Epidemiological Investigation Of Psychological Disorders In Patients With Suspected Or Confirmed Coronary Heart Disease

Background and ObjectiveChest pain is one of the most common reasons for admission to the emergency department or cardiovascular clinic of a general hospital.However,only 10%～40% of all patients with chest pain were diagnosed with coronary heart disease(CHD),and the other patients were diagnosed as non-cardiac chest pain(NCCP)after the exclusion of chest pain caused by organic diseases and discharged for observation.However,in the real clinical world,these patients often see the doctor again or for many times because of repeated chest pain,or even be hospitalized repeatedly,occupying a large of medical and health resources.With the change of medical model,the influence of psychological factors on disease has been gradually known.In recent years,CHD combined with psychological disorder has become one of the hot spots in clinical research,up to 15%～45% have psychological disorders and psychological intervention can improve the prognosis of CHD.Some studies have shown that the main cause of non-cardiac chest pain may be caused by simple psychological disorders.Although the symptoms have been improved after "anti-ischemia" treatment,chest pain still appears repeatedly,which not only increases the economic burden of patients,but also aggravates the contradiction between doctors and patients.Therefore,early recognition of mental disorders in patients with non-cardiac chest pain is particularly important.The purpose of this study was to early identificate of somatization symptoms and anxiety and depression in patients with suspected or confirmed CHD due to chest pain,so as to further provide a basis for accurate clinical diagnosis and treatment.Materials and methods1 Research object: Data of 493 patients with suspected CHD who were admitted to the Department of Cardiology,Luoyang Central Hospital affiliated to Zhengzhou University from May 2018 to October 2019 was retrospective analyzed.Age,sex,marital status,height,weight,education,smoking,diabetes,hypertension,and the use of antiplatelet,lipid-lowering drugs and antihypertensive drugs were recorded in detail during hospitalization.After admission,vein blood was drawn the next morning,and the indexes of fasting blood glucose,glycosylated hemoglobin,plasma cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,TSH,T3,T4 and so on were detected.Echocardiography was performed and left ventricular ejection fraction was recorded.2 Methods2.1 Grouping method: According to the International Society of Cardiology and Association and the World Health Organization Clinical Nomenclature standardization joint task group "nomenclature and diagnostic criteria of ischemic heart disease" the main coronary arteries and its main branch lumen diameter stenosis(Right coronary artery,left circumflex,Left anterior descending branch and Left main coronary artery)< 50% for non-cardiac chest pain group,the rest of the group for ischemic chest pain.2.2 Screening and scale evaluation of psychological disorders:According to the recommendation of "Chinese Expert Consensus on Psychological Prescription of Patients in Cardiovascular Department" in China,a brief three-question method was adopted to preliminarily screen out patients with possible problems.It is recommended that all patients were assessed with the physical self-rating scale(SSS),the assessed generalized anxiety disorder(GAD-7)and the patient health questionnaire(PHQ-9).2.3 Statistical methods:SPSS23.0 software was used to analyze the data.Conform to the normal distribution of measurement data to mean± standard deviation(x±s),using t test is compared between two groups;Median and quad(M(P25,P75))were used to represent the measurement data of non-normal distribution,and Kruskal-Wallish method was used to compare the two groups.Chi-square test was used to compare the counting data between the two groups.Univariate analysis was carried out on the study data,and multivariate logistic regression model was established.The software Graph Pad Prism8.3.0 was used to draw the ROC curve and analyze the recognition value.Med Calc19.1 software was used to analyze AUC differences,and P<0.05 was considered statistically significant.Result(1)Comparison of clinical data between the two groups showed age(P=0.013),sex(P=0.002),diabetes(P=0.015),smoking(P=0.004),TG(P=0.001),HDL-C(P=0.002),TC(P=0.002),LDL-C(P=0.001),TSH(P=0.004),T3(P=0.003),T4(P=0.001),FBG(P=0.02),Hb A1C(P=0.04),takinghypoglycemic-drugs(P=0.005),lipid-loweringdrugs(P=0.002),vasodilators(P=0.003),and antiplatelet drugs(P=0.004).Differences between groups were significantly different(P<0.05),while other factors had no statistical significance(P>0.05).(2)The incidence of somatization symptoms,anxiety,depression and anxiety combined with depression in NCCP group was higher than that in ICP group,and the difference was statistically significant(P<0.05).(3)The scores of SSS,PHQ-9 and GAD-7 in NCCP group were significantly higher than those in ICP group(P<0.001).(4)Multivariate logistic regression showed FBG[OR=1.374,95% CI(1.028,1.873)],SSS score[OR=1.332,95% CI(1.135,1.562)],TG[OR= 1.258,95% CI(1.045,1.532)] were risk factors for NCCP(P<0.05).(5)Statistical analysis of ROC curve showed that SSS score might have predictive value for the occurrence of NCCP,and the areas under the curve were0.860.Conclusion(1)The prevalence of psychological disorders is not low,which deserves the attention of clinicians.(2)The evaluation of SSS scale has the greatest predictive value for NCCP.(3)The assessment of psychological disorders can better identify patients with NCCP,thus reducing unnecessary coronary angiography and avoiding the waste of medical resources.