Cardiac Depression Scale Research Articles

The Association between Depression, Self-efficacy, and Health-related Quality of Life Among Chinese Patients Undergoing Their First Percutaneous Coronary Intervention

Introduction: The demand for percutaneous coronary intervention (PCI) has been steadily increasing along with the number of patients with coronary heart disease (CHD) in China. However, there is a lack of studies investigating health-related quality of life (HRQoL), self-efficacy, and depression among Chinese patients undergoing their first PCI. The aim of this study was to explore the association between depression, self-efficacy, and HRQoL among Chinese patients with CHD undergoing their first PCI. Methods: In this cross-sectional study, 212 Chinese patients with CHD who underwent their first PCI were recruited through convenience sampling from October 2019 to March 2020. HRQoL, self-efficacy, and depression were assessed using the Seattle Angina Questionnaire, Cardiac Self-Efficacy Scale, and Short-Form Cardiac Depression Scale, respectively, along with the collection of patients’ sociodemographic and clinical information. Results: Among the 212 participants, the average age was 59.82 years, and 145 (68.4%) were male. The average scores for self-efficacy, depression, and HRQoL were 33.49 (±10.28), 16.14 (±6.12), and 328.33 (±62.55), respectively. Among the 212 patients who underwent PCI, 134 (63.21%) were found to have depression symptoms according to the cutoff score of 14. A higher body mass index, a diagnosis of acute coronary syndrome, fewer years of CHD diagnosis, the absence of symptoms of depression and greater self-efficacy were significantly positively associated with HRQoL. In total, these variables explained 37.2% of the variance in HRQoL. Conclusion: This study revealed that the HRQoL of patients in this group needs to receive more attention. A comprehensive secondary prevention intervention for CHD patients undergoing their first PCI should emphasize mitigating depression and positively influencing their self-efficacy.

The Slovenian version of the Cardiac depression scale – validity and reliability

IntroductionCardiovascular diseases (CVD) were the cause of 40% of all deaths in Slovenia in 2016, and are the seventh most common cause of visits to the general practitioner. The prevalence of depression in people with CVD is high and is a strong predictor of mortality and additional cardiac events. In patients with coronary artery disease, depressive symptoms contribute to a lower quality of life and to physical limitations.Objectives The purpose of this study was to translate the Cardiac Depression Scale into Slovenian (S-CDS) and to assess its psychometric properties on Slovenian patients with heart disease.Methods After obtaining the consent from the original authors, the Cardiac depression scale was translated by three bilingual Slovenian native speakers with medical knowledge. Afterwards, they worked jointly to reach consensus on one version, which was then back-translated (Slovenian to English) by two independent English translators unfamiliar with the original version. The original authors approved the final draft. The S-CDS was then applied to a total of 272 patients with heart disease that underwent elective coronary angiography. At the same time the Spielberger Stait Anxiety Inventory (STAI-S) and the Center for Epidemiologic Studies Depression Scale-20 (CES-D) were used. An exploratory and confirmatory factor analysis, internal consistency, test–retest reliability and concurrent validity were performed.ResultsThe total scale had Cronbach’s alpha 0.92 and test–retest reliability 0.71. Six factors were confirmed by the exploratory factor analysis, accounting for 60.88% of total variance. A two and one factor solution indicated by the confirmatory factor analysis had acceptable goodness-of-fit measures. A one factor solution was kept, considering a high correlation between the two factors and the theoretical background in previous studies. A moderate to strong correlations were confirmed by concurrent validation against the CES-D and the STAI-S.ConclusionsThe S-CDS with 25 questions is a reliable and valid instrument for measuring depressive symptoms in Slovenian patients with heart disease.Disclosure of InterestNone Declared

Effect of resourcefulness practice combined with mindfulness training on improving the symptoms of depression in patients after percutaneous coronary intervention

ObjectiveThis study aimed to explore the effect of resourcefulness and mindfulness training on depressive patients after percutaneous coronary intervention (PCI). MethodsThis single-center, randomized clinical trial was conducted. From October 2020 to August 2021, 132 depressive patients after PCI were selected from 4 wards of the cardiovascular department of a Class A tertiary hospital in Tangshan, China and divided into control group (CNG), resourcefulness practice group (RPG), mindfulness training group (MTG) and resourcefulness practice combined mindfulness training group (CMG). On the basis of routine nursing, the three intervention groups received resourecfulness practice, mindfulness training, and resourcefulness practice combined with mindfulness training for 12 weeks (1–6 weeks, once a week, 30 min each time; 7–12 weeks, practice three times a week and live on WeChat once a week, 30 min each time). The control group received routine nursing. Before the intervention, at 12 weeks and 24 weeks after the intervention, the Chinese version of the Cardiac Depression Scale, the Chinese Resourcefulness Scale, and the Five Facet Mindfulness Questionnaire were used to evaluate the depressive symptoms, the level of resourcefulness and the level of mindfulness among patients, respectively. ResultsA total of 132 patients completed the study (33 participants in each groups). After 12 weeks of intervention, the mixed effects model revealed that the level of resourcefulness and mindfulness were improved, and the depressive symptoms of patients were reduced in CMG as compared to CNG (the least square mean difference was −12.99, −37.19, 19.45, respectively, P < 0.01). Compared with the RPG, the level of mindfulness was improved, and the depressive symptoms were reduced in CMG (the least squares mean difference was −13.54, 10.99, respectively, P < 0.01). The level of resourcefulness of patients in CMG was higher than MTG (least squares mean difference was −8.37, P < 0.05). After 24 weeks of intervention, the level of mindfulness was improved, and the depressive symptoms were reduced in CMG, as compared to CNG (the least squares mean difference of the depressive symptoms and the level of mindfulness was −12.45, 13.03, respectively, P < 0.01) and RPG (the least squares mean difference was −7.79, 9.09, respectively, P < 0.05). Compared with the MTG, the depressive symptoms among patients were reduced in CMG (least squares mean difference was 7.37, P < 0.05). ConclusionResourcefulness practice combined with mindfulness training can be effective in reducing the symptoms of depression in patients after PCI, and the effects could last longer. Mindfulness training can supplement spiritual resourcefulness in resourcefulness practice.

Psychometric Properties of the Slovenian Version of the Cardiac Depression Scale.

The aim of this study was to translate the Cardiac Depression Scale into the Slovenian language and test its validity and reliability on Slovenian patients with heart disease. A total of 272 patients with heart disease who underwent elective coronary angiography at Celje General Hospital participated in this study. We used the Slovenian Cardiac Depression Scale (S-CDS), the Spielberger State Anxiety Inventory (STAI-S), and the Center for Epidemiologic Studies Depression Scale-20 (CES-D) to collect data. An exploratory and confirmatory factor analysis, internal consistency, test-retest reliability, and concurrent validity were performed. Cronbach's alpha for the total scale was 0.92 and the test-retest reliability was 0.71. Exploratory factor analysis confirmed six factors, accounting for 61% of the total variance. The confirmatory factor analysis indicated that a two- and one-factor solution had acceptable goodness-of-fit measures. However, we kept a more parsimonious one-factor method, given a high correlation between the two factors and the theoretical background in previous studies. Concurrent validation against the CES-D and the STAI-S showed moderate to strong correlations. The S-CDS is a reliable and valid instrument for screening for depression in Slovenian patients with heart disease.

Improving depression and perceived social support enhances overall quality of life among myocardial infarction survivors: necessity for integrating mental health care into cardiac rehabilitation programs

BackgroundDepression and low perceived social support (PSS) have been found to deleteriously affect quality of life (QoL) among myocardial infarction (MI) survivors. The complex relationship between these variables has not been assessed. We wanted to assess first the prevalence of depression among MI survivors and whether depression mediates the effect of PSS on QoL and, second, whether the physical and social domains of QoL mediated the effect of depression and PSS on the emotional domain. This cross-sectional study was done among MI survivors using Cardiac Depression Scale, MacNew Quality of Life After Myocardial Infarction Questionnaire and Multidimensional Scale of Perceived Social Support to assess for depression, QoL and PSS respectively.ResultsA total of 103 MI survivors were included in the study, and the mean age was 59.66 (± 10.42) years. Depression was found in 21.36% of the participants. The indirect effect of PSS on QoL with depression as a mediator was significant (b = 0.15, p < 0.001, 95% CI = 0.12, 0.18). The direct effect of PSS on QoL controlling for depression was also significant (b = 0.05, p < 0.001, 95% CI = 0.02, 0.07). Depression as a mediator in the relationship explained 75.3% of the effect of PSS on QoL. PSS and depression did not have a significant direct effect on emotional QoL, but it became significant when the physical and social domains were included in the model. The total indirect effects of PSS and depression on emotional QoL were b = 0.16, p < 0.001, 95% CI = 0.05, 0.17 and b = − 0.05, p < 0.001, 95% CI = − 0.06, − 0.03, respectively.ConclusionDepression and poor PSS impair physical and social domains, which impairs the emotional domain of QoL; as such, overall QoL is undermined. As limited physical and social activity because of depression and poor PSS may increase the risk of further cardiovascular events, a holistic approach which includes mental health care is warranted.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest

AimsWe recently reported early outcomes in patients enrolled in a randomised trial of adrenaline in out-of-hospital cardiac arrest: the PARAMEDIC2 (Prehospital Assessment of the Role of Adrenaline: Measuring the Effectiveness of Drug Administration in Cardiac Arrest) trial. The purpose of the present paper is to report long-term survival, quality of life, functional and cognitive outcomes at 3, 6 and 12-months. MethodsPARAMEDIC2 was a pragmatic, individually randomised, double blind, controlled trial with an economic evaluation. Patients were randomised to either adrenaline or placebo. This paper reports results on the modified Rankin Scale scores at 6-months, survival at 6 and 12-months, as well as other cognitive, functional and quality of life outcomes collected at 3 and 6 months (Two Simple Questions, the Mini Mental State Examination, the Informant Questionnaire on Cognitive Decline Evaluation for Cardiac Arrest, Hospital Anxiety and Depression Scale, the Post Traumatic Stress Disorder Checklist - Civilian Version, Short-Form 12-item Health Survey and the EuroQoL EQ-5D-5L). Results8014 patients were randomised with confirmed trial drug administration. At 6-months, 78 (2.0%) of the patients in the adrenaline group and 58 (1.5%) of patients in the placebo group had a favourable neurological outcome (adjusted odds ratio 1.35 [95% confidence interval: 0.93, 1.97]). 117 (2.9%) patients were alive at 6-months in the adrenaline group compared with 86 (2.2%) in the placebo group (1.43 [1.05, 1.96], reducing to 107 (2.7%) and 80 (2.0%) respectively at 12-months (1.38 [1.00, 1.92]). Measures of 3 and 6-month cognitive, functional and quality of life outcomes were reduced, but there was no strong evidence of differences between groups. ConclusionAdrenaline improved survival through to 12-months follow-up. The study did not find evidence of improvements in favourable neurological outcomes. (ISCRTN 73485024)

Abstract 16297: Persistent and Delayed Depression Predict All-cause Unplanned Rehospitalisations Following Acute Myocardial Infarction

Introduction: Depression following acute myocardial infarction (AMI) is a risk factor for future events and mortality. The aim of this study was to explore the post-AMI trajectory of depression as a risk factor for all-cause unplanned rehospitalisations. Methods: A total of 118 adults (101 men; mean±SD age = 64.76±11.16 years) completed the Cardiac Depression Scale (CDS) during and one month following AMI admission. On the basis of their CDS scores during index admission and 30 days post-AMI (≥ 95 = probable major depression) patients were categorized as having chronic; absent; recovered; or delayed depression. All-cause, unplanned rehospitalisations were sourced from electronic hospital databases (Cerner and TrakCare) from the time of the enrolment admission to census (11 th Dec 2019). Time in the study ranged from 61 days to 4.8 years. Results: A total of 41% of the sample (n = 48) had ≥ 1 all-cause unplanned rehospitalisation following their index AMI admission. Kaplan Meier Survival analyses revealed that worsening or persistent depression trajectories had earlier unplanned rehospitalisations (p &lt; .05). Pairwise Log Rank tests showed that patients with delayed depression had significantly less time to their first all-cause unplanned rehospitalisation compared to those with absent or recovered depression (p &lt; .05). Patients with chronic depression had significantly earlier unplanned rehospitalisations than those with recovered depression (p &lt; .05). Cox Regression analyses revealed that chronic (HR = 9.62109 [95% CI 2.53, 36.62] and delayed depression (HR = 2.94 [95% CI 1.08, 7.97] significantly increased the risk of all-cause unplanned rehospitalisations, after adjusting for time in the study, demographic factors, illness severity, heart disease knowledge, state anxiety and psychological resilience. Conclusions: Persistent or delayed trajectories of depression from admission to 30 days following AMI independently increases the risk of all-cause unplanned hospital readmissions. Patients should be screened for depression during AMI admission and throughout the early adjustment period (2-3 months post-AMI). Further research to increase capacity to predict post-AMI depression trajectories is warranted.

Pharmacological Restoration of mOod in HEART Failure: outcomes of the PRO-HEART trial

Abstract Background Depression is common in chronic heart failure (CHF) patients and is associated with increased morbidity and mortality. Anti-depressant medication has shown benefits in coronary artery disease but efficacy has not been demonstrated in CHF patients. Purpose To assess whether escitalopram is more effective than placebo in treating major and/or minor depression in patients with CHF. Methods This was a randomized, placebo-controlled, double-blind, parallel group study. Adult patients with systolic CHF (NYHA Class ≥2, nadir LVEF &amp;lt;40%) were screened for depression using the Cardiac Depression Scale (CDS) for a score ≥95 (sensitivity 97% at 85% specificity for major Depression (MDD)) followed by a clinical diagnosis of major or minor depression using the SCID interview. Patients were randomised to active escitalopram or matching placebo for 6 months, stratified for major or minor depression. Blinded therapy started with 5mg with automatic uptitration to 10mg after 2 weeks and further uptitration to 20mg at 2 months if CDS score remained ≥95. The primary end-point was change in CDS score over 6 months with secondary end-point change in Hamilton Depression Rating Scale (HAM-D). Results Of 28 CHF patients (males = 25; mean age = 63.61±10.32), mean CHF diagnosis 5.8 years, ischaemic aetiology (n=18), entry LVEF 42.2±9.6%; eGFR 61.8±15.4, 14 were diagnosed with major and 14 with minor depression. Two-way Mixed Model ANOVA showed a significant improvement from baseline to 6 months in both CDS (F(1,25)=18.76, p&amp;lt;0.001) and HAM-D (F(1,25)=17.32, p&amp;lt;0.001), but no significant interaction between condition and change over time. Three-way Mixed Model ANOVA showed no interaction between baseline depression diagnosis (Major or Minor) and response to treatment by condition. There were 7 SAEs for hospitalisation, unrelated to study medications and no differences between groups on AE/SAEs. Conclusions Patients showed a significant improvement in depression with both placebo and active drug but with no benefit of escitalopram over placebo. This suggests that there is no additional benefit from antidepressant therapy for CHF patients beyond that conferred by placebo. Further research is needed to explore whether greater benefits might be achieved by combination therapies or in particular subgroups of depressed CHF patients. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Heart Foundation of Australia, Beyond Blue

Psychometric properties of the Arabic version of the cardiac depression scale tested on Jordanian patients with cardiovascular diseases

BackgroundThe Cardiac Depression Scale (CDS) is an instrument to screen for depression, specifically in patients with cardiovascular diseases (CVD). The purpose of this study was to evaluate the psychometric properties of the Arabic version of the CDS in the Jordanian population.MethodA cross-sectional design was used for 304 participants diagnosed with CVD. An exploratory factor analysis (EFA) was performed to explore the underlying structure of the new Arabic version of the CDS tool.ResultsCronbach’s alpha for the total scale was 0.87. An EFA suggested a two-factor solution. The first factor has 18 items, measuring “My tolerance” of CVD, and the second factor has seven items, measuring “My activities” in the context of CVD. Based on the EFA simple structure, one item was removed due to its low factor loading (< 0.3). A confirmatory factor analysis (CFA) supported a two-factor model with the root mean square error of approximation (RMSEA = 0.06), comparative fit index (CFI = 0.856), and Tucker-Lewis index (TLI = 0.83) indicating acceptable fit. The Cronbach’s alpha values for the first and second factors were 0.86 and 0.84, respectively.ConclusionThe Arabic version of the CDS is a reliable and valid instrument to screen for depression among Jordanian patients with CVD.

643 Psychological Resilience Protects Against All-Cause Unplanned Hospital Readmissions Following Acute Myocardial Infarction

Depression is a significant risk factor for unplanned rehospitalisations following acute myocardial infarction (AMI). Psychological resilience may reduce this risk through better adjustment to illness and adversity. The aim of this study was to explore whether psychological resilience protects against all-cause unplanned rehospitalisations following AMI. A total of 234 consecutive adult post-AMI patients (185 men; mean±SD age =63.84±12.38 years) completed a depression scale (Cardiac Depression Scale; CDS), an anxiety scale (Spielberger’s State-Trait Anxiety Inventory), and a psychological resilience scale (Sense of Coherence Scale; SOC) comprising three subscales (Manageability, Comprehensibility and Meaningfulness), during their AMI admission. All-cause unplanned rehospitalisations were sourced from electronic hospital databases (Cerner and TrakCare) from the time of the enrolment admission to census (11th Dec 2019). Time in the study ranged from 54 days to 4.8 years. 41.5% of the sample (n=97) had ≥1 unplanned rehospitalisation following their original AMI admission (range 0-17 readmissions). Hierarchical Linear Regression analyses (adjusted for time in the study, demographic and illness severity, CVD knowledge, depression, anxiety) revealed that higher levels of perceived Meaningfulness in life (β=-.13, p=.03) predicted fewer all-cause unplanned rehospitalisations. Psychological resilience, as indexed by perceived meaningfulness in life, is a significant protective factor against all-cause unplanned rehospitalisations, independent of sociodemographic, clinical and other psychosocial factors. Research is needed to determine whether this cohort may benefit from positive psychology interventions that have shown promise in optimising psychological resilience in other health and illness settings.

Chinese Herbal Medicines and Conventional Chronic Heart Failure Treatment for the Management of Chronic Heart Failure Complicated with Depression: A Systematic Review and Meta-Analysis.

Background Combination therapy with Chinese herbal medicines (CHMs) and conventional medical treatment (CMT) was proposed as a therapeutic strategy for chronic heart failure (CHF) patients complicated with depression. Therefore, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess effects of this combination therapy on CHF complicated with depression. Methods RCTs comparing the combination of CHMs and CMT to CMT were retrieved in seven electrical databases till March 30, 2019. The effective rate of cardiac function and Hamilton depression scale (HAMD) were marked as the primary outcomes. Left ventricular ejection fraction (LVEF) and Minnesota Living with Heart Failure Questionnaire (MLHFQ) were marked as the secondary outcomes. The methodological quality of eligible RCTs used the Cochrane bias risk assessment tool. Stata 13.0 and Review Manager 5.3 were preferred for synthesizing the results if the results were appropriate. Results Thirteen RCTs enrolling 1022 subjects met the inclusion criteria. The majority of the retrieved RCTs were evaluated to be of low methodological quality. The pooled results of the meta-analysis showed that CHMs plus CMT group created better outcomes compared to CMT alone therapy, as evidenced by the fact that the overall effects of combination therapy strategy were significantly greater than the control group in increasing effective rate of cardiac function (risk ratio (RR) = 1.28; 95% CI: 1.16 to 1.42), in improving depressive symptoms (HAMD) (standard mean difference (SMD) = −1.31; 95% CI: −1.68 to −0.95) and quality of life (MLHFQ) (weighted mean difference (WMD) = −8.42; 95% CI: −10.08 to −6.76), in increasing LVEF scores (WMD = 5.33; 95% CI: 4.30 to 6.35). Conclusion The combination of CHMs and CMT increased the effective rate of cardiac function and LVEF scores and reduced HAMD and MLHFQ scale scores, which was a potential therapeutic strategy that improved the management of CHF patients complicated with depression. Future trials were needed to verify the above results since abnormal heterogeneity and poor quality of literature have existed in the included studies.

2204Predicting the trajectory of depression following an acute coronary syndrome: the role of resilience

Abstract Background Depression is common in patients following an Acute Coronary Syndrome (ACS) substantially increases the risk of future events and mortality. Post-ACS depression typically resembles one of four longitudinal trajectories: chronic; absent; recovered, or delayed depression. Early identification of a patient's post-ACS depression trajectory will improve risk stratification, treatment implementation and risk management. Purpose To explore whether stable psychosocial traits, such as resilience, predict the trajectory of depression one month and 6 months following an ACS admission. Method Consecutive adult ACS patients (STEMI/NSTEMI) admitted to a large general hospital completed the Cardiac Depression Scale (CDS) and the Sense of Coherence scale during their admission, then one and six months following discharge. Results 132 ACS in-patients (males = 111; mean age = 63.13±13.47) satisfied enrolment criteria. Unconditional linear latent growth modelling identified a 3-class model for the trajectory of depression post-ACS (increasing depression; consistent non-depressed; decreasing non-depressed). For the increasing depression class, resilience at baseline was significant and negative compared to the consistent class, b=−0.06, Wald chi square (1) = 4.42, p=0.036 and the decreasing class, b=−0.09, Wald chi square (1) = 7.20, p=0.007. Conclusions Patients who reported lower levels of resilience during an ACS admission were significantly more likely to experience initially high levels of depressive symptoms (CDS ≥85) that exceeded the clinically relevant cut-off (CDS ≥95) at 6 months post-discharge. This study suggests that screening for resilience and depression will improve risk stratification for persistent and delayed depression post-ACS.

Mediators of gender effects on depression among cardiovascular disease patients in Palestine

BackgroundAmong patients suffering from coronary heart disease (CHD) and comorbid depression, women experience a higher burden compared to men. Little is known on the characteristics that differentiate men and women with both diseases and whether these factors mediate gender effects on depression. This study assessed whether women are more likely to suffer from depression and which characteristics mediate gender effects on depression among a cardiac population in Palestine, specifically addressing the role of post-traumatic stress disorder (PTSD).MethodsUsing a cross-sectional design, patients consecutively admitted with a CHD to one of the four main hospitals in Nablus, Palestine, were interviewed using a structured questionnaire with validated instruments. Data was also obtained from hospital medical records. Patients were assessed for depression using the Cardiac Depression Scale (CDS). Bivariate analysis was conducted to compare characteristics of women and men with and without depressive symptoms. Mediators (direct and indirect effects) of the association between gender and depression were evaluated using a structural equation model (SEM).ResultsWomen were more likely to suffer from severe depression than men (28.7% vs. 18.8%). Female gender was positively associated with higher PTSD symptoms, comorbidities, somatic symptoms and income, and with lower resilience, self-esteem, quality of life, education, prevalence of smoking and physical activity. Structural equation modeling revealed negative indirect effects of gender on depression (CDS score) through resilience, self-esteem and physical activity, whereas positive indirect effects of gender on depression were observed through PTSD, comorbidities, somatic symptoms and smoking. There was no direct effect of gender on depression.ConclusionThis study found a higher prevalence of severe depression in female patients with cardiac disease compared to male cardiac patients. Our findings provide novel information on mediating factors of the association between gender and depression among cardiac patients, in particular PTSD. The results emphasize the need for further research on potential mediating factors that could account for gender differences in depression and the need to provide support programs for female patients with comorbid CHD and depression to improve their psycho-social well-being.

Depression in Nonhospitalized Jordanian Patients With Coronary Artery Disease.

Patients with coronary artery disease (CAD) are likely to experience depression, which contributes to the burden of disease and is a risk factor for mortality. Patients in outpatient clinics in Jordan are not routinely screened for depression. Significant relationships among patient characteristics must be determined to ascertain the predictors of depression. The aims of this research were to assess the level of depression symptoms in nonhospitalized patients with CAD; to examine the relationships between depression and relevant sociodemographic, self-reported health history, and patient health perception variables; and to identify possible predictors of depression in Jordan. This cross-sectional study recruited a convenience sample (N = 174) of nonhospitalized outpatients who had been diagnosed with CAD. Self-reported demographic, health history, and health perception information (independent variables) were provided by the participants. The depression scores (dependent variable) for the participants were assessed using the Cardiac Depression Scale. Data were analyzed using descriptive statistics, the chi-square test, Pearson's correlations, and multiple linear regressions. Half of the participants reported mild to moderate depression, with 37% reporting severe depression. Predictors of depression included gender (being female), having a concomitant chronic disease, prior surgery, irregular exercise, impaired sexual activity, and self-perceived poor psychological health. To improve patient outcomes, clinical personnel should screen patients with CAD for depression and offer a combined pharmaceutical and therapeutic treatment intervention. An easy-to-administer instrument to detect depression may be included in the standard patient checkup routine used in clinics. Several patient characteristics were found to significantly affect depression and health outcomes.

Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population

BackgroundMental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population.MethodsThis cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety.ResultsIn total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience.ConclusionThere was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.

Outcomes of a randomised pilot trial of a nurse-led clinic for patients after percutaneous coronary intervention

BackgroundHospitalisation for percutaneous coronary intervention (PCI) in Australia is reducing. Patients who undergo PCI may be discharged home without a post-discharge health management plan, referral for secondary prevention, or understand their chronic condition. Subsequently, negative psychological symptoms such as anxiety and depression may be experienced in the post-discharge period. ObjectivesThis study assessed the effectiveness of a nurse-led clinic on patients' cardiac self-efficacy and negative psychological symptoms of anxiety and depression 1-week post-PCI discharge. MethodsOne-hundred and eighty-eight potential participants were screened, and 33 participants were block-randomised to study groups. The nurse-led clinic used a person-centred approach and delivered tailored education, health assessment, and post-discharge support. In Phase 1, the Cardiac Self-efficacy Scale and State-Trait Anxiety Inventory measured primary outcomes, while the Cardiac Depression Scale was used to measure secondary outcomes. Phase 2 evaluated participants' experiences and healthcare professionals' perceptions of the intervention through semi-structured interviews. ResultsIn Phase 1, intervention group participants did not show improvements in mental health indicators compared to standard care group participants, except for a moderate reduction in anxiety levels (d = 0.50). Phase 2 qualitative findings; however, highlighted the benefits of the nurse-led clinic. ConclusionsOverall, findings suggest that nurse-led clinics may be valuable to reduce anxiety and act as a supportive measure in the early post-discharge period until commencement of a secondary prevention program. Further research with a more powered sample is needed to determine the significance of the findings.

The association of depressive symptoms in patients with acute myocardial infarction in a regional hospital in Durban, South Africa

Objective: To examine the association of depressive symptoms and contributing psychosocial factors during hospitalisation and 1-month post discharge in patients with acute myocardial infarction (MI). Methods and results: The study population comprised consecutive patients from a multi-ethnic background, admitted June 2015 - November 2015 to the Coronary Care Unit at R. K. Khan Hospital, Durban, South Africa, with a diagnosis of MI. Demographic and clinical data stored in a specialised electronic cardiac database were extracted for all patients. Patients were screened for depressive symptoms using the Cardiac Depression Scale (CDS). Levels of perceived stress were evaluated using the 4-item Perceived Stress Scale (4-PSS). The study cohort consisted of 117 patients with a mean age of 58.16 ± 11.12 years, the majority of whom were males (70%, mean age 56.54 ± 1.23 years) and 30% females (mean age 61.97 ± 1.75 years). Forty-nine percent of the participants were diagnosed with depressive symptoms with a significantly greater number of females experiencing depressive symptoms compared to males (p <0.01). Patients with depressive symptoms were more likely to have a previous history of depression (p=0.02), positive family history of depression (p=0.04), greater non-adherence to their medication (p <0.01) and lower levels of physical activity (p <0.01). Depressed patients also reported higher levels of stress on voluntary (p <0.01) and subjective rating (p <0.01), experienced greater financial stress (p <0.01), major life events (p <0.01) and had higher 4–PSS scores (p <0.01). Thirteen percent of patients experienced major adverse cardiac events (MACE) with a significantly greater number of events found in those with depressive symptoms (p <0.01). Conclusion: Depressive symptoms are a common finding in a South African population presenting with MI. They are linked to higher rates of MACE, a previous history and/or family history of depression, greater stress levels and major life events. Females with MI are significantly more likely to present with depressive symptoms. These findings suggest that patients with MI should be screened for depressive symptoms and psychosocial factors as this may serve as an important arena for research and therapeutic intervention.

The Relationship Between Quality of Life and Psychological and Behavioral Factors in Patients With Heart Failure Following Cardiac Resynchronization Therapy

While cardiac resynchronization therapy improves the quality of life of patients with heart failure, some psychological and behavioral factors still affect the quality of life of these patients. However, information on the factors that affect the quality of life of these patients is limited. To describe the quality of life and investigate the relationship between quality of life and behavioral and psychological factors such as depression, smoking, drinking, water and sodium restrictions, exercise, and adherence in patients with chronic heart failure following cardiac resynchronization therapy. This cross-sectional study was conducted using the Morisky Medication Adherence Scale, Minnesota Living With Heart Failure Questionnaire, and Cardiac Depression Scale. A convenience sample of 141 patients with heart failure following cardiac resynchronization therapy were recruited from a tertiary academic hospital in Chengdu. The mean overall score of the Minnesota Living With Heart Failure Questionnaire was 30.89 (out of a total possible score of 105). Water restrictions, sodium restrictions, depression, and exercise were all shown to significantly predict quality of life among the participants. This paper describes the quality of life and defines the behavioral factors that affect the quality of life of patients with heart failure following cardiac resynchronization therapy. The findings suggest that nurses should manage and conduct health education for patients in order to improve their quality of life.

Psychometric Evaluation of a Persian Version of the Cardiac Depression Scale in Iranian Patients With Acute Myocardial Infarction.

The aim of this study was to validate a Persian version of the Cardiac Depression Scale (CDS) in Iranian patients with acute myocardial infarction (AMI). The CDS was forward translated from English into Persian and back-translated to English. Validity was assessed using face, content, and construct validity. Also Cronbach's alpha (α), theta (), and McDonald's omega coefficient were used to evaluate the reliability. Construct validity of the scale showed two factors with eigenvalues greater than one. The Cronbach's α, , McDonald's omega, and construct reliability were greater than .70. The Persian version of the CDS has a two-factor structure (i.e., death anxiety and life satisfaction) and has acceptable reliability and validity. Therefore, the validated instrument can be used in future studies to assess depression in patients with AMI in Iranians.