Abstract
Heart failure (HF) is a disabling diagnosis with an unfavorable prognosis, which is considered a worldwide public health problem and the first cause of death when compared with other cardiovascular diseases. Research showed that the relationship between psychological disorders and cardiovascular diseases increases the risk and worsens the prognosis of these diseases. Despite being the most present psychological symptoms in this population, anxiety and depression have received less attention in the context of HF. This study aimed to analyze the characteristics of HF patients, to relate their anxiety levels to depression, age, LVEF, cognitive performance, quality of life (QoL), and personality. For that, we assessed 89 patients diagnosed with HF. Results showed that higher levels of anxiety were associated with higher levels of depression, worse cognitive performance, perception of worse QoL, and lower emotional stability. When depression levels were controlled, anxiety continued to affect cognitive performance, emotional stability, and QoL. These results have important implications for clinical practice and for research in the field of psychology, showing the need for development of better approaches and management of these patients in outpatient care.
Resumo
A insuficiência cardíaca (IC) é um diagnóstico incapacitante e de prognóstico desfavorável, considerado um problema de saúde pública mundial e a primeira causa de morte quando comparada às demais doenças cardiovasculares. Estudos mostram que a relação entre transtornos psicológicos e doenças cardiovasculares aumento o risco e o agravamento do prognóstico destas doenças. Apesar de serem os sintomas psicológicos mais presentes nesta população, a ansiedade e a depressão têm recebido pouca atenção no contexto da IC. Este estudo teve como objetivo analisar as características dos pacientes com IC, relacionar os seus níveis de ansiedade com a depressão, idade, FEVE, desempenho cognitivo, qualidade de vida (QV) e personalidade. Para isso, examinamos 89 pacientes diagnosticados com IC. Os resultados mostraram que maiores níveis de ansiedade estão associados a maiores níveis de depressão, pior desempenho cognitivo, pior percepção QV e menor estabilidade emocional. Quando controlamos os efeitos da depressão, a ansiedade continua a afetar o desempenho cognitivo, a estabilidade emocional e a QV. Estes resultados têm importantes implicações para a prática clínica e para a pesquisa no campo da psicologia, mostrando-nos a necessidade de desenvolver melhores abordagens e manejo destes pacientes em ambiente de ambulatório.
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Notes
Given that the factors consist of two items, Cronbach’s alpha was not calculated. However, the original article demonstrated the good reliability and validity of the instrument (Nunes et al. 2018)
References
Bagherian-Sararoudi, R., Gilani, B., Bahrami, E. H., & Sanei, H. (2013). Relationship between left ventricular ejection fraction and depression following myocardial infarction: an original article. ARYA Atherosclerosis, 9, 16–21.
Beck, A., & Clark, D. A. (2012). Terapia cognitiva para os transtornos de ansiedade. Porto Alegre: Artmed.
Bocchi, E. A., Marcondes-Braga, F. G., Ferreira, S. M. A., Rohde, L. E. P., Oliveira, W. A., Almeida, D. R., et al. (2009). Sociedade brasileira de cardiologia: III Diretriz brasileira de insuficiência cardíaca crônica. Arquivos Brasileiros de Cardiologia.
Brannon, L., & Feist, J. (2001). Psicología de la salud. Madrid: Thomson.
Cagle, J. G., Bunting, M., Kelemen, A., Lee, J., Terry, D., & Harris, R. (2017). Psychosocial needs and interventions for heart failure patients and families receiving palliative care support – a systematic review. Heart Failure Reviews, 22, 565–580. https://doi.org/10.1007/s10741-017-9596-5.
Cameron, J., Rendell, P. G., Ski, C. F., Kure, C. E., McLennan, S. N., Rose, N. S., Prior, D. L., & Thompson, D. R. (2015). PROspective Memory Training to improve Heart failUre Self-care (PROMETHEUS): study protocol for a randomized controlled trial. Trials, 16, 196. https://doi.org/10.1186/s13063-015-0721-2.
Carneiro, A. F., Mathias, L. A. S. T., Rassi Jr., A., Morais, N. S., Gozzani, J. L., & Miranda, A. P. (2009). Avaliação da ansiedade e depressão no período pré-operatório em pacientes submetidos a procedimentos cardíacos invasivos. Revista Brasileira de Anestesiologia, 59, 431–438. https://doi.org/10.1590/S0034-70942009000400005.
Castro, G. P., Verdejo, H. P., Garcés, J. L., & González, I. (2006). Predictores de mortalidad intrahospitalaria e hospitalización prolongada em la insuficiencia cardíaca. Revista Medica do Chile, 134, 83–91. https://doi.org/10.4067/S0034-98872006000900001.
Chauvet-Gelinier, J. C., & Bonin, B. (2016). Stress, anxiety and depression in heart disease patients: A major challenger for cardiac rehabilitation. Annals of Physical and Rehabilitation Medicine, 60, 6–12. https://doi.org/10.1016/j.rehab.2016.09.002.
Clausell, N. (2003). Fisiopatologia da insuficiência cardíaca. In A. C. P. Barretto & E. A. Bocchi (Eds.), Insuficiência cardíaca (pp. 23–27). São Paulo: Segmento.
Delfini, A. B. L., Roque, A. P., & Peres, R. S. (2009). Sintomatologia ansiosa e depressiva em adultos hospitalizados: Rastreamento em enfermaria clínica. Revista Interinstitucional de Psicologia, 2, 12–22.
EuroQoL. (1990). A new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208. https://doi.org/10.1016/0168-8510(90)90421-9.
Felker, G. M., Adams, K. F., Konstam, M. A., O’Connor, C. O., & Gheorghiade, M. (2003). The problem of decompensated heart failure: Nomenclature, classification and risk stratification. American Heart Journal, 145, 18–25. https://doi.org/10.1067/mhj.2003.150.
Feola, M., Garnero, S., Vallauri, P., Salvatico, L., Vado, A., Leto, L., & Testa, M. (2013). Relationship between cognitive function, depression/anxiety and functional parameters in patients admitted for congestive heart failure. The Open Cardiovascular Medicine Journal, 7, 54–60. https://doi.org/10.2174/1874192401307010054.
Ferreira, P. L., Ferreira, L. N., & Pereira, L. N. (2013). Contribution for the validation of the Portuguese version of EQ-5D. Acta Médica Portuguesa, 26, 664–675.
Fontana, A. M., & Fontana, M. C. P. S. (2005). Transtornos do humor. In A. M. Fontana (Ed.), Manual de clínica em psiquiatria (pp. 295–316). São Paulo: Atheneu.
Francis, G. S. (2005). Fisiopatologia da síndrome clínica de insuficiência cardíaca. In E. J. Topol (Ed.), Tratado de cardiologia (pp. 1541–1570). Rio de Janeiro: Guanabara Koogan.
Freitas, S., Simões, M. R., & Santana, I. (2014). Montreal cognitive assessment (MoCA): Pontos de corte no défice cognitivo ligeiro, doença de alzheimer, demência frontotemporal e demência vascular. Sinapse, 14, 18–30.
Gaviria, M. F., Pliskin, N. H., & Kney, A. (2011). Cognitive impairment in patients with advanced heart failure and its implications on decision-making capacity. Congestive Heart Failure, 17, 175–179. https://doi.org/10.1111/j.1751-7133.2011.00242.x.
Gomes, W. J., Mendonça, J. T., & Braile, D. M. (2007). Resultados em cirurgia cardiovascular: oportunidade para rediscutir o atendimento médico e cardiológico no sistema público de saúde do país. Revista Brasileira de Cirurgia Cardiovascular, 22, 3–4. https://doi.org/10.1590/S0102-76382007000400002.
Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003). A very brief measure of the Big-Five personality domains. Journal of Research in Personality, 37, 504–528. https://doi.org/10.1016/S0092-6566(03)00046-1.
Jessup, M., & Brozena, S. (2003). Heart failure. The New England Journal of Medicine, 348, 2007–2018. https://doi.org/10.1056/NEJMra021498.
Joyce-Moniz, L., & Barros, L. (2005). Psicologia da doença para cuidados de saúde: desenvolvimento e intervenção. Porto: Edições Asa.
Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. (2002). Emotions, morbidity and mortality: New perspectives from Psychoneuroimmunology. Annual Review of Psychology, 53, 83–107. https://doi.org/10.1146/annurev.psych.53.100901.135217.
Konstam, V., Moser, D. K., & Jong, M. J. (2005). Depression and anxiety in heart failure. Journal of Cardiac Failure, 11, 455–463. https://doi.org/10.1016/j.cardfail.2005.03.006.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
MacMahon, K. M. A., & Lip, G. Y. H. (2002). Psychological factors in heart failure: A review of the literature. Archives of Internal Medicine, 162, 509–516. https://doi.org/10.1001/archinte.162.5.509.
Meneghetti, C. C., Guidolin, B. L., Zimmermann, P. R., & Sfoggia, A. (2017). Screening for symptons of anxiety and depression in patients admitted to a university hospital with acute coronary syndrome. Trends in Psychiatry and Psychoterapy, 39, 12–18. https://doi.org/10.1590/2237-6089-2016-0004.
Meyer, T., Hussein, S., Lange, H. W., & Hermann-Lingen, C. (2013). Anxiety is associated with a reduction in both mortality and major adverse cardiovascular events five years after coronary stenting. European Journal of Preventive Cardiology, 22, 75–82. https://doi.org/10.1177/2047487313505244.
Moryś, J. M., Bellwon, J., Adamczyk, K., & Gruchała, M. (2016). Depression and anxiety in patients with coronary artery disease measured by means of self-report measures and clinician-rated instrument. Kardiologia Polska, 74, 53–60. https://doi.org/10.5603/KP.a2015.0116.
Moser, D. K., Arslanian-Engoren, C., Biddle, M. J., Chung, M. L., Dekker, R. L., Hammash, M. H., Mudd-Martin, G., Alhurani, A. S., & Lennie, T. A. (2016). Psychological aspects of heart failure. Current Cardiology Reports, 18, 119. https://doi.org/10.1007/s11886-016-0799-5.
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x.
Nunes, A., Limpo, T., Lima, C. F., & Castro, S. L. (2018). Short scales for the assessment of personality traits: development and validation of the Portuguese ten-item personality inventory (TIPI). Frontiers in Psychology, 9, 461. https://doi.org/10.3389/fpsyg.2018.00461.
Ogilvie, R. P., Everson-Rose, S. A., Longstreth, W. T. J., Rodriguez, C. J., Diez-Roux, A. V., & Lutsey, P. L. (2015). Psychosocial factors and risk of incident heart failure – The multi-ethnic study of atherosclerosis. Circulation. Heart Failure, 9, e002243. https://doi.org/10.1161/circheartfailure.115.002243.
Pena, F. M., Carreira, M. A. M. Q., Faria, C. A. C., Modenesi, R. F., Barcelos, A. F., Piraciaba, M. C. T., et al. (2010). Sintomas depressivos e hospitalizações por insuficiência cardíaca: prevalência, preditores e mortalidade. Insuficiência Cardíaca, 5, 178–184.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G. F., Coats, A. J. S., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 37, 2129–2200. https://doi.org/10.1093/eurheartj/ehw128.
Putman-Casdorph, H., & McCrone, S. H. (2009). Chronic obstrutive pulmonary disease, anxiety, and depression: state of the science. Heart & lung: the journal of critical care, 38, 34–47. https://doi.org/10.1016/j.hrtlng.2008.02.005.
Reidinger, M. S., Dracup, K. A., & Brecht, M. L. (2002). Quality of life women with heart failure, normative groups, and patients with other chronic conditions. American Journal of Critical Care, 11, 210–219.
Ribeiro, D. S., & Mantovani, M. F. (2001). Caminhando para a cronicidade: as representações do adoecimento em adultos com dor toráxica aguda. Cogitare Enfermagem, 6, 97–104. https://doi.org/10.5380/ce/v6i1/44911.
Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: A meta-analytic review of prevalenca, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology, 48, 1527–1537. https://doi.org/10.1016/j.jacc.2006.06.055.
Sadock, B., & Sadock, V. (2007). Compêndio de psiquiatria: ciência do comportamento e psiquiatria clínica. 9ª edição. São Paulo: Artmed.
Samartzis, L., Dimopoulos, S., Manetos, C., Agapitou, V., Tasoulis, A., Tseliou, E., Pozios, I., Kaldara, E., Terrovitis, J., & Nanas, S. (2014). Neuroticism personality trait is associated with quality of life in patients with chronic heart failure. World Journal of Cardiology, 6, 1113–1121. https://doi.org/10.4330/wjc.v6.i10.1113.
Santos, M. A., Cruz, D. A. L. M., & Barbosa, R. L. (2011). Fatores associados ao padrão de sono de pacientes com insuficiência cardíaca. Revista da escola de enfermagem da USP, 45, 1105–1112. https://doi.org/10.1590/S0080-62342011000500011.
Sokoreli, I., Vries, J. J. G., Pauws, S. C., & Steyerberg, E. W. (2016). Depression and anxiety as predictors of mortality among heart failure patients: systematic review and meta-analysis. Heart Failure Reviews, 21, 49–63. https://doi.org/10.1007/s10741-015-9517-4.
Sousa, T. V., Viveiros, V., Chai, M. V., Vicente, F. L., Jesus, G., Carnot, M. J., Gordo, A. C., & Ferreira, P. L. (2015). Reliability and validity of the Portuguese version of the Generalized Anxiety Disorder (GAD-7) scale. Health and Quality of Life Outcomes, 13, 60. https://doi.org/10.1186/s12955-015-0244-2.
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.
Steptoe, A., & Molloy, G. J. (2007). Personality and heart disease. Heart, 93, 783–784. https://doi.org/10.1136/hrt.2006.109355.
Stewart, A. T., Macintyre, K., Hole, D. J., Capewell, S., & McMurray, J. J. V. (1989). Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. The Journal of the American Medical Association, 262, 907–913.
Sullivan, M., Simon, G., Spertus, J., & Russo, J. (2002). Depression-related costs in heart failure care. Archives of Internal Medicine, 162. https://doi.org/10.1001/archinte.162.16.1860.
Torres, A., Monteiro, S., Pereira, A., & Albuquerque, E. (2016, 2016). Reliability and validity of the PHQ-9 in Portuguese women with breast cancer. EpSBS, 411–423. https://doi.org/10.15405/epsbs.2016.07.02.39.
Vargas, T. V. P., Maia, E. M., & Dantas, R. A. S. (2006). Sentimentos de pacientes no pré-operatório de cirurgia cardíaca. Revista Latino-Americana de Enfermagem, 14, 383–388. https://doi.org/10.1590/S0104-11692006000300012.
Vongmany, J., Hickman, L. D., Lewis, J., Newton, P. J., & Phillips, J. L. (2016). Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review. European Journal of Cardiovascular Nursing, 15, 478–485. https://doi.org/10.1177/1474515116635923.
Yohannes, A. M., Willgoss, R. C., Baldwin, R. C., & Connolly, M. J. (2009). Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles. International Journal of Geriatric Psychiatry, 12, 1209–1221. https://doi.org/10.1002/gps.2463.
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Supported by ERDF through POCI-01-0145-FEDER-007746, funded by COMPETE2020, National Funds through FCT, within CINTESIS (UID/IC/4255/2013), and Project "NORTE-01-0145-FEDER-000026- Symbiotic technology for societal efficiency gains: Deus ex Machina", financed by NORTE2020 under PORTUGAL2020.
Funding
This article is the product of the research project supported by ERDF through POCI-01-0145-FEDER-007746, funded by COMPETE2020, National Funds through FCT, within CINTESIS (UID/IC/4255/2013), and Project "NORTE-01-0145-FEDER-000026- Symbiotic technology for societal efficiency gains: Deus ex Machina", financed by NORTE2020 under PORTUGAL2020.
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Fidelis, T., Azzam, A.P., Nunes, A. et al. Anxiety in Heart Failure Patients: Its Association with Depression, Cognition, Personality, and Quality of Life. Trends in Psychol. 29, 204–221 (2021). https://doi.org/10.1007/s43076-021-00064-4
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DOI: https://doi.org/10.1007/s43076-021-00064-4