BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence ph...BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence physiological outcomes and disease progression.Emerging evidence in psychocardiology highlights the bidirectional interplay between mood disorders and cardiovascular dysfunction through neuroendocrine,autonomic,and behavioral pathways.This study aims to explore the real-world effect of depression severity-measured by the Patient Health Questionnaire-9(PHQ-9)-on left ventricular systolic function and one-year cardiovascular readmission in patients with HF,providing insights into its prognostic relevance within a psychocardiological framework.AIM To investigate the impact of depression severity on medication adherence,ventricular function,and readmission in patients with HF.METHODS A total of 160 patients hospitalized for HF between January 2020 and December 2023 were included in this real-world retrospective cohort study.Depression severity was assessed by using the PHQ-9,with scores≥10 indicating moderate-to-severe depression.Cardiac function was evaluated through transthoracic echocardiography to determine left ventricular ejection fraction(LVEF).Medication adherence was assessed at three and six months postdischarge by employing the four-item Morisky Medication Adherence Scale(MMAS-4)and categorized as high(score=0),moderate(1-2),or low(3-4).Data on antidepressant or anxiolytic prescriptions and psychological interventions during hospitalization were collected.Patients were followed up for one year to capture cardiovascular-related readmissions.Kaplan-Meier analysis was employed to estimate eventfree survival,and Cox regression identified independent predictors of readmission.RESULTS Patients with moderate-to-severe depression(PHQ-9≥10)presented with significantly lower LVEF at baseline,higher N-terminal pro-B-type natriuretic peptide levels,and more severe HF symptoms than other patients.They also demonstrated poorer medication adherence postdischarge,with a higher proportion classified as low adherence on the MMAS-4 scale,and were less likely to receiveβ-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker at discharge than other patients.At three and six months postdischarge,PHQ-9 and MMAS-4 scores were inversely correlated with LVEF,suggesting a behavioral pathway linking depression to impaired cardiac recovery.During the one-year follow-up period,30.0%of patients experienced cardiovascular-related readmissions,predominantly due to worsening HF(54.1%).In multivariable Cox regression analysis,high PHQ-9 scores,reduced LVEF,old age,elevated N-terminal pro-B-type natriuretic peptide levels,New York Heart Association class IV,and absence ofβ-blocker therapy were independently associated with readmission risk.CONCLUSION In patients with HF,depression severity independently predicts impaired ventricular function,low medication adherence,and increased one-year cardiovascular readmission.These findings highlight the psychocardiological relevance of depression screening and behavioral intervention in optimizing adherence and clinical outcomes in routine HF care.展开更多
Background Atrial fibrillation(AF) is one of the common types of heart disease, and the patients are prone to a variety of adverse emotions which can affect the surgery and prognosis. The care of AF is mainly based on...Background Atrial fibrillation(AF) is one of the common types of heart disease, and the patients are prone to a variety of adverse emotions which can affect the surgery and prognosis. The care of AF is mainly based on the concept of psychocardiological comprehensive nursing care. However, psychocardiological care in patients with AF has not been addressed adequately. Methods A randomized controlled clinical trial along with questionnaire surveys were applied in this study. The anxiety self-assessment scale(SAS) was employed to screen and enroll AF patients in the cardiology department of Guangdong provincial people.s hospital from January 2017 to March 2019. Eighty patients with a SAS score of 50 or above and plans of future radiofrequency ablation were selected and randomly divided into control and study groups. The psychocardiological nursing care was prescribed to the subjects in the study group, while the routine nursing care was done for the subjects in the control group.The anxiety levels of all patients were measured and compared upon admission and at 1, 3 and 6 months after discharge, respectively. Results The anxiety levels of the patients undergoing psychocardiological nursing care in the study group were effectively reduced(P<0.05). Conclusion The psychocardiological nursing care exerted positive effects on lowering the anxiety levels of AF patients undergoing radiofrequency ablation.[S Chin J Cardiol 2019;20(4):258-263]展开更多
文摘BACKGROUND Depression is a highly prevalent and clinically significant psychiatric comorbidity in patients with heart failure(HF),exerting multidimensional effects that extend beyond emotional symptoms to influence physiological outcomes and disease progression.Emerging evidence in psychocardiology highlights the bidirectional interplay between mood disorders and cardiovascular dysfunction through neuroendocrine,autonomic,and behavioral pathways.This study aims to explore the real-world effect of depression severity-measured by the Patient Health Questionnaire-9(PHQ-9)-on left ventricular systolic function and one-year cardiovascular readmission in patients with HF,providing insights into its prognostic relevance within a psychocardiological framework.AIM To investigate the impact of depression severity on medication adherence,ventricular function,and readmission in patients with HF.METHODS A total of 160 patients hospitalized for HF between January 2020 and December 2023 were included in this real-world retrospective cohort study.Depression severity was assessed by using the PHQ-9,with scores≥10 indicating moderate-to-severe depression.Cardiac function was evaluated through transthoracic echocardiography to determine left ventricular ejection fraction(LVEF).Medication adherence was assessed at three and six months postdischarge by employing the four-item Morisky Medication Adherence Scale(MMAS-4)and categorized as high(score=0),moderate(1-2),or low(3-4).Data on antidepressant or anxiolytic prescriptions and psychological interventions during hospitalization were collected.Patients were followed up for one year to capture cardiovascular-related readmissions.Kaplan-Meier analysis was employed to estimate eventfree survival,and Cox regression identified independent predictors of readmission.RESULTS Patients with moderate-to-severe depression(PHQ-9≥10)presented with significantly lower LVEF at baseline,higher N-terminal pro-B-type natriuretic peptide levels,and more severe HF symptoms than other patients.They also demonstrated poorer medication adherence postdischarge,with a higher proportion classified as low adherence on the MMAS-4 scale,and were less likely to receiveβ-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker at discharge than other patients.At three and six months postdischarge,PHQ-9 and MMAS-4 scores were inversely correlated with LVEF,suggesting a behavioral pathway linking depression to impaired cardiac recovery.During the one-year follow-up period,30.0%of patients experienced cardiovascular-related readmissions,predominantly due to worsening HF(54.1%).In multivariable Cox regression analysis,high PHQ-9 scores,reduced LVEF,old age,elevated N-terminal pro-B-type natriuretic peptide levels,New York Heart Association class IV,and absence ofβ-blocker therapy were independently associated with readmission risk.CONCLUSION In patients with HF,depression severity independently predicts impaired ventricular function,low medication adherence,and increased one-year cardiovascular readmission.These findings highlight the psychocardiological relevance of depression screening and behavioral intervention in optimizing adherence and clinical outcomes in routine HF care.
基金supported by grants from Guangzhou Science and Technology Project(No.2014Y-00196)grants from Guangdong medical science and technology research fund project(No.A2017516)
文摘Background Atrial fibrillation(AF) is one of the common types of heart disease, and the patients are prone to a variety of adverse emotions which can affect the surgery and prognosis. The care of AF is mainly based on the concept of psychocardiological comprehensive nursing care. However, psychocardiological care in patients with AF has not been addressed adequately. Methods A randomized controlled clinical trial along with questionnaire surveys were applied in this study. The anxiety self-assessment scale(SAS) was employed to screen and enroll AF patients in the cardiology department of Guangdong provincial people.s hospital from January 2017 to March 2019. Eighty patients with a SAS score of 50 or above and plans of future radiofrequency ablation were selected and randomly divided into control and study groups. The psychocardiological nursing care was prescribed to the subjects in the study group, while the routine nursing care was done for the subjects in the control group.The anxiety levels of all patients were measured and compared upon admission and at 1, 3 and 6 months after discharge, respectively. Results The anxiety levels of the patients undergoing psychocardiological nursing care in the study group were effectively reduced(P<0.05). Conclusion The psychocardiological nursing care exerted positive effects on lowering the anxiety levels of AF patients undergoing radiofrequency ablation.[S Chin J Cardiol 2019;20(4):258-263]
