Abstract
BackgroundDepression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. However, the influence of disease severity on mood symptoms is unknown. The specific associations of mood symptoms with NYHA classes remain unexplored.MethodsIn this cross-sectional study, 443 consecutive inpatients with angina pectoris (AP) confirmed by angiography were included into analysis. Somatic and cognitive symptom scores derived from Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess mood symptoms. Predictors for depression and anxiety with strict and lax standards were compared. We hypothesized NYHA classification to be an indicator of disease severity through analyses with clinical features using ordinal logistic model. Applying both binary and ordinal logistic models, we evaluated the associations of mood symptoms with NYHA classes.ResultsDiscrepancy of disease severity existed between the depressed and nondepressed. NYHA classification was proved to be an integrated index under influence of age, coronary stenosis, heart failure and diabetes. NYHA class I and II individuals with AP were at equivalent risk for depression (NYHA II vs I: binary model OR 1.32 (0.59,2.96), p = 0.50; ordinal model OR 1.17 (0.73,1.88), p = 0.52), however NYHA class III/IV patients shared a sharply higher risk (NYHA III/IV vs I: binary model OR 3.32 (1.28,8.61), p = .013; ordinal model OR 3.94 (2.11,7.36), p < .001). Analyses on somatic and cognitive depressive symptoms confirmed this finding and hinted a greater impact of education background on mood when patient’s condition is unstable. Anxiety seemed in the whole picture irrelevant with NYHA classes. Comparing with NYHA class I/II, AP patients in NYHA class III/IV tended to be less anxious. However, when CHD became unstable, the calmness may immediately be broken up. A great distinction of the ratio of anxiety and depression symptom scores between NYHA class III/IV stable and unstable AP patients (p = .018) was observed.ConclusionsMood symptoms in CHD patients are to a great extend derived from disease itself. Only for patients with relatively serious physical condition, unexpected discomforts caused by disease notably impact the emotions. Education background tends to influence the mood especially when disease is still unstable.
Highlights
Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients
Knowing the specific association of mood symptoms with disease severity may help to reach a better understanding of the impact of mood on prognosis, see through some confusing findings about anxiety and depression and find out the most efficient therapies for patients
All participants were surveyed in comparatively stable condition and under supervision of one well-trained psycho-cardiologist, who was responsible for elucidating the Patient Health Questionnaire (PHQ)-9 and Generalized Anxiety Disorder Scale (GAD)-7 questionnaires, assisting patients with failing eyesight or low literacy and conducting a concise review to guarantee data accuracy
Summary
Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. Depression and anxiety, more prevalent in CHD patients than the general population, are associated with an increased risk of worse prognosis [1,2,3,4] These associations in many studies weaken or vanish when adjusted for variables that can reflect physical conditions [5,6,7], indicating a close correlation between emotional symptoms and disease severity [8,9,10]. Few researchers have studied the alteration pattern of mood symptoms along with deterioration of CHD Reasons for this phenomenon lie: (1) no explicit criteria exists for disease severity grading; (2) it seems a common sense for seriously ill patients to be in a bad state of mind. Knowing the specific association of mood symptoms with disease severity may help to reach a better understanding of the impact of mood on prognosis, see through some confusing findings about anxiety and depression and find out the most efficient therapies for patients
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