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1.
Can J Cardiol ; 38(1): 113-122, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33974991

RESUMO

BACKGROUND: The placebo effect is a well described phenomenon in blinded studies evaluating antianginal therapeutics, although its effect on clinical research metrics remains unknown. We conducted a systematic review and meta-analysis to quantify the effect of placebo on end points of symptoms, life quality, and functional outcomes in randomized placebo-controlled trials (RCTs) of symptomatic stable coronary artery disease. METHODS: We systematically reviewed MEDLINE, EMBASE, and the Cochrane database for double-blind RCTs of antiangina therapeutics. Patients randomized to the placebo arm were the study population. Main outcomes were the changes in exercise performance (exercise treadmill test [ETT] parameters), quality of life (Seattle Angina Questionnaire domains), symptoms (Canadian Cardiovascular Society angina class) and drug usage (nitroglycerin tablets per week) between baseline and after placebo treatment. The primary outcome was ETT total duration time. Data were pooled with a random effect model. RESULTS: Seventy-eight RCTs (83% drug-controlled, 17% procedure-controlled) were included encompassing 4925 patients randomized to placebo. ETT total duration time was significantly improved after placebo treatment compared with baseline (mean, 29.2; 95% confidence interval, 20.6-37.8] seconds) with evidence of high heterogeneity (I2 = 98%) At subgroup analysis, crossover design was associated with a smaller placebo effect on ETT performance than parallel study design (P for interaction = 0.001). A significant placebo effect was observed for all secondary outcomes with overall high heterogeneity. CONCLUSIONS: A substantial placebo effect was present in angina RCTs across a variety of functional and life quality metrics. High variability in placebo effect size was present, mostly unexplained by differences in study and patient characteristics.


Assuntos
Angina Pectoris/tratamento farmacológico , Fármacos Cardiovasculares/uso terapêutico , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Angina Pectoris/psicologia , Humanos , Efeito Placebo
2.
Am J Cardiol ; 164: 1-6, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34838288

RESUMO

Angina is a common symptom in patients with coronary artery disease (CAD); however, its impact on patients' quality of life over time is not well understood. We sought to determine the longitudinal association of angina frequency with quality of life and functional status over a 5-year period. We used data from the Heart and Soul Study, a prospective cohort study of 1,023 outpatients with stable CAD. Participants completed the Seattle Angina Questionnaire (SAQ) at baseline and annually for 5 years. We evaluated the population effect of angina frequency on disease-specific quality of life (SAQ Disease Perception), physical function (SAQ Physical Limitation), perceived overall health, and overall quality of life, with adjusted models. We evaluated these associations within the same year and with a time-lagged association between angina and quality of life reported 1 year later. Generalized estimating equation models were used to account for repeated measures and within-subject correlation of responses. Over 5 years of follow-up, patients with daily or weekly angina symptoms had lower quality of life scores (52 vs 89, p <0.001) and greater physical limitation (61 vs 86, p <0.001) after adjustment. Compared with patients with daily or weekly angina symptoms, those with no angina symptoms had 2-fold greater odds of better quality of life (odds ratio 2.39, 95% confidence interval 1.76 to 3.25) and 5-fold greater odds of better perceived overall health (odds ratio 5.45, 95% confidence interval 3.85 to 7.73). In conclusion, angina frequency is strongly associated with quality of life and physical function in patients with CAD. Even after modeling to adjust for both clinical risk factors and repeated measures within subjects, we found that less frequent angina symptoms were associated with better quality of life.


Assuntos
Angina Pectoris/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Qualidade de Vida , Idoso , Angina Pectoris/psicologia , Estudos de Coortes , Doença da Artéria Coronariana/psicologia , Depressão/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Desempenho Físico Funcional , Estudos Prospectivos , Comportamento Sedentário
3.
Circ Cardiovasc Imaging ; 13(8): e010710, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32772572

RESUMO

BACKGROUND: The inferior frontal lobe is an important area of the brain involved in the stress response, and higher activation with acute mental stress may indicate a more severe stress reaction. However, it is unclear if activation of this region with stress correlates with angina in individuals with coronary artery disease. METHODS: Individuals with stable coronary artery disease underwent acute mental stress testing using a series of standardized speech/arithmetic stressors in conjunction with high resolution positron emission tomography imaging of the brain. Blood flow to the inferior frontal lobe was evaluated as a ratio compared with whole brain flow for each scan. Angina was assessed with the Seattle Angina Questionnaire's angina frequency subscale at baseline and 2 years follow-up. RESULTS: We analyzed 148 individuals with coronary artery disease (mean age [SD] 62 [8] years; 69% male, and 35.8% Black). For every doubling in the inferior frontal lobe activation, angina frequency was increased by 13.7 units at baseline ([Formula: see text], 13.7 [95% CI, 6.3-21.7]; P=0.008) and 11.6 units during follow-up ([Formula: see text], 11.6 [95% CI, 4.1-19.2]; P=0.01) in a model adjusted for baseline demographics. Mental stress-induced ischemia and activation of other brain pain processing regions (thalamus, insula, and amygdala) accounted for 40.0% and 13.1% of the total effect of inferior frontal lobe activation on angina severity, respectively. CONCLUSIONS: Inferior frontal lobe activation with mental stress is independently associated with angina at baseline and during follow-up. Mental stress-induced ischemia and other pain processing brain regions may play a contributory role.


Assuntos
Angina Pectoris/fisiopatologia , Circulação Cerebrovascular , Doença da Artéria Coronariana/fisiopatologia , Lobo Frontal/irrigação sanguínea , Estresse Psicológico/fisiopatologia , Idoso , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/psicologia , Velocidade do Fluxo Sanguíneo , Mapeamento Encefálico , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Percepção da Dor , Tomografia por Emissão de Pósitrons , Índice de Gravidade de Doença , Estresse Psicológico/diagnóstico por imagem , Estresse Psicológico/psicologia
4.
J Psychosom Res ; 134: 110110, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32345456

RESUMO

Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD. OBJECTIVE: Examine brain correlates of mental stress in patients with CAD with and without a history of angina. METHODS: Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina. RESULTS: Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history. CONCLUSIONS: Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.


Assuntos
Angina Pectoris/psicologia , Encéfalo/fisiopatologia , Estresse Psicológico/complicações , Doença Aguda/psicologia , Adulto , Angina Pectoris/complicações , Encéfalo/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Estresse Psicológico/diagnóstico por imagem , Estresse Psicológico/fisiopatologia
5.
J Cardiovasc Med (Hagerstown) ; 21(5): 377-382, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32205502

RESUMO

AIMS: There is evidence that stable angina patients may suffer from emotional disorders that further impair their quality of life. However, the emotional experience of living with stable angina from the patient's perspective still has to be explored. Thus, the main aim of this study was to explore patients' emotional experience of having stable angina and their reported needs during the pathway from the first symptoms, through the process of diagnosis, to management and related lifestyle changes. METHODS: A survey was conducted in 75 chronic ischemic heart disease patients with angina (Brazil, China, Romania, Russia, and Turkey) using a 75-min, face-to-face in-depth interview. RESULTS AND CONCLUSION: Patients' responses highlighted the need to increase individuals' awareness on the first signs and symptoms of the disease. The survey also showed that chronic stable angina patients need constant emotional support to overcome stress, anxiety, and depression. Finally, this study suggests the need to offer greater space for dialogue with healthcare professionals to get more comprehensive and 'patient-friendly' information.


Assuntos
Adaptação Psicológica , Angina Pectoris/psicologia , Efeitos Psicossociais da Doença , Emoções , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Qualidade de Vida , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/terapia , Conscientização , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Comportamento de Redução do Risco
6.
J Intern Med ; 287(5): 558-568, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31960499

RESUMO

OBJECTIVE: To assess the association between specific heart diseases and suicide. DESIGN: Nationwide retrospective cohort study. PARTICIPANTS: A total of 7 298 002 individuals (3 640 632 males and 3 657 370 females) aged ≥15 years and living in Denmark during 1980-2016. MAIN OUTCOME MEASURES: Incidence rate ratios (IRR) with 95% confidence intervals. In multivariate analysis, we adjust for sex, period, age group, living status, income level, Charlson Comorbidity Index, psychiatric disorders prior to heart disease and self-harm prior to heart disease. RESULTS: Excess suicide rate ratios were found for following disorders: heart failure (IRR: 1.48; 95% CI: 1.38-1.58); cardiomyopathy (IRR: 1.41; 95% CI: 1.16-1.70); acute myocardial infarction (IRR: 1.28; 95% CI: 1.21-1.36); cardiac arrest with successful resuscitation (IRR: 4.75; 95% CI: 3.57-6.33); atrial fibrillation and flutter (IRR: 1.42; 95% CI: 1.32-1.52); angina pectoris (IRR: 1.19; 95% CI: 1.12-1.26); and ventricular tachycardia (IRR: 1.53; 95% CI: 1.20-1.94). A higher rate of suicide was noted during the first 6 months after the diagnosis of heart failure (IRR: 2.38; 95% CI: 2.04-2.79); acute myocardial infarction (IRR: 2.24; 95% CI: 1.89-2.66); atrial fibrillation and flutter (IRR: 2.70; 95% CI: 2.30-3.18); and angina pectoris (IRR: 1.83; 95% CI: 1.53-2.19) when compared to later. CONCLUSION: Several specific disorders were found to be associated with elevated rates of suicide. Additionally, we found temporal associations with higher suicide rates in the first time after diagnosis. Our results underscore the importance of being attentive towards psychological distress in individuals with heart disease.


Assuntos
Cardiopatias/psicologia , Suicídio Consumado/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/mortalidade , Angina Pectoris/psicologia , Fibrilação Atrial/mortalidade , Fibrilação Atrial/psicologia , Dinamarca/epidemiologia , Feminino , Cardiopatias/mortalidade , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/psicologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/psicologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem
7.
J Cardiovasc Nurs ; 35(4): 375-385, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929322

RESUMO

BACKGROUND: Patients with refractory angina pectoris experience recurrent symptoms that limit their functional capacity, including psychological distress and impaired health-related quality of life (HRQoL), despite optimized medical therapy. Enhanced external counterpulsation (EECP) is an evidence-based alternative noninvasive treatment. Although physical well-being and mental well-being are equally important components of health, few studies have investigated the psychological effects of EECP in patients with refractory angina pectoris. OBJECTIVE: The aim of this study was to evaluate the effects of EECP treatment in patients with refractory angina pectoris regarding medication profile, physical capacity, cardiac anxiety, and HRQoL. METHODS: This quasi-experimental study with 1-group pretest-posttest design includes a 6-month follow-up of 50 patients (men, n = 37; mean age, 65.8 years) who had undergone 1 EECP course. The following pretreatment and posttreatment data were collected: medication use, 6-minute walk test results, functional class according to the Canadian Cardiovascular Society, and self-reported (ie, questionnaire data) cardiac anxiety and HRQoL. In addition, the questionnaires were also completed at a 6-month follow-up. RESULTS: After EECP treatment, patients used significantly less nitrates (P < .001), walking distance increased on average by 46 m (P < .001), and Canadian Cardiovascular Society class improved (P < .001). In addition, all but 1 subscale of cardiac anxiety and all HRQoL components improved significantly (P < .05). The positive effects for cardiac anxiety and HRQoL were maintained at the 6-month follow-up. CONCLUSIONS: Enhanced external counterpulsation treatment resulted in reduced symptom burden, improved physical capacity, and less cardiac anxiety, leading to increased physical activity and enhanced life satisfaction for patients with refractory angina pectoris. Enhanced external counterpulsation treatment should be considered to improve the life situation for these patients.


Assuntos
Angina Pectoris/psicologia , Angina Pectoris/terapia , Ansiedade/psicologia , Contrapulsação/métodos , Qualidade de Vida/psicologia , Índice de Gravidade de Doença , Idoso , Angina Pectoris/complicações , Ansiedade/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Resultado do Tratamento
8.
Qual Life Res ; 29(4): 1027-1035, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31823184

RESUMO

BACKGROUND: Despite the negative impact of angina and its worsening symptoms on the quality of life of the affected patients, little research has evaluated the factors associated with poor health-related quality of life (HRQOL) among patients with angina. OBJECTIVE: The study aim was to evaluate HRQOL and to explore factors associated with poor HRQOL in patients with angina in Jordan. SETTING: The present study used data collected for patients attending the cardiology clinic at the Royal Medical Services (RMS) Hospital in Amman. METHODS: In addition to collecting sociodemographic and clinical data, the EQ-5D questionnaire was used to assess HRQOL in outpatients with angina in the present study. Multiple linear regression analysis was conducted to build a model with variables that are significantly and independently associated with poor HRQOL. MAIN OUTCOME MEASURE: HRQOL quantified using the EQ-5D. RESULTS: The mean of the total EQ-5D score of the 500 participants was 0.392. Most of the patients reported 'some problems' through the five dimensions, with the highest percentage (66.6%) related to mobility domain. Regression analysis identified female gender (B = - 0.232; P < 0.05) elevated fasting blood sugar (FBS) (P < 0.05; B = - 0.219), and low high density lipoprotein (HDL) (B = - 0.183; P < 0.05) as being significantly associated with poor HRQOL. CONCLUSIONS: The HRQOL has considerable scope for improvement for patients with angina in Jordan. Female gender, elevated FBS, and decreased HDL levels were significantly associated with poor HRQoL in the present study.


Assuntos
Angina Pectoris/psicologia , Glicemia/análise , Nível de Saúde , Lipoproteínas HDL/sangue , Qualidade de Vida/psicologia , Adulto , Idoso , Feminino , Humanos , Jordânia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Questionário de Saúde do Paciente , Análise de Regressão
9.
Qual Life Res ; 29(4): 1093-1105, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31832979

RESUMO

PURPOSE: The aim of this study was to evaluate psychometric properties of the core disease-specific 14-item German HeartQoL questionnaire. METHODS: As an extension of the international HeartQol Project, cross-sectional and longitudinal health-related quality of life (HRQL) data were collected from 305 patients with angina (N = 101), myocardial infarction (N = 123), or ischemic heart failure (N = 81) in Austria and Switzerland using German versions of the HeartQoL, the Short Form-36 Health Survey (SF-36), and the Hospital Anxiety and Depression Scale. The underlying factor structure was examined with Mokken Scaling analysis; then convergent, divergent, and discriminative validity, internal consistency reliability, and responsiveness were assessed. RESULTS: The highest HRQL scores were reported by patients with myocardial infarction followed by ischemic heart failure and then angina. The two-factor structure was confirmed with strong physical, emotional, and global scale H coefficients (> .50). Divergent and convergent validity (from r = .04 to .78) were shown for each diagnosis; discriminative validity was verified as well (partially: age, sex, and disease severity; largely: SF-36 health status/transition; totally: anxiety and depression). Internal consistency reliability was excellent (Cronbach's alpha = .91). In terms of responsiveness, physical and global scale scores improved significantly after percutaneous coronary intervention (p < .01) while after cardiac rehabilitation all scale scores improved significantly (p < .001). CONCLUSIONS: The German HeartQoL questionnaire is a valid and reliable HRQL instrument with these data supporting its potential use in clinical practice and research to assess and compare HRQL in German-speaking patients with ischemic heart disease. The shortness of the tool may prove to be helpful particularly in clinical practice.


Assuntos
Isquemia Miocárdica/psicologia , Psicometria/métodos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Idoso , Angina Pectoris/psicologia , Ansiedade/psicologia , Transtornos de Ansiedade/psicologia , Áustria , Estudos Transversais , Depressão/psicologia , Transtorno Depressivo/psicologia , Emoções , Feminino , Nível de Saúde , Insuficiência Cardíaca/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , Reprodutibilidade dos Testes , Suíça
10.
PLoS One ; 14(11): e0224451, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31703084

RESUMO

BACKGROUND: Psychological distress is an undifferentiated combination of symptoms that may be related to the occurrence of angina pectoris (AP). However, few studies have investigated the relationship between psychological distress and AP, particularly in Asian populations. The purpose of this study was to examine the relationship between psychological distress and AP in Taiwanese adults. METHODS: We adopted a cross-sectional design to explore the data of the 2005-2008 Nutrition and Health Survey in Taiwan. In total, 2080 subjects (aged ≥ 19 years) responded to questionnaire interviews and underwent physical examinations. Each of the five dimensions of psychological distress (sleep disturbance, anxiety, hostility, depression, and feelings of inferiority) were scored (from 0-20) according to the Five-Item Brief Symptom Rating Scale (BSRS-5). A score ≥ 6 points indicated psychological distress. AP was evaluated using a modified Rose questionnaire. FINDINGS: In total, 102 subjects (3.6%) had AP, and 231 subjects (8.8%) had symptoms of psychological distress. After adjusting for the basic data, metabolism, and lifestyle covariates, the BSRS-5 total score was associated with AP (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.13-1.26, p < 0.001). Subjects with psychological distress had a higher risk of AP (OR = 2.97, 95% CI = 1.76-4.99, p < 0.001). CONCLUSIONS: The presence of AP is associated with psychological distress. Health care providers should therefore be aware of the impact of psychological distress on AP. Our study findings can serve as a reference for AP assessments. Large scale longitudinal studies are needed to confirm a causal relationship between psychological distress and AP.


Assuntos
Angina Pectoris/psicologia , Angústia Psicológica , Adolescente , Adulto , Idoso , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
J Psychosom Res ; 125: 109794, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31445320

RESUMO

OBJECTIVE: Cardiac patients with psychological distress have a poorer prognosis than patients without distress; which may in part reflect differences in treatment. We quantified variation in coronary angiography and revascularisation procedures according to psychological distress among patients admitted with incident acute myocardial infarction (AMI) or angina. METHODS: Questionnaire data (collected 2006-09) from 45 and Up Study participants were linked to hospitalisation and mortality data, to 30 June 2016. Among patients free from ischaemic heart disease at baseline and subsequently hospitalised with AMI or angina, Cox regression was used to model the association between distress (Kessler-10 scores: low [10-<12], mild [12-<16], moderate [16-<22] and high [22-50]) - assessed on the questionnaire - and coronary angiography and revascularisation procedures (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) within 30 days of admission, adjusting for personal characteristics, including physical functioning. RESULTS: Proportions receiving angiography and PCI/CABG were 71.4% and 51.7% following AMI (n = 3749), and 61.3% and 31.3% for angina patients (n = 3772), respectively. Following AMI, age-sex-adjusted rates of PCI/CABG were lower with higher levels of distress (test for trend: p = .037), as were rates of angiography and PCI/CABG (p < .01) following admission with angina. After additional adjustment for personal characteristics, associations between distress and procedure rates attenuated substantively and were no longer significant, except that PCI/CABG rates remained lower among angina patients with high versus low distress (HR = 0.76, 95%CI: 0.59-0.99). CONCLUSION: Distress-related variation in coronary procedures largely reflects differences in personal characteristics. Whether lower revascularisation rates among angina patients with high compared to low distress are clinically appropriate or represent under-treatment remains unclear.


Assuntos
Angina Pectoris/psicologia , Angiografia Coronária/psicologia , Infarto do Miocárdio/psicologia , Intervenção Coronária Percutânea/psicologia , Angústia Psicológica , Idoso , Angina Pectoris/cirurgia , Angiografia Coronária/métodos , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos
12.
Int J Cardiol ; 293: 25-31, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31281046

RESUMO

BACKGROUND: There are limited data comparing the consistency of angina reporting by patients and clinicians. METHODS: We performed a retrospective analysis of data from the randomised Stent or Surgery (SoS) trial. The trial required reporting of angina using the Canadian Cardiovascular Society (CCS) classification by both patients and clinicians at baseline and twelve months. We compared paired observations to describe the magnitude and direction of differences in clinician and patient reporting. The difference in CCS grade was expressed as the clinician minus patient value. We also examined the proportion of trial subjects reported as being free from angina (CCS = 0) in clinician and patient reporting. RESULTS: Paired CCS data was available for 912 and 887 cases at baseline and 12 months respectively. At baseline, clinicians reported freedom from angina in a single case (1/912 = 0.1%) compared to 70/912 (7.7%) patients (Delta 7.6% 95% CI 5.8 to 9.3, P ≤0.001). At 12 months, the position was reversed, with clinicians reporting 639/887 (72%) angina free compared to 449/887 (50.6%) for patients (Delta -21.4 95% CI -17.1 to -25.8 P ≤ 0.001). For the reported CCS grade at follow-up, the weighted linear kappa for overall agreement was 0.312. Discordant reporting involved the clinician suggesting less angina rather than more (36% v 8% of cases). CONCLUSIONS: These findings have implications for our perception of previous research which has, in the main, focussed on clinician reporting. This emphasises the importance of patient reporting and a need to better understand reasons for discordance.


Assuntos
Angina Pectoris/psicologia , Angina Pectoris/cirurgia , Revascularização Miocárdica/tendências , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Papel do Médico/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Stents/tendências , Angina Pectoris/epidemiologia , Canadá/epidemiologia , Ponte de Artéria Coronária/psicologia , Ponte de Artéria Coronária/tendências , Humanos , Revascularização Miocárdica/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto/psicologia , Estudos Retrospectivos
13.
Age Ageing ; 48(4): 513-518, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31220207

RESUMO

BACKGROUND: cognitive impairment is common among older adults, necessitating the use of collateral sources in epidemiological studies involving this age group. The objective of this study was to evaluate agreement between self- and proxy-reports of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds. Further, both self- and proxy-reports were compared with hospital register data. METHODS: data were obtained from the Gothenburg H70 Birth Cohort Studies in Sweden. The study had a cross-sectional design and information was collected through semi-structured interviews in 2009-2012 from participants born in 1930 (N = 419) and their proxy informants. The National Patient Register provided diagnoses registered during hospital stays. Agreement was measured with Kappa values (K). RESULTS: agreement between self- and proxy-reports was substantial for diabetes mellitus (K = 0.79), atrial fibrillation (K = 0.61), myocardial infarction (K = 0.75), angina pectoris (K = 0.73) and hypertension (K = 0.62), and fair for intermittent claudication (K = 0.38) and heart failure (K = 0.40). Compared to the National Patient Register, a large proportion of those with a hospital discharge diagnosis were also self- and proxy-reported. CONCLUSIONS: proxy informants can be an important source of information, at least for well-defined conditions such as myocardial infarction, angina pectoris and diabetes mellitus.


Assuntos
Doenças Cardiovasculares/diagnóstico , Diabetes Mellitus/diagnóstico , Procurador , Autorrelato , Angina Pectoris/diagnóstico , Angina Pectoris/epidemiologia , Angina Pectoris/psicologia , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/psicologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/psicologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/psicologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/psicologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/psicologia , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/epidemiologia , Claudicação Intermitente/psicologia , Entrevistas como Assunto , Masculino , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/psicologia , Procurador/estatística & dados numéricos , Sistema de Registros , Autorrelato/estatística & dados numéricos , Suécia/epidemiologia
14.
BMC Psychiatry ; 19(1): 85, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836983

RESUMO

BACKGROUND: Depression and anxiety are prevalent and associated with a worse prognosis in coronary heart disease (CHD) patients. However, the influence of disease severity on mood symptoms is unknown. The specific associations of mood symptoms with NYHA classes remain unexplored. METHODS: In this cross-sectional study, 443 consecutive inpatients with angina pectoris (AP) confirmed by angiography were included into analysis. Somatic and cognitive symptom scores derived from Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7) were used to assess mood symptoms. Predictors for depression and anxiety with strict and lax standards were compared. We hypothesized NYHA classification to be an indicator of disease severity through analyses with clinical features using ordinal logistic model. Applying both binary and ordinal logistic models, we evaluated the associations of mood symptoms with NYHA classes. RESULTS: Discrepancy of disease severity existed between the depressed and nondepressed. NYHA classification was proved to be an integrated index under influence of age, coronary stenosis, heart failure and diabetes. NYHA class I and II individuals with AP were at equivalent risk for depression (NYHA II vs I: binary model OR 1.32 (0.59,2.96), p = 0.50; ordinal model OR 1.17 (0.73,1.88), p = 0.52), however NYHA class III/IV patients shared a sharply higher risk (NYHA III/IV vs I: binary model OR 3.32 (1.28,8.61), p = .013; ordinal model OR 3.94 (2.11,7.36), p < .001). Analyses on somatic and cognitive depressive symptoms confirmed this finding and hinted a greater impact of education background on mood when patient's condition is unstable. Anxiety seemed in the whole picture irrelevant with NYHA classes. Comparing with NYHA class I/II, AP patients in NYHA class III/IV tended to be less anxious. However, when CHD became unstable, the calmness may immediately be broken up. A great distinction of the ratio of anxiety and depression symptom scores between NYHA class III/IV stable and unstable AP patients (p = .018) was observed. CONCLUSIONS: Mood symptoms in CHD patients are to a great extend derived from disease itself. Only for patients with relatively serious physical condition, unexpected discomforts caused by disease notably impact the emotions. Education background tends to influence the mood especially when disease is still unstable.


Assuntos
Angina Pectoris/psicologia , Ansiedade/psicologia , Insuficiência Cardíaca/psicologia , Índice de Gravidade de Doença , Idoso , Angina Pectoris/epidemiologia , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/psicologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Prevalência
15.
Circ Cardiovasc Interv ; 12(3): e007558, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30871356

RESUMO

BACKGROUND: Health status and quality of life improvement after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) among patients with refractory angina has not been reported. We sought to determine the degree of quality of life improvement after CTO PCI in patients with refractory angina. METHODS AND RESULTS: Among 1000 consecutive patients who underwent CTO PCI in a 12-center registry, refractory angina was defined as any angina (baseline Seattle Angina Questionnaire [SAQ] Angina Frequency score of ≤90) despite treatment with ≥3 antianginal medications. Health status at baseline and 1-year follow-up was quantified using the SAQ. Refractory angina was present at baseline in 148 patients (14.8%). Technical success was achieved in 120 (81.1%) at the initial attempt and major adverse cardiac and cerebral events occurred in 10 (6.8%). There were no procedural deaths. Refractory angina patients were highly symptomatic at baseline with mean SAQ Angina Frequency of 51.1±23.8, SAQ quality of life of 35.3±21.2, and SAQ Summary Score of 47.2±17.9, improving by 32.0±27.8, 35.7±23.9, and 32.1±20.1 at 1 year. Through 1-year follow-up, patients with successful CTO PCI had significantly larger degree of improvement of SAQ Angina Frequency and SAQ Summary Score (35.0±26.8 versus 18.8±28.9, P<0.01; 34.2±19.4 versus 22.5±20.8, P<0.01) compared with unsuccessful CTO PCI. CONCLUSIONS: Refractory angina was present in 1 of 7 patients in the OPEN-CTO (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Hybrid Procedures) registry. Patients with refractory angina experienced large, clinically significant health status improvements that persisted through 12 months, and patients with successful CTO PCI had larger health status improvement than those without.


Assuntos
Angina Pectoris/terapia , Oclusão Coronária/terapia , Intervenção Coronária Percutânea , Qualidade de Vida , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/epidemiologia , Angina Pectoris/psicologia , Fármacos Cardiovasculares/uso terapêutico , Doença Crônica , Oclusão Coronária/diagnóstico , Oclusão Coronária/epidemiologia , Oclusão Coronária/psicologia , Resistência a Medicamentos , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
16.
Am J Cardiol ; 123(9): 1399-1405, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30771861

RESUMO

Greater optimism regarding recovery from chronic illness is associated with improved quality of life and clinical outcomes. We performed a post-hoc analysis on the association between optimism and outcomes in Ranolazine in Patients with Incomplete Revascularization after Percutaneous Coronary Intervention (RIVER-PCI), a randomized trial in patients with chronic angina pectoris who had incomplete revascularization following percutaneous coronary intervention. At baseline, patients answered how much they agreed with the phrase, "I am optimistic about my future and returning to a normal lifestyle." We evaluated the association between baseline optimism and time to ischemia-driven hospitalization or revascularization using a Cox model, and the association between baseline optimism and change in frequency of angina pectoris using a mixed measures model. Of 2,389 patients, 782 (33.2%) were very optimistic ("strongly agree"), 1,000 (42.4%) were optimistic ("agree"), 451 (19.1%) were neutral ("undecided"), and 123 (5.2%) were not optimistic ("disagree" or "strongly disagree"). Very optimistic patients had a lower prevalence of co-morbidities and less severe angina at baseline than less optimistic patients. The rate of ischemia-driven revascularization or hospitalization was higher in neutral and not optimistic patients compared with very optimistic patients; this finding persisted after adjustment for co-morbidities and baseline angina frequency (hazard ratio 1.42, 95% confidence interval 1.14 to 1.77 for neutral vs very optimistic; hazard ratio 1.38, 95% confidence interval 0.98 to 1.94 for not optimistic vs very optimistic). Neutral and not optimistic patients also had less improvement in angina than very optimistic patients. In conclusion, in patients with angina, those with more self-reported optimism had better health status outcomes. Whether structured interventions targeting optimism improve outcomes in these patients warrants further study.


Assuntos
Angina Pectoris/terapia , Nível de Saúde , Revascularização Miocárdica/métodos , Qualidade de Vida , Ranolazina/uso terapêutico , Idoso , Angina Pectoris/epidemiologia , Angina Pectoris/psicologia , Doença Crônica , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Prognóstico , Bloqueadores dos Canais de Sódio/uso terapêutico , Estados Unidos/epidemiologia
17.
Acta Anaesthesiol Scand ; 63(4): 515-522, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30374950

RESUMO

BACKGROUND: Thoracic epidural analgesia (TEDA) was offered to patients with refractory angina pectoris. Our primary objectives were to evaluate TEDAs´ influence on quality of life (QoL, base for power analysis), and hypothesising that TEDA with bupivacaine during 1 month counteracts exercise-induced myocardial hypoperfusion and increase physical performance. METHODS: Patients with refractory angina and exercise inducible hypoperfusion, as demonstrated by myocardial perfusion imaging (MPI), were randomised to 1-month treatment with TEDA with bupivacaine (B-group, n = 9) or saline (P-group, n = 10) in a double-blind fashion. MPI and bicycle ergometry were performed before TEDA and after 1 month while subjective QoL on a visual analogue scale (VAS) reported by the patients was checked weekly. RESULTS: During this month VAS (mean [95%CI]) increased similarly in both groups (B-group from 33 [18-50] to 54 [30-78] P < 0.05; P-group from 40 [19-61] to 48 [25-70] P < 0.05). The B-group reduced their exertional-induced myocardial hypoperfusion (from 32% [12-52] to 21% [3-39]; n = 9; P < 0.05), while the P-group showed no significant change (before 21% [6-35]; at 1 month 23% [6-40]; n = 10). MPI at rest did not change and no improvement in physical performance was detected in neither of the groups. CONCLUSIONS: In refractory angina, TEDA with bupivacaine inhibits myocardial ischaemia in contrast to TEDA with saline. Regardless of whether bupivacaine or saline is applied intermittently every day, TEDA during 1 month improves the quality of life and reduces angina, even when physical performance remains low. A significant placebo effect has to be considered.


Assuntos
Analgesia Epidural/métodos , Angina Pectoris/complicações , Angina Pectoris/tratamento farmacológico , Exercício Físico , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/etiologia , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Angina Pectoris/psicologia , Bupivacaína/administração & dosagem , Bupivacaína/uso terapêutico , Método Duplo-Cego , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/psicologia , Medição da Dor , Imagem de Perfusão , Desempenho Psicomotor , Qualidade de Vida
18.
BMJ Open ; 8(11): e022868, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30391917

RESUMO

OBJECTIVE: To assess the clinical effectiveness and safety of modified 'Huoxue Shugan' (HXSG) formulas used as Chinese herbal medicine in treating patients with coronary heart disease (CHD) and depression. METHODS: A systematic literature search of articles up to March 2018 will be performed in the following electronic databases: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese Biomedical Database, Chinese Biomedical Literature Service System and Wanfang Database. Inclusion criteria are as follows: randomised controlled trials of modified HXSG formulas in patients with CHD and depression. The primary outcome measures will be CHD-related clinical evaluation (frequency of acute angina, severity of angina pectoris, ECG changes, dose of nitroglycerin) and the scores or amount of reduction in scales measuring depression (ie, the Hamilton Depression Scale or other widely used depression scales). The safety outcome measures will be adverse events, liver and kidney function. RevMan V.5.3 software will be used for data synthesis, sensitivity analyses, subgroup analyses and risk of bias assessment. A funnel plot will be developed to evaluate reporting bias. Stata V.12.0 will be used for meta-regression and Egger tests. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence. ETHICS AND DISSEMINATION: This systematic review does not require ethics approval and will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018089641.


Assuntos
Angina Pectoris/tratamento farmacológico , Doença das Coronárias/tratamento farmacológico , Depressão/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Angina Pectoris/complicações , Angina Pectoris/psicologia , Doença das Coronárias/complicações , Doença das Coronárias/psicologia , Depressão/complicações , Depressão/psicologia , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Humanos , Resultado do Tratamento , Revisões Sistemáticas como Assunto
19.
Int J Cardiol ; 269: 40-44, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-29983248

RESUMO

BACKGROUND: The coronary sinus (CS) Reducer is a novel device designed to aid in the management and to improve quality of life of patients with severe angina symptoms refractory to optimal medical and interventional therapies. This study aims to assess the safety and efficacy of the Reducer in a real-world cohort of patients presenting with refractory angina. METHODS: One hundred forty-one consecutive patients were treated with CS Reducer implantation. The primary efficacy endpoint was reduction in angina symptoms from baseline as assessed by Canadian Cardiovascular Society (CCS) class status and Seattle Angina Questionnaire (SAQ) scores. The primary safety endpoint was successful Reducer device delivery and deployment in the absence of any device-related events. RESULTS: Procedural success was achieved in 139 (98.6%) patients. Reducer implantation was not obtained in 2 (1.4%) patients because of unfavorable anatomy of the CS. There were no CS perforations, cardiac tamponade, peri-procedural death or myocardial infarction during a median follow-up of 14 months (range from 6- to 70-month). In patients undergoing Reducer implantation, mean CCS class improved from 3.05 ±â€¯0.53 at baseline to 1.63 ±â€¯0.98 at follow-up (p < 0.001). Overall, 113 (81%) patients experienced at least 1 CCS improvement, and 63 (45%) patients at least 2 CCS-class improvement. All SAQ items improved significantly (p < 0.001 for all) and translated into a significant reduction in the mean number of anti-ischemic drugs prescribed (2.37 ±â€¯0.97 vs 2.17 ±â€¯0.95; p = 0.003). CONCLUSIONS: In a real-world multi-center experience, implantation of the CS Reducer appears safe, and efficacious in reducing symptoms of angina and improving quality of life.


Assuntos
Angina Pectoris/diagnóstico por imagem , Angina Pectoris/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/instrumentação , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Sistema de Registros , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/psicologia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Estudos de Coortes , Teste de Esforço/métodos , Teste de Esforço/tendências , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Resultado do Tratamento
20.
J Psychiatr Res ; 103: 173-181, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29883925

RESUMO

OBJECTIVE: Many researchers view retrospective reports with skepticism. Indeed, the observed association between retrospectively-reported childhood disadvantage (CD) and morbidity in adulthood has been criticized as an artefactual correlation driven by the psychological state of the respondent at the time of reporting (current psychological state). The aim of this study was to assess the role of current psychological state in the association between childhood disadvantage and morbidity in adulthood. METHODS: The present analysis used cross-sectional data collected in 2007-2008 within the framework of the Tromsø Study (N = 10,765), a representative study of adult men and women in Norway. The association between CD and the physical health outcomes heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (i.e., the sum of these physical health outcomes) was assessed with Poisson regression models. Relative risks (RR) and 95% confidence intervals (CI) were estimated. A wide range of indicators of respondents' current psychological state were included in the models to assess the % attenuation in estimates. RESULTS: CD was associated with an increased risk of heart attack, angina pectoris, chronic bronchitis/emphysema/COPD, diabetes mellitus, hypothyroid/low metabolism, migraine, hypertension, and comorbidity (p < 0.05), independent of respondents' current psychological state. A sizeable proportion (23-42%) of the association between CD and physical health outcomes was driven by recall bias or mediation via respondents' current psychological state. Controlling for indicators of current psychological state reduced the strength of associations between CD and physical health outcomes; however, the independent associations remained in the same direction. CONCLUSION: The association between retrospectively-reported CD and physical health outcomes in adulthood is not driven entirely by respondent's current psychological state.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Demência/psicologia , Negociação/métodos , Estresse Psicológico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angina Pectoris/epidemiologia , Angina Pectoris/psicologia , Estudos de Coortes , Estudos Transversais , Demência/epidemiologia , Feminino , Humanos , Masculino , Rememoração Mental/fisiologia , Pessoa de Meia-Idade , Morbidade , Noruega , Autorrelato , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Estresse Psicológico/reabilitação , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia
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