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Health and Quality of Life Outcomes

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01-12-2020 | Affective Disorder | Research

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

Authors: Mandreker Bahall, George Legall, Katija Khan

Published in: Health and Quality of Life Outcomes | Issue 1/2020

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

Depression: definition [Internet]. Euro.who.int. 2019. https://www.euro.who.int/en/health-topics/noncommunicable-diseases/pages/news/news/2012/10/depression-in-europe/depression-definition Accessed 14 Aug 2019.

Hasin DS, Sarvet AL, Meyers JL, Saha TD, Ruan WJ, Stohl M, et al. Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry. 2018. https://doi.org/10.1001/jamapsychiatry.2017.4602.

Minister of Health's statement on the observance of World Mental Health Day. Trinidad and Tobago Government News [Internet]. News.gov.tt. 2012. http://www.news.gov.tt/content/minister-healths-statement-observance-world-mental-health-day#.XVRCiONKiM - http://www.news.gov.tt/content/minister-healths-statement-observance-world-mental-health-day#.XSYqAutKiM8. Accessed 14 Aug 2019.

Celano CM, Huffman JC. Depression and cardiac disease: a review. Cardiol Rev. 2011. https://doi.org/10.1097/CRD.0b013e31820e8106.

Bahall M. Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago. BMC Psychiatry. 2019. https://doi.org/10.1186/s12888-018-1977-3.

Khawaja IS, Westermeyer JJ, Gajwani P, Feinstein RE. Depression and coronary artery disease: the association, mechanisms, and therapeutic implications. Psychiatry (Edgemont). 2009;6:38–51.

Haas DC. Depression and disability in coronary patients: time to focus on quality of life as an end point. Heart. 2006. https://doi.org/10.1136/hrt.2005.066035.

Jankowska PB, Uchmanowicz I, Dudek K, Łoboz-Grudzień K. Impact of depression on quality of life results in patients following acute coronary syndrome treated with percutaneous coronary intervention (PCI). J Nurs Care. 2014. https://doi.org/10.4172/2167-1168.1000222.

Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Ann Rev Public Health. 2013. https://doi.org/10.1146/annurev-publhealth-031912-114409.

10.

Ruo B, Rumsfeld JS, Hlatky MA, Liu H, Browner WS, Whooley MA. Depressive symptoms and health-related quality of life: the heart and soul study. JAMA. 2003. https://doi.org/10.1001/jama.290.2.215.

11.

The Impact of Depression on Daily Life. Depression Alliance. https://ec.europa.eu/health/ph_determinants/life_style/mental/docs/insidestory.pdf. Accessed 3 Aug 2019.

12.

Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, et al. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002. https://doi.org/10.1136/heart.87.3.235.

13.

Van Jaarsveld CH, Sanderman R, Miedema I, Ranchor AV, Kempen GI. Changes in health-related quality of life in older patients with acute myocardial infarction or congestive heart failure: a prospective study. J Am Geriatr Soc. 2001. https://doi.org/10.1046/j.1532-5415.2001.49208.x.

14.

Riedinger MS, Dracup KA, Brecht ML. Quality of life in women with heart failure, normative groups, and patients with other chronic conditions. Am J Crit Care. 2002;11:211–9.PubMed

15.

Dixon T, Lim LL, Oldridge NB. The MacNew heart disease health-related quality of life instrument: reference data for users. Qual Life Res. 2002. https://doi.org/10.1023/a:1015005109731.

16.

Huffman JC, Celano CM, Beach SR, Motiwala SR, Januzzi JL. Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry and Neurol. 2013. https://doi.org/10.1155/2013/695925.

17.

May HT, Horne B, Knight S, Knowlton K, Bair T, Lappe D, et al. The association of depression at any time to the risk of death following coronary artery disease diagnosis: the intermountain inspire registry. J Am Coll Cardiol. 2017. https://doi.org/10.1093/ehjqcco/qcx017.

18.

Utilisation Report of the Medical Records Department. South West Regional Health Authority, Ministry of Health, Trinidad. 2012.

19.

Lwanga, S.K., Lemeshow, S. World Health Organization. Sample Size Determination in Health Studies: A Practical Manual 1991. https://apps.who.int/iris/handle/10665/40062.

20.

Instruction Manual. Instructions for Patient Health Questionnaire (PHQ) and GAD-7 Measures. https://www.pcpcc.org/sites/default/files/resources/instructions.pdf. Accessed 14 Aug 2019.

21.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987. https://doi.org/10.1016/0021-9681(87)90171-8.

22.

Ware JE, Kosinski MA, Keller SD. SF-12: how to score the SF-12 physical and mental health summary scales. 1998. https://www.researchgate.net/publication/242636950_SF-12_How_to_Score_the_SF-12_Physical_and_Mental_Health_Summary_Scales. Accessed 14 Aug 2019.

23.

How to score the SF-12 Health Survey Items. https://www.anesthesiologie.nl/uploads/files/PR_2_-_Toelichting_SF-12v2.pdf. Accessed 14 Aug 2019.

24.

Weiss M, Michels G, Eberhardt F, Fehske W, Winter S, Baer F, et al. Anxiety, depression and quality of life in acute high risk cardiac disease patients eligible for wearable cardioverter defibrillator: results from the prospective multicenter CRED-registry. PLoS One. 2019. https://doi.org/10.1371/journal.pone.0213261.

25.

De Jonge P, Spijkerman TA, Van den Brink RH, Ormel J. Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months. Heart. 2006. https://doi.org/10.1136/hrt.2004.059451.

26.

AbuRuz ME, Alaloul F, Saifan A, Masa'deh R, Abusalem S. Quality of life for Saudi patients with heart failure: a cross-sectional correlational study. Glob J Health Sci. 2016. https://doi.org/10.5539/gjhs.v8n3p49.

27.

Lau-Walker MO, Cowie MR, Roughton M. Coronary heart disease patients' perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge. J Clin Nurs. 2009. https://doi.org/10.1111/j.1365-2702.2008.02386.x.

28.

Durmaz T, Ozdemir O, Ozdemir BA, Keles T, Bayram NA, Bozkurt E. Factors affecting quality of life in patients with coronary heart disease. Turk J Med Sci. 2009. https://doi.org/10.3906/sag-0901-26.

29.

Shah SJ, Krumholz HM, Reid KJ, Rathore SS, Mandawat A, Spertus JA, et al. Financial stress and outcomes after acute myocardial infarction. PLoS One. 2012. https://doi.org/10.1371/journal.pone.0047420.

30.

Thombs BD, Ziegelstein RC, Stewart DE, Abbey SE, Parakh K, Grace SL. Usefulness of persistent symptoms of depression to predict physical health status 12 months after an acute coronary syndrome. Am J Cardiol. 2008. https://doi.org/10.1016/j.amjcard.2007.07.043.

31.

Allabadi A, Alkaiyat A, Alkhayyat A, Hammoudi H, Odeh J, Shtayeh M, et al. Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital based study in a Palestinian population H. BMC Public Health. 2019. https://doi.org/10.1186/s12889-019-6561-3.

32.

Shad B, Ashouri A, Hasandokht T, Rajati F, Salari A, Naghshbandi M, et al. Effect of multimorbidity on quality of life in adult with cardiovascular disease: a cross-sectional study. Health Qual Life Outcomes. 2017. https://doi.org/10.1186/s12955-017-0820-8.

33.

Tušek-Bunc K, Petek D. Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life. Health Qual Life Outcomes. 2016. https://doi.org/10.1186/s12955-016-0560-1.

34.

Sertoz OO, Aydemir O, Gulpek D, Elbi H, Ozenli Y, Yilmaz A, et al. The impact of physical and psychological comorbid conditions on the quality of life of patients with acute myocardial infarction: a multi-center, cross-sectional observational study from Turkey. Int J Psychiatry Med. 2013. https://doi.org/10.2190/PM.45.2.a.

35.

Prior JA, Jordan KP, Kadam UT. Associations between cardiovascular disease severity, osteoarthritis co-morbidity and physical health: a population-based study. Rheumatology. 2014. https://doi.org/10.1093/rheumatology/keu175.

36.

Alosco ML, Spitznagel MB, Josephson R, Hughes J, Gunstad J. COPD is associated with cognitive dysfunction and poor physical fitness in heart failure. Heart Lung. 2015. https://doi.org/10.1016/j.hrtlng.2014.09.002.

37.

Streng KW, Nautaa JF, Hillegea HL, Ankerb SD, Clelandc JG, Dickstein K. Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol. 2018. https://doi.org/10.1016/j.ijcard.2018.04.001.

38.

Reeves GC, Alhurani AS, Frazier SK, Watkins JF, Lennie TA, Mose DK. The association of comorbid diabetes mellitus and symptoms of depression with all-cause mortality and cardiac rehospitalization in patients with heart failure. BMJ Open Diabetes Res Care. 2015. https://doi.org/10.1136/bmjdrc-2014-000077.

39.

Hoogwegt MT, Kupper N, Jordaens L, Pedersen SS, Theuns DAMJ. Comorbidity burden is associated with poor psychological well-being and physical health status in patients with an implantable cardioverter-defibrillator. EP Europace. 2013. https://doi.org/10.1093/europace/eut072.

40.

Assari S, Lankarani MM, Ahmadi K. Comorbidity influences multiple aspects of well-being of patients with ischemic heart disease. Int Cardiovasc Res J. 2013;7:118–23.PubMedPubMedCentral

41.

AbuRuz ME. Anxiety and depression predicted quality of life among patients with heart failure. J Multidiscip Healthc. 2018. https://doi.org/10.2147/JMDH.S170327.

42.

Najafi M. Quality of life-associated factors among patients undergoing coronary artery bypass surgery as measured using the WHOQOL-BREF. Cardiovasc J Afr. 2009;20:284–9.PubMedPubMedCentral

43.

Nesbitt T, Doctorvaladan S, Southard JA, Singh S, Fekete A, Marie K, et al. Correlates of quality of life in rural heart failure patients. Circ Heart Fail. 2014. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000577.

44.

Dickens C, Cherrington A, McGowan L. Depression and health-related quality of life in people with coronary heart disease: a systematic review. Eur J Cardiovasc Nurs. 2012. https://doi.org/10.1177/1474515111430928.

45.

Rehman AU, Kazmi SF, Perveen S, Jabeen T. Health related quality of life among coronary heart disease patients, with and without anxiety & depression. Pak Heart J. 2016. https://doi.org/10.6084/m9.figshare.4263296.v1.

46.

Wang W, Chow A, Thompson DR, Koh K, Kowitlawakul Y, He HG. Predictors of health-related quality of life among patients with myocardial infarction. West J Nurs Res. 2016. https://doi.org/10.1177/0193945914546201.

47.

Cruz LN, Fleck MP, Polanczyk CA. Depression as a determinant of quality of life in patients with chronic disease: data from Brazil. Soc Psychiatry Psychiatr Epidemiol. 2010. https://doi.org/10.1007/s00127-009-0141-2.

48.

Hawkes AL, Patrao TA, Ware R, Atherton JJ, Taylor CB, Oldenburg BF. Predictors of physical and mental health-related quality of life outcomes among myocardial infarction patients. BMC Cardiovasc Disord. 2013. https://doi.org/10.1186/1471-2261-13-69.

49.

McBurney CR, Eagle KA, Kline-Rogers EM, Cooper JV, Mani OC, Smith DE, et al. Health-related quality of life in patients 7 months after a myocardial infarction: factors affecting the short Form-12. Pharmacotherapy. 2002. https://doi.org/10.1592/phco.22.17.1616.34121.

50.

El-Baz N, Ondusova D, Studencan M, Rosenberger J, Reijneveld SA, van Dijk JP, et al. Differences between Slovak and Dutch patients scheduled for coronary artery bypass graft surgery regarding clinical and psychosocial predictors of physical and mental health-related quality of life. Eur J Cardiovasc Nurs. 2017. https://doi.org/10.1177/1474515117747571.

51.

Dueñas M, Ramirez C, Arana R, Failde I. Gender differences and determinants of health related quality of life in coronary patients: a follow-up study. BMC Cardiovasc Disord. 2011. https://doi.org/10.1186/1471-2261-11-24.

Title: Quality of life among patients with cardiac disease: the impact of comorbid depression
Authors: Mandreker Bahall
George Legall
Katija Khan
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Affective Disorder
Affective Disorder
Published in: Health and Quality of Life Outcomes / Issue 1/2020
Electronic ISSN: 1477-7525
DOI: https://doi.org/10.1186/s12955-020-01433-w

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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