Perceived social support among percutaneous coronary intervention patients over a long-term follow-up period.

AIM: To investigate perceived social support and the associated factors as well as the sources of social support among post-percutaneous intervention patients over a long-term follow-up period. DESIGN: An explanatory and descriptive survey with a six-year follow-up (STROBE Statement: Supplementary file 1). METHODS: Baseline data (n = 416) were collected from Finnish patients in 2013, with follow-up data collected from the same study group in 2019 (n = 154). The research employed the Social Support of Patients with Coronary Heart Disease self-reported questionnaire. Data were analysed using descriptive statistics and multivariate methods. RESULTS: In the acute phase, higher informational support was associated with lower LDL cholesterol and female gender and higher emotional support with working status. In long-term follow-up period, physical activity, younger age, normal cholesterol levels and previous percutaneous coronary intervention predicted higher informational support, regular participation in follow-up sessions and relationship status predicted higher emotional support, and previous coronary artery bypass grafting, smoking, alcohol consumption, normal cholesterol and regular follow-ups predicted higher functional support. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures.

OBJECTIVE: To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. METHODS: A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. RESULTS: Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01). CONCLUSION: Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.

Neurological outcome after minimally invasive coronary artery bypass surgery (NOMICS): An observational prospective cohort study.

BACKGROUND/OBJECTIVES: Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG. METHODS/DESIGN: In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG. RESULTS: In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups. CONCLUSIONS: The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI. TRIAL REGISTRATION: Registered on ClinicalTrials.gov (NCT02979782).

Effect of peer support on patient anxiety during the coronary angiography or percutaneous coronary intervention perioperative period: a protocol for a systematic review and meta-analysis of randomised controlled trials.

INTRODUCTION: The purpose of this study is to investigate the effect of peer support on patient anxiety during the perioperative period of coronary angiography or percutaneous coronary intervention (PCI). METHODS AND ANALYSIS: We will search the following databases (PubMed, Web of Science, EMBASE, Cochrane Library, CINAHL, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform, Google Scholar, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodicals Database, Chinese BioMedical Database and Wanfang Data) from the date of database inception to January 2019. Only randomised controlled trials will be included. For the data analysis, we will use RevMan V.5.3.5 software to evaluate the risk of bias, and the heterogeneity will be investigated using the Q statistic and P index. Additionally, the Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the quality of evidence. ETHICS AND DISSEMINATION: No ethics approval will be required since this is a systematic review of published studies. We aim to report information regarding the effects of peer support on patient anxiety during the perioperative period of coronary angiography or PCI. This systematic review and meta-analysis will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42019123290.

Employment status three years after percutaneous coronary intervention and predictors for being employed: A nationwide prospective cohort study.

BACKGROUND: Vocational support is recommended for patients in cardiac rehabilitation (CR), as returning to work is important in patients social readjusting after an acute coronary event. Information is lacking on whether CR leads to higher long-term employment after percutaneous coronary intervention (PCI). AIMS: The aims of this study were to determine employment status three years after PCI, to compare employment status between CR participants and CR non-participants and to assess predictors for employment. METHODS: We included first-time PCI patients from the NorStent trial, who were of working age (<63 years; n = 2488) at a three-year follow-up. Employment status and CR participation were assessed using a self-report questionnaire. Propensity score method was used in comparing employment status of CR participants and CR non-participants. RESULTS: Seventy per cent of participants who were <60 years of age at the index event were employed at follow-up and CR participation had no effect on employment status. Being male, living with a partner and attaining higher levels of education were associated with a higher chance of being employed, while being older, prior cardiovascular morbidity and smoking status were associated with lower chance of being employed at follow-up. CONCLUSION: Because a significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization, updated incentives should be implemented to promote vocational support. Such programmes should focus on females, patients lacking higher education and patients who are living alone, as they are more likely to remain unemployed.

Support from next of kin and nurses are significant predictors of long-term adherence to treatment in post-PCI patients.

BACKGROUND: Adherence to treatment is a crucial factor in preventing the progression of coronary heart disease. More evidence of the predictors of long-term adherence is needed. AIMS: The purpose of this study was to identify the predictive factors of adherence to treatment six years after percutaneous coronary intervention. METHODS: Baseline data (n=416) was collected in 2013 and follow-up data in 2019 (n=169) at two university hospitals and three central hospitals in Finland. The self-reported Adherence of Patients with Chronic Disease Instrument was used. Data were analysed using descriptive statistics and binary logistic regression analysis. RESULTS: The respondents reported higher adherence to a healthy lifestyle six years after percutaneous coronary intervention in comparison to four months post-percutaneous coronary intervention; adherence was seen in their healthy behaviour, such as decreased smoking and reduced alcohol consumption. Participating in regular follow-up control predicted adherence. Support from next of kin predicted physical activity and normal cholesterol levels; this outcome was associated with close relationships, which also predicted willingness to be responsible for treatment adherence. Women perceived lower support from nurses and physicians, and they had more fear of complications. Fear was more common among respondents with a longer duration of coronary heart disease. Physical activity and male gender were associated with perceived results of care. CONCLUSION: Support from next of kin, nurses and physicians, results of care, responsibility, fear of complication and continuum of care predicted adherence to treatment in long term. These issues should be emphasised among women, patients without a close relationship, physically inactive and those with a longer duration of coronary heart disease.

Effect of a nurse-led individualized self-management program for Chinese patients with acute myocardial infarction undergoing percutaneous coronary intervention.

BACKGROUND: The study of the development and evaluation of self-management intervention among patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is lacking, especially in China. AIM: To examine the effects of a nurse-led individualized self-management program (NISMP) on health behaviors, control of cardiac risk factors, and health-related quality of life (HRQoL) among patients with AMI undergoing PCI. METHODS: The quasi-experimental design included a convenience sample of 112 participants recruited from a tertiary hospital in China. The participants were assigned to the control group (n = 56) or the intervention group (n = 56). The intervention group underwent the NISMP, which includes six group-based education sessions, a face-to-face individual consultation, and 12-month telephone follow-ups. Data were collected at baseline and at the end of the 12-month program using the Health Promotion Lifestyle Profile, the Risk Factors Assessment Form, and the Short Form 36-item Health Survey. RESULTS: The baseline sociodemographic and clinical characteristics of the two groups were comparable (p > 0.05). After the 12-month intervention, the health behaviors and HRQoL of the participants in the intervention group had significantly improved (p < 0.05 for both) compared to those of the control group. Compared to the control group, the participants in the intervention group also reported significantly better control of cardiac risk factors including smoking (χ2 = 4.709, p = 0.030), low-density lipoprotein (χ2 = 4.160, p = 0.041), body mass index (χ2 = 3.886, p = 0.049) and exercise (χ2 = 10.096, p = 0.001). CONCLUSION: The NISMP demonstrated positive effects on health behaviors, control of cardiac risk factors, and HRQoL among Chinese patients with AMI undergoing PCI.

The effect of nature sounds and earplugs on anxiety in patients following percutaneous coronary intervention: A randomized controlled trial.

BACKGROUND: Percutaneous coronary interventions cause anxiety in patients, although these procedures are lifesaving. AIM: The aim of this study was to determine the effect of nature sounds and earplug interventions on the anxiety of patients after percutaneous coronary interventions. METHODS: A randomized controlled trial design was used in this study. A total of 114 patients who were scheduled to undergo percutaneous coronary intervention were allocated to three groups in a randomized manner: two intervention groups (nature sound group, earplug group) and one control group. The Visual Analog Scale, State Anxiety Inventory and physiological parameters were used to measure anxiety. Data were collected from the patients at three time points: immediately before, immediately after and 30 minutes after the interventions. RESULTS: The respiratory rates and the Visual Analog Scale and State Anxiety Inventory scores of patients in the nature sound and earplug groups immediately after and 30 minutes after the interventions were significantly lower than those of the control group (p < 0.05). No differences were found when comparing respiratory rates, Visual Analog Scale scores and State Anxiety Inventory scores between patients in the nature sound group and patients in the earplug group (p > 0.05). No changes were observed in the pulse and systolic/diastolic blood pressure values of patients in the control and intervention groups (p > 0.05). CONCLUSIONS: It was determined that nature sounds and earplug interventions are effective in reducing the anxiety of patients following percutaneous coronary intervention.

Identifying patients with refusal of percutaneous coronary intervention for acute myocardial infarction: a classification and regression tree analysis.

The purpose of the present study is to develop and validate a prediction tool to identify patients who refuse to receive percutaneous coronary intervention (PCI) rapidly. We developed a risk stratification model using the derivation cohort of 288 patients with ST segment elevation myocardial infarction (STEMI) in our hospital and validated it in a prospective cohort of 115 patients. There were 52 (18.1%) patients and 18 (15.7%) patients who refused PCI among derivation and validation cohort, respectively. A classification and regression tree (CART) analysis and multivariate logistic regression were used for statistical analysis. The decision-making factors for refusal of PCI were also investigated. The CART analysis and logistic regression both showed that self-rated mild symptom was the most significant predictor of not choosing PCI. The model generated three risk groups. The high-risk group included: self-rated mild symptoms; self-rated severe symptom, glomerular filtration rate < 60 ml/min/1.73m2. The intermediate-risk group included: self-rated severe symptom, glomerular filtration rate ≥ 60 ml/min/1.73m2 and age ≥ 75 years. The low-risk group included: self-rated severe symptom, glomerular filtration rate ≥ 60 ml/min/1.73m2 and age < 75 years. The prevalence for refusal of PCI of the three groups were 45%-44%, 18% and 4%, respectively. The sensitivity was 88% and the negative predictive value was 96%. And similar results were obtained when this prediction tool was applied prospectively to the validation cohort. Patients at low and high risk can be easily identified for refusal of PCI by the prediction tool using common clinical data. This practical model might provide useful information for rapid recognition and early response for this kind of crowd.

Social support for patients with coronary artery disease after percutaneous coronary intervention.

BACKGROUND: To assess how social support relates to parameters of patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI), and how social support affects patient's prognosis within 1 year after surgery. METHODS: The study included 739 male and 236 female patients (975) who underwent PCI. To determine level of social support, the Multidimensional Scale of Perceived Social Support was used. The mean duration of a prospective follow-up was 12.0 ±â€¯1.7 months. The Cox multivariate regression proportional hazard model was used to estimate the hazard ratio (HR) of death from all causes and cardiovascular disease (CVD). RESULTS: A low level of social support in 5.7% of patients was observed, while 30.5% had a moderate level and 63.8% had a high level. Patients with low and moderate levels of social support were older than those with high level. Among patients with high levels of social support, more were male compared to patients with moderate level. During observation, 24 patients died from all causes (2.5%), while 21 (2.2%) died from CVD. In the multivariate Cox regression model the HR of social support for all causes of death was 0.97 (95% confidence interval, [CI], 0.94-0.99, p = 0.007), while death from CVD was 0.97 (95% CI, 0.94-1.00, p = 0.048). For patients with low level of social support, the HR for death from all causes was 4.52 (95% CI, 1.37-14.95, p = 0.013), while death from CVD was 3.66 (95% CI, 0.94-14.25, p = 0.061). CONCLUSION: Social support level was associated with age and gender, and significantly and independently affected CAD patients' risk of death after PCI.

Association between illness perception and health-related quality of life in patients with preexisting premature coronary artery disease.

OBJECTIVES: Illness perception in younger age differs from that in older age. We aimed to examine the association between illness perception and health-related quality of life (HRQoL) in patients with premature coronary artery disease (CAD). METHODS: In a cross-sectional design, between November 2016 and September 2017, a total of 779 adults (52.5% female) with premature CAD (diagnosed in men aged ≤ 45 y and women aged ≤ 55 y) completed the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Brief Illness Perception, and the Short-Form Health Survey 36 questionnaires in an outpatient clinic 8 years after the diagnosis. RESULTS: The patients were treated with coronary artery bypass graft surgery (24.6%), percutaneous coronary intervention (39.5%), and medical treatment (35.8%). The cognitive, emotional, and comprehension aspects of illness perception had significant associations with both physical and mental health in univariable analysis (all Ps < 0.001). After adjustments for potential confounding factors, higher cognitive perception was independently associated with greater physical health [OR = 4.13, Confidence interval (CI): 3.53-4.72] and mental health (OR = 3.17, CI: 2.57-3.77). Additionally, emotional perception was also directly associated with higher physical (OR = 1.62, CI: 1.17-2.06) and mental (OR = 1.52, CI: 1.07-1.96) health; all Ps < 0.001. CONCLUSIONS: Of the 3 different aspects of illness perception, cognitive perception appeared to have the greatest influence on HRQoL, either physical or mental health. Further studies are needed to investigate whether cognitive interventions can improve HRQoL in premature CAD patients and, thus, their outcome.

Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective.

BACKGROUND: Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge. OBJECTIVES: To explore patients' experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention. DESIGN: An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention. SETTINGS: Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology. PARTICIPANTS: Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017. METHODS: Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis. FINDINGS: Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence. CONCLUSION: Patients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities.

Family involvement in rehabilitation: Coronary artery disease-patients' perspectives.

AIMS AND OBJECTIVES: To describe coronary artery disease patients' perceptions of family involvement in rehabilitation and the connection between background factors and family involvement. BACKGROUND: Coronary artery disease patients' hospital stays can be very concise. Family members can support rehabilitation, but many challenges can emerge. There is a need to nurture patients and family members in an individual way and to recognise their concerns. More accurate patient education should be available for patients and their family members. DESIGN: This study is a descriptive cross-sectional study. METHODS: Data were collected from patients with coronary artery disease at least 6 weeks after discharge from hospital (n = 169) with a postal questionnaire. The Family Involvement in Rehabilitation (FIRE) scale measures family members' promotion of patients' rehabilitation and issues encumbering rehabilitation in family. The data have been analysed with statistical methods. Both parametric and nonparametric tests were used to evaluate group differences. RESULTS: Patients with coronary artery disease perceived that family promotes their rehabilitation significantly. Respondents also perceived challenges at home. Family relations before hospitalisation were related to all subareas of family promoting rehabilitation and one subarea of issues encumbering rehabilitation in family. Patients with symptoms at rest also had more encumbrance on their rehabilitation. Patients who had undergone coronary artery bypass surgery perceived more challenges than percutaneous coronary intervention (PCI) patients in many subareas of issues encumbering rehabilitation in family. CONCLUSIONS: Family relations prior to illness and the rigour of heart symptoms are significantly relevant to challenges that can occur between patient and their family members. RELEVANCE TO CLINICAL PRACTICE: Healthcare staff need to pay attention to coronary artery disease patients' individual situation, and patient education should be more family-centred. In the future, it would be noteworthy to collect more data from family members of patients with coronary artery disease and to find out their perceptions of family involvement.

Predictors of smoking relapse after percutaneous coronary intervention in Chinese patients.

AIMS AND OBJECTIVES: To evaluate the prevalence and predictors of smoking relapse after percutaneous coronary intervention in Chinese patients. BACKGROUND: Smoking is considered a vital risk factor for coronary heart disease. Although smoking cessation could decrease the risks of adverse cardiac outcomes, many patients resume smoking following a short period of abstinence. However, little is known about smoking resumption in patients who have undergone percutaneous coronary intervention. DESIGN AND METHODS: A longitudinal study was conducted among Chinese patients who underwent percutaneous coronary intervention. Predictive variables were assessed at baseline through medical records and interviews with questionnaires including the Fagerström Test for Nicotine Dependence, Center for Epidemiologic Studies-Depression scale and Smoking Self-Efficacy Questionnaire. Smoking relapses were recorded at three, six, nine and 12 months by the self-reporting through telephone or at routine visits to the cardiology outpatient clinics. RESULTS: A total of 221 patients who quit smoking immediately after percutaneous coronary intervention completed the whole study. Overall, 51.1%(n = 113) of the patients relapsed within 12 months after percutaneous coronary intervention. The prevalence showed a particular rise (49.6%, n = 56) in the first 3 months and a more gradual increase in the following months. The patients who were employed and had higher nicotine dependence, worse depressive symptoms and lower level of smoking self-efficacy were more vulnerable to relapse to cigarettes. CONCLUSION: The prevalence of smoking relapse is high in the patients who stop smoking in the hospital due to percutaneous coronary intervention. The predictors of smoking relapse are employment, nicotine dependence, depression and smoking self-efficacy in the post- percutaneous coronary intervention patients. RELEVANCE TO CLINICAL PRACTICE: This study may prompt the healthcare providers to focus on the issue of smoking relapse and provide some instructions for identification of the patients with a high-risk of relapse after percutaneous coronary intervention.

Persistent smoking rate after coronary revascularization and factors related to smoking cessation in Turkey.

Background: Although smoking is an established risk factor for coronary artery disease, smoking cessation efforts, as part of a lifestyle change, have been disappointing so far. Therefore, assessing current smoking trends and identifying patients who are at risk of smoking continuation is of paramount importance. In this study, our aim was to assess current smoking rates after coronary revascularization as of 2017, and to define factors that potentially affect smoking cessation. Methods: Overall, 350 patients who had undergone coronary revascularization, either by percutaneous coronary intervention or bypass surgery were included in this cross-sectional, observational study. Patients were queried for various sociodemographic characteristics and smoking habits. Disease related data were obtained from the hospital archives. Results: The overall smoking rate was 57% after coronary revascularization. Age, bypass surgery and the occurrence of in-hospital adverse events were found to be independent predictors of smoking cessation in multivariate analysis. Conclusions: Despite efforts, smoking rates after coronary intervention remain substantially high. Therefore, a multidisciplinary approach to smoking cessation that incorporates cardiac rehabilitation programs and medications should be implemented in clinical practice.

Impact of smoking on health-related quality of Life after percutaneous coronary intervention treated with drug-eluting stents: a longitudinal observational study.

BACKGROUND: Smoking has been shown to reduce health-related quality of life (HRQOL) in patients with coronary artery disease (CAD) undergoing percutanous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents (BMS). Drug-eluting stents (DES) have now been widely used and are related to substantial reduction of restenosis and significantly improved HRQOL compared with BMS. This study aimed to evaluate the effects of smoking on HRQOL in patients after PCI in DES era. METHODS: A cohort of 649 patients admitted for CAD and treated with drug-eluting stents were included in this prospective, observational study. Patients were classified as non-smokers (n = 351, 54.1%), quitters (n = 126, 19,4%), or persistent smokers (n = 172, 26.5%) according to their smoking status at the time they first admitted to hospital and during the first year of follow-up. Each patient was prospectively interviewed at baseline, 6 months and 1 year following PCI. HRQOL was assessed with the use of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). RESULTS: For the overall population, HRQOL scores at 1-year follow-up were significantly higher than baseline for all 8 domains. At 1-year follow-up, the HRQOL scores in persistent smokers were still lower than that in non-smokers in 6 domains except for bodily pain and mental health, and than that in quitters in 5 domains except for bodily pain, role emotional and mental health. There were no significant differences with regard to the scores between non-smokers and quitters except role emotional for which non-smokers had higher scores. After adjustment, persistent smokers demonstrated significantly less improvements in HRQOL than non-smokers in 6 domains except for bodily pain and social functioning and significantly less improvement than quitters for general health. Improvements of quitters were comparable to that of non-smokers in all domains. Multivariate linear regression analyses showed persistent smoking was an independent risk factor for PCS and MCS improvements. CONCLUSIONS: Persistent smoking substantially diminishes the potential quality-of-life benefits of DES. Efforts should be made to promote smoking cessation after DES implantation which could greatly improve the health quality outcomes.

Predictors of Depression in Patients Diagnosed with Myocardial Infarction after Undergoing Percutaneous Coronary Intervention: A literature review.

AIM: This study identified the factors associated with depression in patients diagnosed with myocardial infarction (MI) who underwent percutaneous coronary intervention (PCI). METHODS: We searched the literature using PubMed and CINAHL from their inception in 1946 to December 2014. The search terms were "myocardial infarction," "depression," and "percutaneous coronary intervention." Studies which investigated factors associated with depression in patients diagnosed with MI who underwent typical medical procedures were searched. RESULTS: Eleven studies met our inclusion criteria. None of these limited their samples to patients with MI who underwent PCI. Twenty-one factors were identified as possible risk factors for depression in patients who were diagnosed with MI and underwent PCI: gender; negative illness beliefs; neuroticism; autonomy; baseline depression scores; previous diagnosis of depression, anxiety, or stress; smoking; marital status; Type D personality; procedure; length of hospital stay; fat intake; functional disability; time engaged in physical activity; social support; and a history of angina, MI, coronary artery bypass graft surgery, PCI, diabetes mellitus, and stroke. CONCLUSIONS: This review suggests that these 21 factors should be considered in future studies as possible independent variables or covariates of depression among MI patients who have undergone PCI.

Increased prevalence of anxiety and depression symptoms in patients with coronary artery disease before and after percutaneous coronary intervention treatment.

BACKGROUND: Evidence suggests that coronary heart disease (CHD) is associated with increased anxiety and a high incidence of comorbid anxiety and depression. However, the association between percutaneous coronary intervention (PCI) and comorbid anxiety and depression has not been previously investigated. This study aims to determine the relationship between PCI and anxiety and depression symptoms in CHD patients in terms of the occurrence, prone factors, and long-term outcomes of CHD. METHODS: One hundred seventy CHD patients who underwent PCI treatment between September 2013 and February 2014 at the Second Hospital of Hebei Medical University were randomly selected. All patients independently completed the Hospital Anxiety and Depression Scale (HADS) and a preoperative questionnaire; they also provided details regarding their PCI-related concerns one day before PCI, as well as one day and one, three, six, and 12 months after PCI. RESULTS: PCI treatment was significantly associated with the symptoms of anxiety, depression, affective disorders, and comorbid anxiety and depression (χ(2) = 90.18, 54.45, 101.59, 64.83; p < 0.01) at each follow-up time point. Moreover, PCI treatment was linearly correlated with each of these psychological issues (p < 0.01). CONCLUSION: The prevalence of anxiety, depression, and comorbid anxiety and depression symptoms significantly increases one day before and after PCI treatment; however, the incidence of these psychological issues significantly decreases with time following PCI. A low level of education, apprehension with regard to nursing quality, potential cardiac dysfunction, surgery sequelae, and surgery failure are also associated with a high prevalence of anxiety and depression symptoms.

Estado de saúde e saúde mental de pacientes após intervenção coronária percutânea / Estado de salud y salud mental de pacientes tras intervención coronaria percutánea / Health status and mental health in patients after percutaneous coronary intervention

RESUMOObjetivo:avaliar a associação entre o estado de saúde percebido e a saúde mental de pacientes submetidos à intervenção coronária percutânea, após a alta hospitalar.Método:estudo quantitativo, transversal, com 101 participantes. Os instrumentos utilizados foram: caracterização sociodemográfica e clínica, Medical Outcomes Study 36-Item Short-Form Health Survey (SF- 36) e Escala Hospitalar de Ansiedade e Depressão (HADS). Os participantes foram divididos em três grupos: sem ansiedade e sem depressão (G1), com ansiedade ou depressão (G2) e com ambos (G3). Para comparação das médias dos domínios do SF-36 entre os grupos, foi utilizado o teste ANOVA.Resultados:houve associação entre o estado de saúde percebido e a saúde mental. Participantes pertencentes ao G1 apresentaram maiores escores em todos os domínios do SF-36 quando comparado àqueles pertencentes ao G2 e G3.Conclusão:participantes sem ansiedade e depressão apresentaram melhor estado de saúde percebido que aqueles com ansiedade ou depressão, ou ambos.

RESUMENObjetivo:evaluar la asociación entre el estado de salud percibido y la salud mental de pacientes sometidos a intervención coronaria percutánea tras el alta.Método:estudio cuantitativo, transversal, con 101 participantes. Los instrumentos utilizados fueron: instrumento de caracterización sociodemográfica y clínica, Medical Outcomes Study 36-Item Short-Form Health Surrvey(SF-36) y Escala Hospitalaria de Ansiedad y Depresión (HADS). Los participantes fueron divididos en tres grupos: sin ansiedad y sin depresión (G1), con ansiedad o con depresión (G2) y con ambos (G3). Para comparar los promedios de los dominios del SF-36 entre los grupos, fue utilizado el test ANOVA.Resultados:hubo asociación entre el estado de salud percibido y salud mental. Los participantes en G1 revelaron mayores escores en todos los dominios del SF-36 en comparación con aquellos en G2 y G3.Conclusión:los participantes sin ansiedad y sin depresión presentaron mejor estado de salud percibido en comparación con aquellos con ansiedad o con depresión, o con ambos.

ABSTRACTObjective:to assess the association between perceived health status and the mental health of patients submitted to percutaneous coronary intervention after hospital discharge.Method:a quantitative and cross-sectional study involving 101 participants. The following instruments were used: a sociodemographic and clinical characterization instrument, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). Participants were divided into three groups: no anxiety and no depression (G1); anxiety or depression (G2); and both (G3). The ANOVA test was used for the intergroup comparison of means on the SF-36 domains.Results:There was an association between perceived health status and mental health. The participants in G1 presented higher scores in all SF-36 domains in comparison with participants in G2 and G3.Conclusion:Participants with no anxiety and depression presented better-perceived health status in comparison with those with anxiety or depression, or both.

[Effect of a vascular event on drug regimen compliance in patients with coronary atherosclerosis].

In order to assess the effect of a vascular event on adherence to treatment we examined a total of 68 patients presenting with coronary atherosclerosis. The patients' age varied from 31 to 84 years (mean 57.1±8.7). There were 55 (81.1%) men and 13 (18.9%) women. Drug regimen compliance was evaluated by means of the Morisky-Green Medication Adherence Questionnaire before and after the vascular event. Of the 68 examined patients, 15 (22.1%) had not taken any therapeutic agents before the vascular event occurred, despite existing arterial hypertension. Drug regimen compliance prior to the vascular event was low in 82.4% of cases. The number of patients with coronary atherosclerosis and low compliance to treatment before the vascular event decreased significantly thereafter (p=0.0012). After the vascular event, the number of patients adhering to the doctor's recommendations on medicamentous therapy increases considerably. At the same time, a sufficiently great number of patients [about 30% of patients after endured myocardial infarction (MI) and 18% after transcutaneous coronary intervention (TCI)] still remain in the category of those "having low drug regimen compliance" and, accordingly, have high risk for the development of recurrent vascular events. Endured TCI increases patient compliance more significantly than MI, which requires additional study of a psychological component of the given fact.