Srivastava Shruti, Shekhar Skand, Bhatia Manjeet Singh, Dwivedi Shridhar
Department of Psychiatry, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India.
Medicine/Preventive Cardiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India; National Heart Institute, East of Kailash, New Delhi, India.
Oman Med J. 2017 Jan;32(1):20-26. doi: 10.5001/omj.2017.04.
The quality of life (QOL) of patients with coronary artery disease (CAD) is known to be impaired. Non-cardiac chest pain referrals are often under-diagnosed and untreated, and there are hardly any studies comparing the QOL of CAD and panic disorder related (non-cardiac) chest pain referrals (PDRC).
We assessed the psychiatric morbidity and QOL of patients newly diagnosed with CAD (n = 40) at baseline and six weeks post-treatment and compared their QOL with patients with PDRC (n = 40) and age- and gender-matched healthy controls (n = 57). Psychiatric morbidity in the CAD group was assessed using the General Health Questionnaire (GHQ12) item, Hamilton Anxiety Scores (HAM-A), and Hamilton Depression Scores (HAMD). QOL measures were determined by the World Health Organization QOL questionnaire (brief) and Seattle Angina Questionnaire. The CAD group was treated with anti-ischemic drugs (nitrates, betablockers), antiplatelet drugs (acetylsalicylsalicylic acid), anticoagulants (low molecular weight heparin, clopidogrel), and managed for risk factors. The PDRC group was treated with selective serotonin reuptake inhibitors and anxiolytics.
Patients with panic disorder had a worse QOL than those with CAD and healthy controls in the physical domain and psychological domain (PDRC vs. CAD vs. healthy controls, < 0.001). In the CAD group, smoking was associated with change in angina stability ( 0.049) whereas other tobacco products were associated with change in angina frequency ( 0.044). Psychiatric morbidity was present in 40.0% of patients with CAD. In the PDRC group, a significant correlation of HAM-A scores was noted in the physical ( 0.000), psychological ( 0.001), social ( 0.006), and environment ( 0.001) domains of QOL. Patients with panic disorder had a significant improvement in anxiety scores after treatment compared to baseline (HAM-A scores difference 21.0 [16.5-25.6]; < 0.001).
Patients in the PDRC group had a worse QOL than those in the CAD and healthy control groups. This highlights the need for careful diagnosis and prompt treatment of panic disorder in these patients to improve their QOL. Additionally, smoking, the use of other tobacco products, and hypercholesterolemia were associated with angina symptoms in patients with CAD.
已知冠状动脉疾病（CAD）患者的生活质量（QOL）受损。非心源性胸痛转诊患者往往诊断不足且未得到治疗，几乎没有研究比较CAD患者与惊恐障碍相关（非心源性）胸痛转诊患者（PDRC）的生活质量。
我们评估了40例新诊断为CAD的患者在基线和治疗后6周的精神疾病发病率和生活质量，并将他们的生活质量与40例PDRC患者以及年龄和性别匹配的57名健康对照者进行比较。使用一般健康问卷（GHQ12）项目、汉密尔顿焦虑评分（HAM - A）和汉密尔顿抑郁评分（HAMD）评估CAD组的精神疾病发病率。生活质量测量由世界卫生组织生活质量问卷（简表）和西雅图心绞痛问卷确定。CAD组接受抗缺血药物（硝酸盐、β受体阻滞剂）、抗血小板药物（乙酰水杨酸）、抗凝剂（低分子量肝素、氯吡格雷）治疗，并对危险因素进行管理。PDRC组接受选择性5 - 羟色胺再摄取抑制剂和抗焦虑药治疗。
惊恐障碍患者在身体领域和心理领域的生活质量比CAD患者和健康对照者更差（PDRC组对比CAD组对比健康对照组，P < 0.001）。在CAD组中，吸烟与心绞痛稳定性变化相关（P = 0.049），而其他烟草制品与心绞痛频率变化相关（P = 0.044）。40.0%的CAD患者存在精神疾病。在PDRC组中，生活质量的身体（P = 0.000）、心理（P = 0.001）、社会（P = 0.006）和环境（P = 0.001）领域的HAM - A评分存在显著相关性。与基线相比，惊恐障碍患者治疗后的焦虑评分有显著改善（HAM - A评分差异为21.0 [16.5 - 25.6]；P < 0.001）。
PDRC组患者的生活质量比CAD组和健康对照组患者更差。这凸显了对这些患者进行惊恐障碍的仔细诊断和及时治疗以改善其生活质量的必要性。此外，吸烟、使用其他烟草制品和高胆固醇血症与CAD患者的心绞痛症状相关。
