Abstract
Background/Aims Depression, anxiety, and perceived stress are common in patients with coronary heart disease (CHD) and are associated with an increased risk for dying after an acute coronary syndrome (ACS). Data are needed on how these psychosocial factors relate to quality of life, physical functioning, or anginal status after hospital discharge in ACS patients.
Methods Adults admitted with an ACS at 3 medical centers in MA and GA were interviewed during their hospitalization and again at 1-month (1M) after discharge as part of the Transitions, Risk, and Actions in Acute Coronary Events: Center for Outcomes Research and Education (TRACE-CORE). At enrollment, patients completed standardized assessments of depression (PHQ-9; cut-point: >4), perceived stress (PSS-4; cut-point: > 7) and anxiety (GAD-8; cut-point: >4). At 1M after discharge, participants (n=281) completed the Seattle Angina Questionnaire, including questions regarding frequency of angina, physical limitation, and disease-specific quality of life (QoL). Tertiles representing the worst physical limitation and QoL scores defined high limitation and low QoL, respectively. Presence of angina, physical limitation, and low QoL at 1M were examined in relation to in-hospital psychosocial factors.
Results Approximately one-third of participants were women (98 of 281), 77% were non-Hispanic white (216 of 281), and their mean age was 61.3 ± 11.0 years. At 1M after discharge, 44% (36 of 281) reported angina. Those depressed at baseline (45%, 126 of 281) were significantly more likely to report low QoL, high physical limitations, and angina at 1M than those without depression (p <0.05 for all). Enrollees with anxiety (46%, 131 of 281) at baseline were more likely to report low QoL, and high physical limitation, than patients without anxiety (p <0.001 for all) at 1M. Participants with highest baseline perceived stress (25%, 60 of 281) were significantly more likely to report lower QoL, high physical limitations, and angina than participants with lower perceived stress at 1M (p for all <0.001).
Discussion Depression, anxiety, and perceived stress during ACS admission are related to CHD-specific functional status, angina, and QoL 1M after hospital discharge. These psychosocial factors may help identify patients at higher risk for poor outcomes after an ACS.
