Mark W. Conard

Assessing Depression in the Cardiac Patient When Is the Appropriate Time to Assess Depression in the Patient Undergoing Coronary Revascularization

Depression is a well-established risk factor for cardiovascular disease-related morbidity and mortality. It is common to screen for depression in patients undergoing coronary revascularization prior to revascularization; however, the validity of this assessment is unclear as some patients may experience transient, reactive depression rather than persistent depression. The authors evaluated whether an initial or 1-month postprocedure screen was optimal for identifying consistently depressed patients. Depression at 1-month postprocedurewas a stronger predictor of depression at months 2 to 6 than baseline depression. After adjusting potential confounding variables, there was a much stronger relationship between 1-month and 6-month depression status (OR = 28.7 if depressed at 1 month, p < .001) than between baseline and 6-month depression status (OR = 6.5 if depressed at baseline, p < .001). Screening for depression at the time of revascularization is not as predictive of depression at 6 months as it is 1 month postprocedure.

Impact of obesity on disease-specific health status after percutaneous coronary intervention in coronary disease patients

OBJECTIVE: Several investigators have focused on obesity as a specific risk factor for mortality in patients undergoing bypass surgery, but few have examined it as a risk factor among patients undergoing percutaneous coronary interventions (PCI). In addition, none have evaluated the impact of obesity on post-PCI quality of life or disease-specific health status. This study examined whether obesity is a risk factor for poor quality of life or diminished health status 12-months postprocedure among a large cohort of PCI patients.RESEARCH METHODS AND PROCEDURES: A total of 1631 consecutive PCI patients were enrolled into the study and classified as underweight (BMI <20 kg/m2), normal weight range (BMI ≥20 and <25 kg/m2), overweight (BMI ≥25 and <30 kg/m2), class I obese (BMI ≥30 kg/m2), or class II and III obese (BMI ≥35 kg/m2). The 12-month postprocedure outcomes included need for repeat procedure, survival, quality of life and health status, assessed using the Seattle Angina Questionnaire (SAQ) and the Short Form-12.RESULTS: Obese patients with and without a history of revascularization were significantly younger than overweight, normal weight range, or underweight patients at the time of PCI. However, obese patients demonstrated similar long-term recovery and improved disease-specific health status and quality of life when compared to patients in the normal weight range after PCI. In addition, mortality and risk for repeat procedure was similar to those patients in the normal weight range patients at 12-months postrevascularization. Underweight patients who had no previous history of revascularization reported lower quality of life (F=3.02; P=0.018) and poorer physical functioning (F=2.82; P=0.024) than other BMI groups.CONCLUSION: Obese patients presenting for revascularization were younger when compared to patients in the normal weight range, regardless of previous history of revascularization. However, weight status was not a significant predictor of differences in long-term disease-specific health status, quality of life, repeat procedures, or survival. Underweight patients demonstrated less improvement in quality of life and physical functioning than other BMI groups.

Health Status Assessment

Physicians treat patients either to extend their survival or to make them feel better. Quantifying this latter objective is the purpose of health status assessment; the evaluation of patients’ perceptions of their symptoms, functioning, and quality of life. This chapter defines health status, reviews the types of health status instruments available and their required attributes, and discusses current applications of health status assessment. It concludes with a summary of currently available measures in cardiovascular disease and reviews challenges in the implementation and analysis of health status instruments.

The impact of smoking status on the health status of heart failure patients.

Smoking is a major risk factor for the development of heart failure (HF). Yet, little is known about smokings effects on the health status of established HF patients. HF patients were recruited from outpatient clinics across North America. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess disease-specific health status. Smoking behaviors were classified as never having smoked, prior smoker, and as having smoked within the past 30 days. Risk-adjusted multivariable regression was used to evaluate the association of smoking status with baseline and 1-year KCCQ overall summary scores. Smoking was not associated with baseline health status. However, a significant effect was observed on 1-year health status among outpatients with HF with current smokers reporting significantly lower KCCQ scores than never smokers or ex-smokers. These findings highlight an additional adverse consequence of smoking in HF patients not previously discussed.

Lifestyle and Cardiovascular Risk in Type 2 Diabetes

Type 2 diabetes is diagnosed with ever increasing frequency in the U.S. among both adults and children. Type 2 diabetes accounts for 17.2% of all deaths primarily related to cardiovascular disease (CVD) mortality. Various CVD risk factors that result from the effects of type 2 diabetes have been discovered including hyperglycemia, insulin resistance, hypertension, and dyslipidemia. Research has uncovered numerous lifestyle influences that affect the development of type 2 diabetes and these CVD risk factors include diet, physical inactivity, obesity, socioeconomic status, and acculturation. Alterations in lifestyle have been shown to reduce the impact of type 2 diabetes on CVD risk. The most effective lifestyle modification appears to be when individuals with type 2 diabetes lower their weight by eating a diet high in fruits, vegetables, and low-fat dairy foods combined with regular, moderate exercise to reduce hypertension, hyperglycemia, and regain lipid balance.