Psychological status in patients with cardiac interventions

Depression is relatively common in patients with ischaemic heart disease and is associated with an increased risk of morbidity and mortality1. Singh et al2, in their study, evaluated two groups of 30 patients each who underwent coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) (28 males and 2 females in each group) with quality of life (QoL) and the Hamilton Rating Scale for Depression before and six months after each procedure. Their results demonstrated a significant improvement of the WHO-QoL scores six months after each procedure. Specifically, after CABG, there were improvements in all total, physical and psychological domains, and in the PTCA group in total and physical domains. The authors concluded that there was a significant improvement in depression six months after these procedures, higher in PTCA than CABG. However, after controlling for hypertension, diabetes and post-intervention diet restriction, CABG predicted lower improvements in overall QoL compared to PTCA.

These results of outcome in psychological and physical QoL were in accordance with our previous findings, on the prevalence of depression/anxiety in patients undertaking myocardial perfusion imaging (MPI) with 99mTc-tetrofosmin stress-rest single-photon emission computed tomography2. All patients selected for our study had no known previous psychological disease, any use of illicit drugs or diseases that could influence psychological status such as cancer3,4. The study included 35 patients with previous PTCA and CABG (mean age: 66.7 yr), 20 of whom had in addition previous myocardial infarction. These patients, just before the MPI, were subjected to the Zung Self-Rating Depression Scale and the Hamilton Anxiety Questionnaire. The results showed that 25 per cent had depression, 25 per cent anxiety and 7.1 per cent both depression and anxiety. The anxiety/depression of these patients was compared with that of 45 patients who had been subjected to myocardial perfusion imaging for non-specific cardiac complaints, such as atypical chest pain, dyspnoea or episodic tachycardia. Our results demonstrated that patients with myocardial dysfunction had a higher incidence of depression, anxiety or both, implying that these conditions may promote ischaemic heart disease1.

Thus, although the psychological QoL (i.e. depression) may be substantially improved after CABG or PTCA, a significant percentage of patients continue exhibiting depression/anxiety that may require probably long-term management.