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Mind and body in acute cardiovascular care
concern" was significantly higher in CABG while "denial" was significantly higher
in VR. Multivariate analysis showed that these two significant differences were
independent from the gender of the patients.
IBQ scores by type of surgery
Psychosomatic
Concern
CABG 1.70±0.03
VR
1.54±0.04
p
0.005
Denial
Affective
Disease
Irritability Dysphoria Hypochondrias
Inhibition Convinction
3.40±0.05 2.23±0.05 2.27±0.05 1.29±0.05 1.64±0.05
3.61±0.06 2.13±0.07 2.17±0.07 1.25±0.06 1.69±0.07
0.02
0.19
0.22
0.59
0.71
2.18±0.06
2.14±0.08
0.65
Scores as mean ± sem; p = significance of the difference between CABG and VR groups.
Conclusions: Significant differences related to the type of pre-operative cardiac
disease do exist between CABG and VR patients in the psychological response
to illness. These differences may have relevance in the rehabilitative phase and
in the clinical outcome after surgery.
P5116 | SPOTLIGHT 2013
Anxiety is prevalent among patients hospitalized with acute
dyspnea and independently associated with long-term mortality:
data from the Akershus Cardiac Examination (ACE) 2 study
G. Einvik 1 , T. Dammen 2 , A.D. Hoiseth 1 , J. Brynildsen 1 , T.-A. Hagve 3 ,
G. Christensen 4 , T. Omland 1 , H. Rosjo 1 . 1 Division of Medicine, Akershus
University Hospital and University of Oslo, Lorenskog, Norway; 2 Dep. of
Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, University
of Oslo, Oslo, Norway; 3 Division of Diagnostics and Technology, Akershus
University Hospital and University of Oslo, Lorenskog, Norway; 4 University of
Oslo, Institute for Experimental Medical Research, Ulleval University Hospital,
Oslo, Norway
Figure 1
Conclusion: In patients hospitalized with acute dyspnea, the prevalence of anxiety is high, but not closely associated with cardiovascular risk factors. Anxiety
was independently associated with mortality during follow-up and may represent
an additional risk factor for a poor outcome in these patients.
P5117 | BEDSIDE
The relationship between perceived support from healthcare
professionals, shock anxiety and device acceptance in implantable
cardioverter defibrillator recipients
I. Morken 1 , T.M. Norekval 2 , E. Bru 3 , A.I. Larsen 1 , B. Karlsen 3 . 1 Stavanger
University Hospital, Department of Cardiology, Stavanger, Norway; 2 Haukeland
University Hospital, Department of Cardiology, Bergen, Norway; 3 University of
Stavanger, Department of Health Studies, Stavanger, Norway
Purpose: The recipients acceptance of the implantable cardioverter defibrillator
(ICD) can be influenced by several factors. One factor is perceived support from
healthcare professionals during regular follow-up visits. Another factor is shock
anxiety, i.e. the recipients concerns and fear related to possible future shocks.
However, little is known about the relationship between perceived support from
healthcare professionals, shock anxiety and device acceptance among the recipients. The purpose of this study is 1) to investigate the extent to which shock
anxiety and perceived support from healthcare professional support is related to
device acceptance and 2) to determine to what degree perceived support from
health care professional moderates the relationship between shock anxiety and
device acceptance in ICD recipients.
Methods: A cross-sectional study comprising recipients (N-167, 80% male, mean
age = 64 years) attending an outpatient device clinic completed standardized and
validated questionnaires assessing perceived support from healthcare professionals, shock anxiety (the Florida Shock Anxiety Scale) and device acceptance
(the Florida Patient Acceptance Survey). Demographic and clinical data were collected by self-report and from medical records in September-October 2010. The
statistical analyses included descriptive statistics and multiple regression analyses.
Results: The descriptive results indicated that 84.4% of the recipients reported
high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance (p<0.05) and moderated the negative relationship between shock anxiety
and device acceptance (p<0.05). Non-constructive support and shock anxiety
were statistically negatively associated with device acceptance (p<0.01).
Conclusions: Healthcare professionals represent a valuable constructive support system that can enhance device acceptance among ICD recipients, partly by
preventing shock anxiety from leading to poor device acceptance. On the other
hand, the findings suggest that non-constructive communication on the part of
healthcare professionals could hinder device acceptance.
P5118 | BEDSIDE
Fast screening of depression in cardiac patients: a study on 350
patients
S. Molinaro 1 , V. Tesio 1 , L. Castelli 2 , P. Sbarra 3 , T. Usmiani 3 , A. Fanelli 3 ,
S. Marra 3 , R. Torta 1 . 1 University of Turin, San Giovanni Battista "Molinette"
Hospital - Psycho-Oncology Unit, 2 University of Turin, Dept. of Psychology, 3 San
Giovanni Battista "Molinette" Hospital, Cardiology Department 2, Turin, Italy
Purpose: A prevalence of Major Depressive Disorders (MDD) ranging between
15% to 20% has been reported in patients with coronary artery disease (CAD)
and myocardial infarction. Given the significant and negative impact that depression can have on the course, mortality and quality of life in cardiac patients, several clinical guidelines recommended the screening and the evaluation for treatment of depression.
Our aims were to address whether the Hospital Anxiety and Depression Scale
(HADS) can be considered a valid first-step screening tool and to verify which
was the best cut-off value for the depression subscale (HADS-D).
Methods: In a cohort of Acute Coronary Syndrome (ACS) and Coronary Artery
Disease (CAD) patients admitted in a Cardiac Unit, we analysed the concordance
between the HADS-D and one of the gold-standard clinician-rated diagnostic
tools, the Montgomery-Asberg Depression Rating Scale (MADRS). In addition,
we analysed which values, between the standard cut-off of 8 and the cut-off of 5,
recently suggested as optimal in a cardiac population, showed the best concordance in identifying the presence of clinically relevant level of depressive symptoms. 350 patients were analyzed: 244 patients with ACS and 106 CAD patients
composed all the population.
Results: A high positive correlation was found between HADS-D and MADRS
raw scores in both the CVDs (ACS: r=0.71, p<0.001; CAD: r=0.651, p<0.001),
confirming a good convergent validity between the two instruments. The scores
of the MADRS pointed out a 13% prevalence of depressed patients with ACS
and an 18% prevalence of depressed between CAD chronic patients. We found
a substantial agreement between the two assessment tools in both the pathologies when a cut-off value of 8 was used (ACS: McNemar: p=0.327; Cohen K test
= 0.556, p<0.001; CAD: McNemar: p= .648; Cohen K test = 0.351, p<0.001).
Conversely, a fair agreement was found between the MADRS and the HADS using the cut-off of 5 (ACS: McNemar: p<0.001; Cohen K test = 0.317, p=0.057;
CAD: McNemar: p<0.001; Cohen K test = 0.317, p=0.057), which brought to an
overestimation of the percentage of depressed patients.
Conclusions: Results of our study highlighted that the HADS could be considered an effective self-rating instrument to screen for depression in inpatients with
acute coronary syndrome and with coronary artery disease. The early screening
of depression symptoms will allow performing a prompt depression treatment that
could improve the long-term prognosis of cardiac patients.
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Purpose: To explore the prevalence of anxiety symptoms, the association with
cardiovascular risk factors and the prognostic implication of anxiety in patients
hospitalized with acute dyspnea.
Methods: In a prospective cohort-study of 185 patients (mean [SD] age 68 [14]
years, 56% males), the Hospital Anxiety and Depression Scale (HADS) was distributed <48 h of hospitalization. Anxiety was defined as HADS-anxiety score
≥8. We recorded medical history, smoking status, systolic blood pressure and
heart rate on admission, calculated body mass index (BMI) and creatinine clearance and measured high-sensitivity cardiac troponin T (hs-cTnT) and NT-proBNP
levels. The presence of acute heart failure (HF) was adjudicated according to
guidelines by an end-point committee and all-cause mortality was registered.
Results: 56 patients (30%) suffered from anxiety, with no difference between
patients hospitalized due to HF compared to patients with non-HF hospitalization (33% vs. 29%, p=0.63). In univariate analyses, anxiety was associated with
current smoking and lower BMI. In contrast, there was no association between
anxiety and other risk factors. During a median follow-up of 835 days, 53 patients
(29%) died. Anxiety was associated with increased mortality (p=0.021 by the logrank test, Figure 1). Adjusting for established risk factors and acute HF as the
cause of the hospitalization, we still found an independent association between
anxiety and mortality during follow-up: HR 2.0 (1.1-3.5), p=0.026.
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