Evaluating the impact of depression, anxiety &amp; autonomic function on health related quality of life, vocational functioning and health care utilisation in acute coronary syndrome patients: the ADVENT study protocol

John C Oldroyd,Kristy Sanderson,Sheila Cyril,David M Clarke,David L Hare,Adrienne O’Neil,Aaron J Fisher,Bhanuja S Wijayatilaka,Andrew B Forbes,Dean P Mckenzie,Silva Zavarsek,Brian Oldenburg,C Barr Taylor,Ian T Meredith

doi:10.1186/1471-2261-13-103

Abstract

BackgroundDepression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality although their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. We are conducting a prospective cohort study which aims to examine in acute coronary syndrome patients: (1) the role of somatic subtypes of depression and anxiety as predictors of health related quality of life outcomes; (2) how somatic subtypes of depression and anxiety relate to long term vocational functioning and healthcare utilisation; and (3) the role of the autonomic nervous system assessed by heart rate variability as a moderator of these associations.MethodsPatients are being screened after index admission for acute coronary syndrome at a single, high volume centre, MonashHeart, Monash Health, Victoria, Australia. The inclusion criterion is all patients aged > 21 years old and fluent in English admitted to MonashHeart, Monash Health with a diagnosis of acute coronary syndrome. The primary outcome is mean health related quality of life (Short Form-36) Physical and Mental Health Summary scores at 12 and 24 months in subtypes with somatic symptoms of depression and anxiety. Depressive domains are assessed by the Beck Depression Inventory II and the Cardiac Depression Scale. Anxiety is measured using the Speilberger State-Trait Anxiety Inventory and the Crown Crisp Phobic Anxiety questionnaire. Secondary outcomes include clinical variables, healthcare service utilisation and vocational functioning.DiscussionThis manuscript presents the protocol for a prospective cohort study which will investigate the role of somatic subtypes of depression and anxiety as predictors of health related quality of life, long-term vocational functioning and health service use, and the role of the autonomic nervous system in moderating these associations. Findings from the study have the potential to inform more effective pharmacological, psychological and behavioural interventions and better guide health policy on the use of health care resources.

Highlights

Depression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients
There is evidence that depression dominated by somatic symptoms may have worse outcomes than depression dominated by cognitive symptoms
This paper presents the study protocol for a prospective cohort study that is in progress

Summary

Introduction

Depression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. Less severe symptoms of depression are found in 2030% of patients after ACS, with similar prevalence rates for anxiety [1,2,3,4]. Key depression subtypes, regardless of whether or not diagnostic thresholds for a disorder are satisfied, have the potential to predict important patient outcomes such as long-term functioning and recovery [16]. Identifying the key symptom subtypes related to these functional outcomes has the potential to guide development and delivery of more targeted and effective interventions

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