence of anxiety, depression and fatigue and their possible relationships among nurses during the pandemic. The study population consisted of nurses from five tertiary-level public hospitals in Athens who completed the Fatigue Assessment Scale (FAS), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires. Gender, age and years of work experience were recorded. The study was conducted from mid-November to mid-December 2021. The sample included 404 nurses (69 males and 335 females) with a mean age of 42.88 years (SD = 10.90) and 17.96 (SD = 12.00) years of work experience. Symptoms of fatigue were noted in 60.4% of participants, while 39.7% had symptoms of depression, 60.1% had abnormal scores on state anxiety and 46.8% on trait anxiety, with females showing higher scores on all scales (p < 0.05). High positive correlations (p < 0.01) were found between the FAS, BDI, State Anxiety and Trait Anxiety scales. Regression analysis showed that 51.7% of the variance in FAS scores can be explained by trait anxiety, an additional 6.2% by the BDI and 1.2% by state anxiety. Mediation analysis showed that state anxiety and BDI mediate the relationship between trait anxiety and FAS. Finally, BDI was found to exert a moderating role in the relationship between trait anxiety and fatigue. In conclusion, our study showed that nurses continue to experience high rates of anxiety, depression and fatigue. The variation in fatigue appears to be significantly dependent on trait anxiety. Depressive symptomatology and state anxiety exert a parallel positive mediation on the relationship between trait anxiety and fatigue, with depression exhibiting a moderating role in this relationship.

Symptoms of Depression, Anxiety, and Posttraumatic Stress among Patients with Cardiac Pacemakers

Despite being a prerequisite for tailoring specific therapeutic interventions, knowledge of pattern and prevalence of clinically significant psychiatric symptomatology among patients with cardiac pacemakers (PMs), especially of symptoms of posttraumatic stress, is limited. We studied symptoms of depression, anxiety, and posttraumatic stress among PM patients (PM due to syncope or presyncope) compared to participants of (i) a cardiac, (ii) a chronic disease, and (iii) a healthy control group. Symptoms of depression, anxiety and posttraumatic stress were measured by validated self-report scales at least 6 months after implantation of the PM (PM group; n = 38), percutaneous coronary intervention (PCI; PCI control group; n = 23), and first dialysis (Dialysis control group; n = 17). Blood donors constituted the Healthy control group (n = 42). Both PM, PCI, and dialysis patients reported depressive symptoms above clinical cut-off more frequently than the healthy controls (16.2, 26.1, 41.2, and 0%, respectively; p < 0.001). Self-report of symptoms of anxiety and posttraumatic stress did not differ significantly across study groups. However, a non-negligible proportion of PM patients reported on symptoms of posttraumatic stress of anticipated clinical relevance. Identification and treatment of depression deserves attention in clinical routine in all three patient populations. Further study of posttraumatic stress in PM patients seems advisable.

Mental fatigue in individuals with psychiatric disorders: a scoping review

Objective: The aim of this study was to complete a scoping review of the published literature describing the relationship between mental fatigue and various psychiatric disorders, to better understand its frequency and clinical impact, and to provide recommendations for future clinical research.Methods: A scoping review using PubMed/MEDLINE, Cochrane and PsychArticles databases was conducted using the keywords 'mental fatigue', 'mental tiredness' or 'mental exhaustion', and completed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews 2018 checklist.Results: We extracted 10 studies fulfilling our inclusion criteria from a total of 2937 publications. Mental fatigue was studied within mood disorders, anxiety disorders, obsessive compulsive disorder and obsessive-compulsive personality disorder. A commonly used tool to measure mental fatigue in these samples was the Multidimensional Fatigue Inventory-20. Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender and diagnosis.Conclusion: Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation.Key pointsA commonly used tool to measure mental fatigue was the Multidimensional Fatigue Inventory-20. However, more research into the validity and reliability for illness specific instruments to measure mental fatigue in psychiatric population is required.Reduction of mental fatigue was associated with improvement on quality of life.Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender.Reviewed articles indicated that mental fatigue presence was associated with lower odds of OCD. In addition, the results suggested that mental fatigue symptoms were more common in individuals with OCPD rather than OCD.Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation to prevent potential misattribution as mental fatigue symptoms overlap between different psychiatric disorders.

Interventions in the Diagnosis and Adoption of Pacemaker Therapy in Sinus Node Dysfunction Patients: Results from the IMPROVE Brady study

Aims

IMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients.

Methods

/Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant.

A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001).

Conclusions

A process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.

Comparison of Anxiety and Depression Symptoms in Individuals According to their Sex, Type of Cardiac Device, and Diagnosis of Chagas Disease

INTRODUCTION

Implantable cardiac pacemakers or cardioverter defibrillators are alternatives for the treatment of arrhythmias, however, their use has caused changes in the emotional state of patients. The objective of this study was to compare the measures of anxiety and depression symptoms in individuals according to their sex, type of cardiac device, and diagnosis of Chagas disease.

METHODS

This is an observational and cross-sectional study conducted with adults with implantable cardiac pacemakers or cardioverter defibrillators. Data was collected using a sociodemographic and clinical questionnaire and the Hospital Anxiety and Depression Scale. We used the Student's t-test for independent samples and the Chi-squared test, with a significance level of 0.05.

RESULTS

Two hundred forty-four patients participated in the study, 168 with cardiac pacemakers and 76 with implantable cardioverter defibrillators; 104 had Chagas cardiomyopathy (85 with cardiac pacemakers and 19 with implantable cardioverter defibrillators). No statistically significant differences were found in measures of anxiety and depression symptoms according to device type (P=0.594 and P=0.071, respectively) and the presence of Chagas etiology (P=0.649 and P=0.354, respectively). Women had higher mean scores for anxiety (P=0.002) and depression symptoms (P<0.001).

CONCLUSION

In the comparison between the groups, according to the type of implanted device and the diagnosis of Chagas disease, no significant differences were found in the measures of anxiety and depression symptoms. Women showed higher means when compared to men, indicating the need to test and implement interventions to minimize these symptoms in this population.

The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis

The implantation of cardiac devices significantly reduces morbidity and mortality in patients with cardiac arrhythmias. Arrhythmias as well as therapy delivered by the device may impact quality of life of patients concerned considerably. Therefore we aimed at conducting a systematic search and meta-analysis of trials examining the impact of the implantation of cardiac devices, namely implantable cardioverter-defibrillators (ICD), pacemakers and left-ventricular assist devices (LVAD) on quality of life. After pre-registering the trial with the PROSPERO database, we searched Medline, PsycINFO, Web of Science and the Cochrane databases for relevant publications. Study quality was assessed by two independent reviewers using standardized protocols. A total of 37 trials met our inclusion criteria. Of these, 31 trials were cohort trials while 6 trials used a randomized controlled design. We found large pre-post effect sizes for positive associations between quality of life and all types of devices. The effect sizes for LVAD, pacemaker and ICD patients were g = 1.64, g = 1.32 and g = 0.64, respectively. There was a lack of trials examining the effect of implantation on quality of life relative to control conditions. Trials assessing quality of life in patients with cardiac devices are still scarce. Yet, the existing data suggest beneficial effects of cardiac devices on quality of life. We recommend that clinical trials on cardiac devices routinely assess quality of life or other parameters of psychological well-being as a decisive study endpoint. Furthermore, improvements in psychological well-being should influence decisions about implantations of cardiac devices and be part of patient education and may impact shared decision-making.

Patient Perceptions and Quality of Life in Pacemaker Recipients

Quality of life (QoL) reflects the multidimensional impact of a clinical condition and its treatment on patients’ daily lives. Although permanent cardiac pacemakers (PPMs) have made a significant contribution to the improvement of patients’ QoL, patients’ perceptions remain crucial after implantation. Hence, the present study was carried out to explore the QoL and the associated perceptions of PPM patients. A total of 150 PPM patients were enrolled. Data were collected using the Short Form–36 (SF-36) health survey, which also included patients’ characteristics. The statistical significance level was set at p < 0.05. The physical health score as measured by SF-36 was 42.9 ± 19.5 points, and the mental health score was 54.1 ± 26.6 points. Study participants had higher scores in emotional well-being (66.5 ± 18.8 points), and the lowest scores were in physical functioning (22.5 ± 10.7 points). The level of information about PPM was associated with physical role (p = 0.005), emotional role (p = 0.004), emotional well-being (p = 0.001), social functioning (p = 0.002), and general health (p = 0.001). Attendance at follow-up was associated with physical role (p = 0.015), emotional role (p = 0.014), social functioning (p = 0.003), and general health (p = 0.016). The belief that the device prevents disease deterioration was associated with physical role (p = 0.005), emotional role (p = 0.001), energy/fatigue (p = 0.010), emotional well-being (p = 0.004), social functioning (p = 0.001), pain (p = 0.005), and general health (p = 0.001). Dependency on the device was associated with energy/fatigue (p = 0.006), emotional well-being (p = 0.001), and social functioning (p = 0.002). Social difficulties due to the device were associated with emotional well-being (p = 0.001), social functioning (p = 0.001), pain (p = 0.001), and general health (p = 0.004). Family support was associated with emotional role (p = 0.023) and general health (p = 0.036), while pain was associated with information about the family (p = 0.001). In conclusion, the present findings regarding factors associated with QoL provide key opportunities for interventions aimed at facilitating positive adjustments after PPM implantation.

Post-surgery anxiety and depression in prostate cancer patients: prevalence, longitudinal progression, and their correlations with survival profiles during a 3-year follow-up

Background

Anxiety and depression are more frequent in cancer patients than general population and may be correlated with cancer prognosis; however, their value in prostate cancer patients is largely unknown. We aimed to evaluate prevalence of anxiety and depression in prostate cancer survivors post the surgeries, and their correlations with patients’ disease-free survival (DFS) and overall survival (OS).

Methods

A hundred and ninety-four patients with prostate cancer who underwent radical prostatectomy were enrolled. After discharged from hospital, patients were assessed for post-surgery anxiety and depression every 3 months using Zung Self-rating Anxiety/Depression Scale (SAS/SDS) for a total of 36 months. In addition, disease conditions, DFS, and OS were also documented.

Results

SAS score (P < 0.001), anxiety rate (P = 0.004), SDS score (P < 0.001), and depression rate (P < 0.001) gradually elevated from baseline to month 36 in prostate cancer patients. Anxiety at baseline (P = 0.009) and anxiety at 3 years (P = 0.017) were correlated with worse DFS, and anxiety at baseline (P = 0.009) was also correlated with shorter OS in prostate cancer patients. Furthermore, depression at baseline (P = 0.005) and depression at 2 years (P = 0.008) were associated with unfavorable DFS, and depression at baseline (P = 0.001), 1 year (P = 0.025), and 2 years (P = 0.008) were associated with worse OS in prostate cancer patients. Moreover, multivariate Cox’s proportional hazards regression analysis elucidated that depression at baseline (P = 0.027) was an independent predictive factor for shorter DFS in prostate cancer patients.

Conclusion

Anxiety and depression both gradually deteriorate, and they correlate with unfavorable survival profile in prostate cancer patients after radical prostatectomy.

State and trait anxiety in islander cardiac patients: associated factors and the impact of perceived social support

Introduction

Cardiac patients frequently experience elevated levels of anxiety, which may influence clinical outcomes. Perceived social support is a precious resource with which to minimise anxiety. The aim of the study was to explore levels of perceived social support, levels of anxiety (state and trait), and the associated factors as well as the impact of patents’ characteristics and social support on anxiety.

Material and methods

The study sample consisted of 82 island inhabitant patients with cardiac problems (49 men and 33 women). Data collected by the completion of the State-trait anxiety inventory (STAI) and the Multidimensional scale of perceived social support questionnaire (MSPSS). The statistical significance level was set at p < 0.05.

Results

Regarding state and trait anxiety, half of the patients scored below 37 and 38, respectively, (medians) while 25% of participants scored more than 50 and 48, respectively. These values indicate moderate levels of anxiety. Regarding social support, at least 50% of patients scored over 27, 27, and 20 (median) on support from significant ones, family, and friends, respectively. In addition, 25% of patients scored above 28, 28, and 26, respectively. These values indicate high levels of social support. The association between anxiety and social support was found to be linearly negative, meaning that the more support a patient felt, the less anxiety they also experienced.

Conclusions

Enhancing perceived social support may be a key-element in alleviating anxiety among cardiac patients.

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

Introduction

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

Material and methods

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

Results

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

Conclusions

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

Arrhythmia Perception and Quality of Life in Bradyarrhythmia Patients Following Permanent Pacemaker Implantation

Although studies have evaluated the quality of life (QoL) of patients undergoing permanent pacemaker (PPM) placement, their results are inconsistent. To assess arrhythmia perceptions and QoL in bradyarrhythmia patients following PPM implantation, 137 patients completed demographic, arrhythmia perception, and QoL questionnaires before and six months after implantation. Before implantation, they reported fatigue (74.1%), dizziness (72.9%), dyspnea (64.7%), chest pain (62.4%), and heart fluttering (54.1%). After implantation, arrhythmia perceptions and QoL showed significant improvement (p < .05), except vitality (p > .05). However, patients with arrhythmia for more than three years, three or more PPM implants, two or more comorbidities, or were 41-50 years showed no significant QoL improvement. Doctors and hospital educators, rather than nurses, provided the most PPM information to patients. Since nurses provide primary in-hospital care to PPM patients, they should impart more patient education while considering individual characteristics in caring situations to enhance patients' QoL.

Fatigue in heart failure outpatients: levels, associated factors, and the impact on quality of life

Introduction

Heart failure (HF) patients experience various psychosocial issues and physical symptoms such as fatigue, which adversely affect their quality of life (QoL). The aim of the study was to assess levels of fatigue in HF outpatients and the associated factors, as well as to explore the correlation between fatigue and QoL.

Material and methods

One hundred and thirty patients were enrolled in the study. Data collection was performed by the completion of “Minnesota Living With Heart Failure” questionnaire (MLHFQ) and the Greek version of the Modified Fatigue Impact Scale (MFIS-Greek). Data also included self-reported patients’ characteristics.

Results

Of the 130 HF outpatients, 50% scored above 69 (median) in total fatigue and above 41 and 29 (median) in physical and mental fatigue, respectively. Furthermore, 50% scored above 66 (median) in total QoL and above 32.5 and 13 (median) in the physical and mental state, respectively. These values indicate moderate to high impact of HF on fatigue and on patients’ QoL. Total fatigue was statistically significantly associated with NYHA stage (p = 0.001), confidence to acknowledge health deteriorations (p = 0.004), decrease in appetite (p = 0.001), dyspnoea at night (p = 0.001), oedema in lower limbs (p = 0.023), relation with health professionals (p = 0.031), and whether patients had limited daily activities (p = 0.002), social contacts (p = 0.014), and if they had financial worries (p = 0.003). Finally, as the score of fatigue increased, so the QoL score also increased.

Conclusions

A broader understanding of this distressing symptom in HF may contribute to the development of suitable interventions with the ultimate goal of improving QoL.

Assessment of quality of life and anxiety in heart failure outpatients

Introduction

Heart failure (HF) is a chronic disease associated with increased morbidity and mortality. HF prevalence is expected to expand enormously, largely due to population ageing, rising incidence of HF risk factors and increased survival after cardiovascular events. The aim of the study was to assess levels of quality of life (QOL) and anxiety in HF outpatients and the associated factors as well as to explore the impact of anxiety on QOL.

Material and methods

One hundred HF outpatients were enrolled in the study. Data collection was performed by completion of the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Self-rating Anxiety Scale (SAS) and a questionnaire including patients’ characteristics.

Results

Of the 100 HF outpatients, 64% were men and 66% above 70 years old. Regarding QOL, at least 50% of patients scored above 68 (median) in the total score of MLHFQ and in terms of anxiety, 50% scored above 46 (median) in the SAS. These values indicate a large impact of HF on QOL and a moderate impact of HF on anxiety. Furthermore, a statistically significant correlation was observed between QOL and anxiety in HF outpatients (rho > 0.6, p < 0.001). An increase in anxiety score by one unit implies a statistically significant increase in QOL by 1.22 points (95% CI: 0.91–1.52, p < 0.001), after adjustment for potential confounders.

Conclusions

The present findings emphasize the importance of alleviating the emotional burden of anxiety, thus improving patients’ QOL.

Immune to happiness - inflammatory process indicators and depressive personality traits

INTRODUCTION

Nowadays, depression is conceptualized as an immune-inflammatory and oxidative stress disorder associated with neuroprogressive changes as a consequence of peripherally activated immune-inflammatory pathways, including peripheral cytokines and immune cells which penetrate into the brain via the blood barrier, as well as nitro-oxidative stress and antioxidant imbalances. The aim of this study was to investigate whether personality traits predisposing to a depressive episode (hypochondria, dysthymic, hysteria) are associated with changes in peripheral gene expression for selected indicators of inflammation and oxidative balance.

MATERIAL AND METHODS

One hundred four people meeting the diagnostic criteria specified for a depressive episode took part in the study. Selected scales of the Minnesota Multiphasic Personality Inventory (MMPI-2) were used to measure personality traits. Expression at the mRNA and protein level for manganese superoxide dismutase (MnSOD), myeloperoxidase (MPO), cyclooxygenase 2 (COX-2), inducible nitric oxide synthase (iNOS), and metalloproteinases 2 and 9 (MMP-2, MMP-9) was examined.

RESULTS

Scales for the neurotic triad of the MMPI-2 test correlated significantly with the expression at the level of mRNA and protein for MnSOD, MPO and metalloproteinases 2 and 9.

CONCLUSIONS

The scales specified for the neurotic triad of the MMPI-2 test correspond substantially with the expression of MnSOD, MPO and metalloproteinases 2 and 9 at the mRNA and protein levels in the group of patients suffering from depression.