| [Objective] Along with the aged tendency of population, urbanization,changing of eating habits, working pattern, and family structure, and fast-paced society, coronary heart disease (CHD) has been recognized as a psychosomatic diseases._The prevalence rate of CHD is increasing year after year with high motality and disability, which affects patients’quality of life and lives greatly, and places a huge burden on families, government, and society. As a result of the changing of environment, life style, and work rhythm, the impact of mental stress on the the developments of CHD has been much more concerned. Anxiety and depression, two common negative affective responses due to stress, has been confirmed to interact and associate with the development and poor prognosis of CHD., Burnout is another negative affective response. To date the association between burnout and the development of CHD is rarely studied.[Objective] The participants were patients after their first onset of acute coronary syndrome (ACS), who were admitted into coronary intensive care unit,1st Affiliated Hospital of Kunming Medical University, to identify the association between burnout and GRACE score of patients who suffered from their first ACS, verify whether burnout is associated with lower heart rate variability (HRV) after ACS, so that providing theoretic foundation for early psychological intervention to patients with CHD.[method]1.It was a cross-section study. The participants were patients after their first onset of ACS, who were admitted into coronary intensive care unit,1st Affiliated Hospital of Kunming Medical University. After the patients and their families signed informed consents, we established their archives.2.Disease related information, such as the patients’demographic characteristics, smoking and drinking habits, medical history, family history of cardiovascular disease, clinical manifestation, diagnosis, drug and non-drug therapy, auxiliary examination, and index of prognosis, were recorded.3.The GRACE risk score was calculated according to their symptoms, signs, and auxiliary examination.4. Burnout, anxiety, and depression were accessed by the general burnout subscale of Copenhagen Burnout Inventory (CBI), and hospital anxiety and Depression Scale (HADS).5.All participants were divided into two groups based on the median of burnout score:burnout high and burnout low.6.Time and frequency domain parameters of heart rate variability (HRV) was measured by24-h ambulatory ECG7.Statistical analyses were undertaken using the Stata10.0statistical package to estimate the effects of burnout on GRACE score and HRV. A two-side P value of<0.05was considered to be significant.[results]1.There were46patients participated this study. Of them37were male and9were female. Age range was from36to78years old. The average age was61.39±9.91. All participants were divided into two groups based on the median (47.915) of burnout score:burnout high (score≥47.915,n=23), and burnout low (score<47.915, n=23).2.The GRACE score of burnout high group was higher than that of burnout low group (141.087±40.456vs.115.2174±30.027). The difference was significant (P=0.0178<0.5).3.The burnout high group has a lower SDNN value comparing with burnout low group, but there was no significant difference (137.1013±54.04vs.187.6±49.59, P=0.1360>0.05).4.There was a trend that burnout high group corresponded to lower frequency domain parameters of HRV, but only lnULF and lnVLF were detected significant difference between two groups (7.901±0.091vs. 8.362±0.122,7.676±0.111vs.8.169±0.201, P<0.05).5.A stepwise multiple linear regression model was developed to identify the action of burnout on GRACE score. In this model, GRACE score was adopted as dependent variable, and age, gender, smoking, drinking, medical history, family history of cardiovascular diseases, burnout, anxiety and depression were as independent variables. Burnout entered the regression equation.(Regression coefficient B was0.7724713, P=0.009<0.05).6.To detect the role of burnout on SDNN, a time domain parameter of HRV, a stepwise multiple linear regression model was developed. Burnout entered this equation.(Regression coefficient B was-3.064983, P=0.003<0.05).7.A significant correlation was found in5frequency domain parameters of HRV:lnLF, lnHF, lnULF, lnVLF, and lnTP (r=0.4124-0.9588, P<0.05). We adopt principle components analysis to extract a principle component as dependent variable for next multiple linear regression. This principle component was named as "composite frequency domain index". The multiple linear regression model showed that burnout entered into the regression equation.(Regression coefficient B was-0.0517983, P=0.003<0.05). [Conclusion]1.Burnout and GRACE score of patients with ACS has notable positive correlation., It suggestes thatACS patients with burnout have higher risk of death during hospital, who should be given more monitoring and treatment, and positive psychological intervention as well.2.Burnout and HRV has significant negative correlation. Higher the level of burnout, lower the parameters of HRV.It implicates that burnout could be a predictor of poorer prognosis of CHD. Active medical and psychological interventions should be given to ACS patients with burnout, so that recovering the balance of autonomic nerve and improving the prognosis of ACS.3.Accessment of burnout is probably helpful to understand the development and prognosis of ACS patients, and determine the protocol of psychological intervention.4.It is still not certain that burnout and poor prognosis of ACS have causal relationship. A prospective study with large sample size and long follow-up period will be expected. |
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