Continuous Nursing Based On Telephone Care Program For Coronary Heart Disease Combined With Depression

BACKGROUNDCardiovascular disease(CVD)has become one of the leading cause of mortality in the world,according to prior reports,there are 205 out of 10,000 deaths which are caused by CVD in the world.In China,CVD is also one of the main reasons causing disease-related deaths and premature deaths,the fatality rate caused by CVD occupies 40%in the total mortality in China.Coronary artery disease(CAD),one of the most common CVD,is caused by atherosclerosis of coronary artery induced insufficient blood supply,hypoxia or even necrosis of the myocardium.The neuro system related complications are common in CAD patients,for instance,a large number of previous studies report that neuro system related complicated are frequent in CAD patients,especially the depression,is extensively reported to be a commone complication in CAD patients.Recently,increasing studies illuminate that depression plays a pejorative role in the recovery of CAD patients,and is one of the most crucial obstacles in the improvement of prognosis in CAD patients.Thus,early detection and nursing intervention of depression in CAD patients is necessary.There are several previous studies report that some intervention program could ameliorate depression in CAD patients.However,studies aiming at exploring an effective nursing intervention strategy for improving survival in CAD patients complicated with depression are insufficient.OBJECTIVE1.The aim of this study was to investigate the effect of intensive telephone care program(ITCP)on depression amelioration in CAD patients complicated with depression.2.Investigating the effect of depression amelioration by ITCP on major adverse cardiovascular event(MACE)-firee period in CAD patients complicated with depression.METHODSThree hundred CAD patients complicated with depression were included in this randomized controlled study.All the patients were divided into ITCP group(N=150)and control group(N=150)in a 1:1 ratio by block randomized method after enrollment,and the baseline features of patients were recorded at the same time.All enrolled patients received routine treatment and nursing according to their disease condition.Furthermore,this study consisted of two stages:stage Ⅰ:the 12-month intervention stage,starting at one week before discharge and ending at the end of 12-month after discharge;stage Ⅱ:long-term follow-up stage without intervention,which started at 12 months after the end of the intervention and continued until the patient died or the study was terminated with end date of December 31st,2018.In stage I,patients in the ITCP group received a 12-month ITCP,and patients in the control group received a monthly follow-up also by telephone.At the 12-month intervention stage,patients’ depression condition was assessed by Hospital Anxiety and Depression Scale-depression(HADS-D)and Zung Self-rating depression scale(SDS)scales before enrollment(MO),3 months(M3),6 months(M6),9 months(M9)and 12 months(Ml2),respectively.The last follow-up date was December 31st,2018,and the median follow-up time was 44.0 months(range:5.0-59.0 months).RESULTS1.The HADS-D score at M9(P=0.044)and M12(P=0.016),and the change of score(M12-M0)(P<0.001)in ITCP group were decreased compared with control group.Similarly,the SDS score at M9(P=0.015)and M12(P=0.007)as well as change of SDS score(M12-MO)(P=0.004)were also reduced in ITCP group than those in control group.2.As for the MACE-free period of patients,the MACE-free period in ITCP group was more prolonged compared with that in control group(P=0.010).3.Assessed by HADS-D,the MACE-free period of depression(M12)patients was worse compared with that of non-depression(M12)patients(P=0.010);and when assessed by SDS,the MACE-free period of depression(M12)patients was worse compared with non-depression(M12)patients as well(P=0.002).In addition,at M12,higher the severity of depression assessed by HADS-D(P<0.001),worse the MACE-free period in patients,and similar trends were seen in patients with different depression severities assessed by SDS(P=0.007).4.Then all the patients were divided into non-depression patients in ITCP group,sustained depression patients in ITCP group,non-depression patients in control group and sustained depression patients in control group,and we found that when assessed by HADS-D,the MACE-free period was best in non-depression patients in ITCP group,followed by sustained depression patients in ITCP group and non-depression patients in control group,and the MACE-free period of sustained depression patients in control group was the worst(P=0.009);and the MACE-free survival of non-depression patients in ITCP group was longer than the other patients(P=0.002).When assessed by SDS,the MACE-free period was best in non-depression patients in ITCP group,followed by sustained depression patients in ITCP group and non-depression patients in control group,and the MACE-free survival of sustained depression patients in control group was the worst(P=0.004);similarly,the MACE-free survival of non-depression patients in ITCP group was longer than the other patients(P=0.001).CONCLUSION1.ITCP achieved a markedly more favorable effect regarding depression amelioration compared with a normal care in CAD patients complicated with depression;2.The survival of patients receiving ITCP was notably increased compared with patients receiving normal cai*e5 indicating that ITCP might be beneficial to patients’survival comapred with a normal care;3.After the nursing intervention of 12 months,sustained depression and more severe depression were correlated with worse survival,suggesting that sustained depression more severe depression post nursing intervention might interfere with patients’ survival;4.After the nursing intervention of 12 months,the survival of patients who recovered from depression by ITCP was the best among all the patients,which indicated that ITCP is a promising nursing promgram which could not only ameliorate depression but also benefit surivival in CAD patients complicated with depression.