Influence Of Psychological Disorders On The Physical Recovery, Quality Of Life, And Heart Rate Variability In Patients With Acute Coronary Syndrome

[Objective]The aims of this study were to observe the influence of various psychological disorders, include anxiety, depression and burnout, on the physical recovery, quality of life (QoL), and heart rate variability (HRV) in the patients who were suffered their first onset of acute coronary syndrome (ACS).[Methods]1. The participants were patients with their first ACS and admitted to the Cardiology Department of the First Affiliated Hospital of Kunming Medical University during March 2014 to February 2016. All the participants signed the informed consent.2. Participants’basic data, including Demographic characteristics, tobacco and alcohol addiction, past medical history, family history of heart disease, clinical manifestations, disease diagnosis, physical examination and blood biochemistry were collected during their admission.3. Anxiety and depression were assessed by the Hospital Anxiety and Depression Scale(HADS). Burnout was assessed by the general burnout subscale of Copenhagen Burnout Inventory (CBI) during hospitalization. Patients were divided into anxiety group and non-anxiety group based on anxiety score of HAD S>7 or≤7. In the same way, those with depression score of HADS>7 or≤7 were assigned into depression group and non-depression group respectively. Classification of burnout was based on the upper quartile(P75) of general burnout score:patients whose burnout score≥P75 were assigned into high burnout group, and those whose burnout score<P75 were assigned into low burnout group.4. Participants were followed up at 3 time points:fist month, sixth months and one year after their discharge. Every time of follow-up, all participants were asked to do a test to evaluate their physical capacity, whose name is Short Physical Performance Battery(SPPB). Short Form-8(SF-8) and Seattle Angina Questionnaire(SAQ) were used to assess their QoL. The heart rate variability (HRV) was analyzed by 24-hour Holter monitoring to obtain the time domain and frequency domain measurements. 5.Statistical analyses were performed by SPSS 19.0 and Stata 10.0 software package. First, to compare the differences between anxiety/non-anxiety groups, depression/non-depression groups, or high/low burnout groups, independent samples t-test or Wilcoxon rank sum test was used to continuous variables, and chi-square test was used to categorical variables. Second, generalized estimating equations were developed to compare the differences of repeated measurement of SPPB scores, scores of QoL, and HRV parameters. A p value of <0.05 was considered to be significant.[Results]1.Ninety-one participants were enrolled in this study eventually. According to anxiety score of HADS,50 patients were assigned as anxiety group, including 41 men and 9 women, and 41 patients were assigned into non-anxiety group, including 39 men and 2 women. Similarly,35 patients were classified as depression group, including 28 men and 7 women, and 56 patients, including 52 men and 4 women, were classified as non-depression group. As for burnout, P75 of general burnout scores was 58. Based on P75, patients were divided into high burnout group(n=42), including 35 men and 7 women and low burnout group(n=49), including 45 men and 4 women.2.The SPPB score of high burnout group was significantly lower than that of low burnout group (p<0.01). Meanwhile the SPPB score of depression group was significantly lower than that of non-depression group (p<0.01). After adjustment by confounding factors such as age, sex, BMI, cultural degree and past history of cardiovascular disease, the differences of SPPB scores between high/low burnout groups or depression/non-depression groups were still significantly (p<0.01). There was no significant difference between anxiety group and non-anxiety group in SPPB score(p=0.560).3.Mental health score and physical health score of SF-8 in anxiety group, depression group, or high burnout group were significant lower than those in non-anxiety group, non-depression group or low burnout group(p< 0.05). After adjustment by confounding factors mentioned above, there were still significant differences (p< 0.05).4.The scores of 5 scales of SAQ in high burnout group were significantly lower than low burnout group(p<0.01). After adjustment by confounding factors such as age, sex, BMI, cultural degree and past history of cardiovascular disease, there were still significant differences (p<0.01). The score of anginal frequency(AF), one scale of SAQ, was lower in anxiety group than that in non-anxiety group(p<0.05), but after adjustment by confounding factors, the difference was no significant(p>0.05). There were no significant differences in scores of other four scales of SAQ between anxiety and non-anxiety groups(p>0.05). The physical limitation(PL), anginal stability (AS), AF and treatment satisfaction(TS) scores of SAQ in depression group were significantly lower than those in non-depression group(p<0.01). After adjustment by confounding factors, the differences were still significant (p<0.01). But disease perception (DP) score was not marked between depression group and non-depression group.5.There were no differences in SDNN, a parameter of time domain of HRV, between anxiety/non-anxiety groups, depression/non-depression groups, and high/low burnout groups respectively (p>0.05). Ln(ULF), a frequency domain parameter, showed significantly lower in anxiety group (p<0.05), depression group (p<0.05), or high burnout group (p<0.01) compared with its opposite group respectively. Even adjusted by confounding factors, the significant difference was still showed between depression and non-depression groups(p<0.01), as well high burnout group and low burnout group(p<0.01). But no difference was showed between anxiety group and non anxiety group (p>0.05). Ln(TP), another frequency domain parameter, showed lower in high burnout group compared with low burnout group(p<0.05). After adjusted by confounding factors, there was no difference between two group(p>0.05). Between anxiety group and non-anxiety group, or depression group and non-depression group, Ln(TP) was not marked (p>0.05). Ln(VLF) in high burnout group showed lower than that in low burnout group before and after adjusted by confounding factors (p<0.01). There were no difference of Ln(VLF) between anxiety group and non-anxiety group, as well depression group and non-depression group (p>0.05). Ln(LF) and Ln(HF) were not showed significant difference in all groups (p>0.05).[Conclusions]1. Patients with depression or burnout have poorer physical recovery after ACS. Anxiety has little effect on physical recovery for patients with ACS.2. Psychological disorders, including anxiety, depression and burnout, impair the quality of life of patients after ACS. Especially depression and burnout adversely affect QoL more.3. During the recovery of ACS, patients with depression or burnout have lower time domain parameters of HRV, which could be one of the reasons to impair the prognosis of ACS. The effect of anxiety on HRV is not distinct.