Depression and anxiety at time of implantable cardioverter defibrillator implantation and the biological link with cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Psychological distress, such as symptoms of anxiety and depression, are frequently present in patients receiving an implantable cardioverter defibrillator (ICD) and they are associated with adverse outcomes. Multiple pathophysiological mechanisms may explain the link between psychological distress and cardiovascular disease, such as autonomic dysfunction, neuro-endocrine alterations and chronic inflammation. Purpose The present study aims to examine the prevalence of psychological distress at time of ICD implantation and evaluates the complex interplay between psychological distress, autonomic function, neuro-endocrine alterations and inflammatory status in ICD patients. Methods We conducted a prospective study that included ICD patients receiving an ICD for primary and secondary prevention of sudden cardiac death. Prior to implantation, patients underwent extensive psychological evaluation, including validated questionnaires for depression, anxiety and personality traits. Cardiac status was evaluated by left ventricular ejection fraction (LVEF) assessment, New York Heart Association (NYHA) functional class evaluation, 6-minute walk test (6MWT), and 24-hour Holter monitoring for heart rate variability (HRV). Thyroid function, catecholamine levels and inflammatory status were also evaluated. Results Of 178 patients included (age 64 ± 12, 79% male, LVEF 35 ± 13%), 35% had symptoms of depression and 32% had symptoms of anxiety. Symptoms of depression and anxiety increased significantly with higher NYHA functional class (P < 0.001). Depressive symptoms were associated with a reduced 6MWT (411 ± 128 m versus 488 ± 89 m, P < 0.001), lower LVEF (29 ± 9% versus 36 ± 13%, P = 0.03), higher heart rate (74 ± 13 bpm versus 70 ± 13 bpm, P = 0.02), higher thyroid stimulating hormone levels (1.8 [1.3-2.8] mU/L versus 1.5 [1.0-2.2] mU/L, P = 0.04) and multiple HRV parameters, indicating reduced HRV. Anxiety symptoms were only associated with a reduced 6MWT (433 ± 112 m versus 477 ± 102, P = 0.02). Symptoms of depression or anxiety were not correlated with c-reactive protein, NT-proBNP or catecholamine levels. Conclusion A substantial part of ICD patients has symptoms of depression and anxiety at time of ICD implantation. Depression was correlated with a higher NYHA class, reduced exercise capacity, reduced LV-function and alterations in autonomic function, suggesting a biological link between depression and cardiac status. Whether depression and anxiety leads to an increase in ventricular arrhythmias will be determined during further follow-up. Abstract Figure. NYHA class and psychological distress

Download Full-text

Outcomes of Patients Undergoing Primary Fontan Operation Beyond First Decade of Life

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117713696 ◽

2017 ◽

Vol 8 (4) ◽

pp. 487-494 ◽

Cited By ~ 6

Author(s):

Sachin Talwar ◽

Sukhjeet Singh ◽

Vishnubhatla Sreenivas ◽

Kulwant Singh Kapoor ◽

Saurabh Kumar Gupta ◽

...

Keyword(s):

Ventricular Dysfunction ◽

Nyha Class ◽

Fontan Operation ◽

Functional Class ◽

Early Mortality ◽

Thromboembolic Events ◽

Class Iii ◽

Pleural Effusions ◽

Nyha Functional Class

Objectives: Studies on older patients undergoing primary Fontan operation (FO) are limited, with conflicting results. We review our experience with these patients beyond the first decade of life. Patients and Methods: Between January 2000 and December 2014, a total of 105 patients ≥10 years of age (mean 15.6 ± 4.9, range 10-31, median 15 years) underwent primary FO without a prior bidirectional superior cavopulmonary anastomosis (Bidirectional Glenn [BDG]). Mean preoperative New York Heart Association (NYHA) class was 2.2 ± 0.57. Results: Operative procedure was extra-cardiac FO in 62 patients (8 were fenestrated). Forty-three had a lateral tunnel FO (26 were fenestrated). There were 11 (10.5%) early deaths. Fourteen of the 94 early survivors experienced prolonged pleural effusions, 7 had arrhythmias, and 2 had thromboembolic events. Two patients underwent Fontan takedown. On univariate analysis, NYHA functional class III, mean pulmonary artery (PA) pressure ≥15 mm Hg, hematocrit ≥60%, preoperative ventricular dysfunction, and atrioventricular valve regurgitation (AVVR) were associated with early mortality. Median follow-up was 78 (mean 88.9 ± 6.3) months. In 94 survivors, 6 (6.4%) late deaths were encountered. At last follow-up, 81 (86.2%) survivors were in NYHA class I. Actuarial survival was 84.7% ± 3.7% at 5, 10, and 15 years. Conclusion: Carefully selected adolescents and young adults can safely undergo the primary FO. However, persistent pleural effusions, arrhythmias, thromboembolic events, and the need for reoperation mandate regular follow-up in such patients. Preoperative NYHA functional class III, mean PA pressure ≧ 15 mm Hg, hematocrit ≥ 60%, ventricular dysfunction, and AVVR were associated with early mortality, suggesting that primary FO should be avoided in such patients.

Download Full-text

Raised homocystein plasma concentration in patients with Heart Failure: clinical significance

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2007.458 ◽

2016 ◽

Vol 68 (2) ◽

Author(s):

E. Vizzardi ◽

S. Nodari ◽

C. Fiorina ◽

M. Metra ◽

L. Dei Cas

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Vascular Disease ◽

Plasma Levels ◽

Nyha Class ◽

Plasma Homocysteine ◽

Functional Class ◽

Nyha Functional Class ◽

Control Subjects ◽

Patients With Heart Failure

Elevated plasma levels of homocysteine is associated with increased risk of thrombotic and atherosclerotic vascular disease. Several studies have demonstrated that hyperhomocysteinemia is an indipendent risk factor for vascular disease and is associated to heart failure. However there are no data regarding the association between homocysteine and various objective as well as subjective measures of heart failure. We hypothesized that plasma homocysteine is associated with clinical and echocardiographic signs of heart failure. On this ground we have analysed levels of homocysteine in patients with heart failure and possible correlation between these levels and clinical-functional pattern (NYHA class and ejection fraction). Methods: Plasma homocysteine levels were determined in 123 patients with dilated cardiomyopathy (59 males, 64 females, mean age 67±10 years, mean EF 31±11% and mean NYHA 2.4±0.9, 47 idiopatic and 76 postischemic cardiomyopathy) and 85 healthy control subjects (homogeneus group for sex and age). Patients with chronic renal failure, vitamin B12 and folate deficiency or factors affecting homocysteine plasma levels were escluded from this study. Homocysteine levels were determined in coded plasma samples by immunoenzimatic methods. Results: Patients with heart failure had a higher homocysteine level (mcg/L) than control subjects (21.72±10.28 vs 12.9±6.86, p<0,001) both postischemic (20.89±9.6 vs 12.9±6.86, p<0,001) and idiopatic cardiomiopathy (23.0±11.2 vs 12.9±6.86, p<0,001). A significant correlation was observed between homocysteine and NYHA functional class (p<0,001), age (p<0,001), creatinine (p<0,001), colesterol (p<0,05) while no correlations were observed with hemodynamic (HR, BP), functional (ejection fraction) and other metabolic parameters (triglycerides). Serum homocysteine was lowest in control and increased with increasing NYHA class. In idiopatic cardiomiopathy the correlation between homocysteine and NYHA functional class, creatinine (p<0,001), fibrinogen (p<0,05) was confirmed; in postischemic cardiomiopathy a significant correlation with creatinine and NYHA class (p<0,001) and with triglycerides (p<0,05) was also found. Conclusion: Plasma homocysteine was directly related to NYHA class. This observation may underline the strong relations of plasma homocysteine to congestive heart failure. Further research is indicated to evaluate a causal or noncausal mechanism for this association.

Download Full-text

The impact of perceived control on psychological distress and health behavior adherence in patients with cardiovascular disease

Journal of Nursing Education and Practice ◽

10.5430/jnep.v9n2p76 ◽

2018 ◽

Vol 9 (2) ◽

pp. 76

Author(s):

Kalon R. Eways ◽

Kymberley K. Bennett ◽

Kadie M. Harry ◽

Jillian M.R. Clark ◽

Elizabeth J. Wilson

Keyword(s):

Cardiovascular Disease ◽

Psychological Distress ◽

Health Behavior ◽

Perceived Control ◽

Self Report ◽

Depression And Anxiety ◽

Long Term Effects ◽

Symptoms Of Depression ◽

The Impact ◽

The Relationship

Background: Symptoms of depression and anxiety have been shown to negatively impact physical health outcomes among individuals with cardiovascular disease (CVD). Therefore, an important step in developing interventions to reduce risk for cardiac event recurrence is to identify the emotional and cognitive predictors of psychological distress. This study examined one possible cognitive predictor: perceived control (PC). Specifically, this study tested whether symptoms of depression and anxiety mediate the relationship between PC and adherence to health behavior recommendations in patients participating in a cardiac rehabilitation (CR) program.Methods: Self-report measures were administered to 146 CR patients at the beginning of CR and 12-weeks later, at the end of CR.Results: Anxiety and depressive symptoms did not mediate the relationship between PC and health behavior adherence. Rather, PC was cross-sectionally related to symptoms of psychological distress, and it predicted health behavior adherence 12-weeks later.Conclusions: Results imply that PC has long-term effects on health behavior adherence, an important outcome in CR that reduces risk for recurrence.

Download Full-text

Preliminary Short-term Results of a Population of Patients Treated with MitraClip Therapy: One Center Experience

International Cardiovascular Forum Journal ◽

10.17987/icfj.v11i0.437 ◽

2017 ◽

Vol 11 ◽

Author(s):

Rossana Taravella ◽

Melchiorre Gilberto Cellura ◽

Giuseppe Cirrincione ◽

Salvatore Asciutto ◽

Marco Caruso ◽

...

Keyword(s):

New York ◽

Nyha Class ◽

Great Majority ◽

Heart Association ◽

Functional Class ◽

Class Iii ◽

Nyha Functional Class ◽

Mitral Repair ◽

Mitraclip Therapy

Objectives: This retrospective analysis sought to evaluate 1-month outcomes and therapy effectiveness of a population of patients treated with MitraClip therapy. We describe in this article the preliminary results of primary effictiveness endpoint.Background: Percutaneous Mitral Repair is being developed to treat severe mitral regurgitation (MR),with increasing real-world cases of functional MR(FMR). In the EVEREST(Endovascular Valve Edge-to-Edge Repair Study)II trial,percutaneous device showed superior safety but less reduction in MR at 1year. 4-year outcomes from EVEREST II trial showed no difference in the prevalence of moderate-severe and severe MR or mortality at 4years between surgical mitral repair and percutaneous approach.Methods: We analysed retrospectively collected data from one center experience in Italy enrolled from January2011 to December2016. The study included 62patients[mean age74±11years, 43 men(69%)] with MR of at least grade3+. Most of patients had functional MR, were in New York Heart Association(NYHA) functional class III or IV,with a large portion(78%) of mild-to-moderate Tricuspid Regurgitation(TR). One or more clips were implanted in 67procedures(62 patients). Results and Conclusions: Severity of MR was reduced in all successfully treated patients,54(90%) were discharged with MR≤2+(primary effictiveness endpoint). Clinical 1-month follow-up data showed an improvement in NYHA functional class (42patients (70%) in NYHA class I-II). 60 of 62 (97 %) successfully treated patients were free from death and mitral valve surgery at 1-month follow-up. MitraClip therapy reduces functional MR with acute MR reduction to <2+ in the great majority of patients,with a large freedom from death, surgery or recurrent MR in a great portion of patients.

Download Full-text

Abstract 13936: Practitioners’ Inaccuracy in Decision-making With Assessing NYHA Functional Class of Patients With Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.13936 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Marilyn A Prasun ◽

Kelly D Stamp ◽

Thomas P McCoy ◽

Lisa Rathman

Keyword(s):

Heart Failure ◽

Decision Making ◽

Patient Outcomes ◽

Nurse Practitioners ◽

Nyha Class ◽

The United States ◽

Functional Class ◽

Evidence Based ◽

Advanced Practice ◽

Nyha Functional Class

Introduction: Heart failure (HF) is a major public health problem and timely evidence-based guideline directed treatment is essential to ensure optimal patient outcomes. New York Heart Association (NYHA) functional class of HF patients is a clinically important assessment as it relates to treatment recommendations. Purpose: The purpose of this study was to examine HF providers’ decision making and ability to correctly assign NYHA functional class. Methods: A cross-sectional, correlational study using survey methods with 244 physicians, advanced practice nurses and physician assistants practicing in the United States in acute and ambulatory care settings that treat adult patients with HF was conducted. Providers completed 8 validated clinical vignettes focused on decision making that related to the four NYHA functional classes. Descriptive statistics and multivariable regression were used to analyze the data. Results: Participants were predominately female (83%), Caucasian (87%) and were on average 51 years of age (SD=11). Sixty-five percent were nurse practitioners and 18% physicians, most were certified in HF (59%) and on average worked with HF patients for 15.1 years (SD=9.6). Providers reported assigning NYHA class to 83% of their patients, with 39% reporting it was useful. Accurate identification of NYHA Class I was 78.7%, for Class II 57.4%, for Class III 59.8% and for Class IV 36.9%. Correct NYHA class scores were associated with providers who typically reported assigning HF stage (p<0.001), increased number of HF patients seen per week (p=0.024) and MD/DO providers relative to other advanced practice providers (p=0.021). Correct NYHA class scores were not associated with years working in a healthcare role, years working in HF, or years of certification adjusting for other provider and practice characteristics. Conclusions: Advanced practice providers who saw fewer HF patients had greater difficulty with accurately assigning NYHA Functional Class. When patients are incorrectly classed, they may not be recommended for evidence-based therapies at the optimal time, thus decreasing patient outcomes. Future research should focus on ways to improve accuracy in assigning NYHA Functional Class to improve patient outcomes.

Download Full-text

P5425Prognostic value of NYHA functional class in heart failure patients undergoing primary prevention implantable cardioverter defibrillator therapy

European Heart Journal ◽

10.1093/eurheartj/ehz746.0382 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Briongos Figuero ◽

A Estevez ◽

M L Perez ◽

J B Martinez-Ferrer ◽

E Garcia ◽

...

Keyword(s):

Cardiovascular Mortality ◽

Event Rate ◽

Nyha Class ◽

Study Groups ◽

Functional Class ◽

Rank Test ◽

Free Survival ◽

Icd Therapy ◽

Nyha Functional Class ◽

Log Rank Test

Abstract Background NYHA functional class (FC) is used for selection of heart failure (HF) patients who are candidates to primary prevention (PP) implantable cardioverter defibrillator (ICD) therapy. However, FC is subjectively estimated and concerns about its real prognostic value are still present in this setting. Purpose To compare whether mortality and arrhythmic risk are different, in a cohort of HF patients undergoing PP ICD-only implant, according to their FC. Methods All HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD-only implant were collected from the UMBRELLA nationwide registry (2006–2015). The sample was divided into three groups: no symptoms (NYHA I), mildly symptomatic patients (NYHA II) and severely symptomatic (NYHA III) patients. Outcomes were studied as follow: all-cause death, cardiovascular mortality and arrhythmia free survival (surrogate marker of sudden cardiac death) defined as survival free of first appropriate ICD therapy delivered in ventricular fibrillation (VF) window. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts. Results Six hundred and twenty one patients were identified (61.1±11.4 years, 87.3% male). Distribution of study groups was as follow: 101 patients in NYHA I; 411 in NYHA II; and 109 in NYHA III. More symptomatic patients were older and had higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD). Higher rates of optimal medical treatment were present among study groups (beta-blockers: 92.1%; ACEI or ARB: 86.8%; aldosterone antagonists: 60.2%). After a median follow-up of 4.2 years (IQR, 2.7–5.7 years) 126 patients died (event rate: 20.3%). All-cause mortality was higher in patients with worse FC (13.9% vs. 18.3% vs. 32.9% for NYHA I, II and III respectively; p<0.001, log-rank test). Seventy-eight out of 126 deaths were related to cardiovascular causes (overall event rate: 12.6%). Cardiovascular mortality risk was also higher in more symptomatic patients (6.9% vs. 11% vs. 23.9% for NYHA I, II and III respectively; p<0.001, log-rank test). One hundred and seventeen patients received afirst appropriate ICD therapy (19.4%). Arrhythmia free survival was not different among study groups (20.8% vs. 18.7% vs. 20.8% for NYHA I, II and III, respectively; p=0.495, log-rank test). Cumulative incidence curves for the three outcomes are shown in Figure 1. After multivariate analysis, worse NYHA class independently predicted cardiovascular mortality but not all-cause death. Moreover, diabetes, AF and CKD strongly predicted both all-cause and cardiovascular mortality. Figure 1 Conclusions In HF patients, prophylactic ICD seems to be useful in preventing death due to life threatening arrhythmias, regardless of the baseline FC. Nevertheless, the combination of NYHA class with other comorbidities may be useful to select those ICD candidates who obtain less survival benefit.

Download Full-text

HUBUNGAN PSYCHOLOGICAL DISTRESS DAN KARAKTERISTIK INDIVIDU, KELUARGA DAN LINGKUNGAN KERJA PADA TENAGA KERJA WANITA (TKW) INDONESIA DI TAIWAN

Jurnal Muara Ilmu Sosial, Humaniora, dan Seni ◽

10.24912/jmishumsen.v3i1.3399 ◽

2019 ◽

Vol 3 (1) ◽

pp. 298

Author(s):

Bianca Marella

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Women Workers ◽

Quantitative Methods ◽

Hypothesis Test ◽

Depression And Anxiety ◽

Snowball Sampling ◽

Symptoms Of Depression ◽

Convenience Sampling ◽

Family Activity

Belum banyak upaya dilakukan untuk mengetahui kesehatan mental tenaga kerja wanita yang berada di luar negeri. Penelitian ini bertujuan untuk melihat gambaran dan faktor-faktor yang berhubungan dengan kesehatan kesehatan mental pada Tenaga Kerja Indonesia yang bekerja di Taiwan. Data diambil menggunakan metode kuantitatif dengan alat ukur the Hopkins Symptoms Checklist-25 (HSCL-25) untuk mengetahui tingkat distres psikologis dan pertanyaan mengenai karakteristik sosiodemografik. Partisipan penelitian ini adalah 181 tenaga kerja wanita Indonesia yang sudah bekerja di Taiwan selama minimal enam bulan, dikumpulkan dengan teknik convenience sampling dan snowball sampling. Berdasarkan penghitungan statistik, sebanyak 17% dari total partisipan mengalami gejala depresi dan kecemasan. Dari uji hipotesis, diketahui terdapat hubungan positif signifikan antara distres psikologis dan komunikasi rutin dengan keluarga, keaktifan di komunitas, dan alasan kerja untuk mencari kesempatan lebih baik. Little effort has been made to find out the mental health of women workers who are abroad. This study aims to look at the picture and factors related to mental health health in Indonesian Workers who work in Taiwan. Data were collected using quantitative methods using the Hopkins Symptoms Checklist-25 (HSCL-25) to determine the level of psychological distress and questions about sociodemographic characteristics. The participants of this study were 181 Indonesian female workers who had worked in Taiwan for a minimum of six months, collected using convenience sampling and snowball sampling techniques. Based on statistical calculations, as many as 17% of the total participants experienced symptoms of depression and anxiety. From the hypothesis test, it is known that there is a significant positive relationship between psychological distress and routine communication with family, activity in the community, and the reasons for work to look for better opportunities.

Download Full-text

Who is shocked and who survives? A multi-state analysis of the NORDIC ICD trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0359 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Gronefeld ◽

A Buchholz ◽

D Boecker ◽

G Klein ◽

C Butter ◽

...

Keyword(s):

Secondary Prevention ◽

Shock Therapy ◽

Functional Class ◽

Clinical Event ◽

Funding Source ◽

Class Iii ◽

Icd Implantation ◽

Risk Of Death ◽

Nyha Functional Class ◽

The Impact

Abstract Background/Purpose The interaction between the risk of arrhythmic death and a competing non-arrhythmic risk of death in patients suitable for implantable cardioverter defibrillator (ICD) implantation is not well understood. Commonly, identification of subpopulations with the largest benefit of ICD implantation has been performed by separate risk models for the outcomes death and appropriate shock therapy. The interrelation between the outcomes was not sufficiently studied. Methods Data were derived from the safety population of the multinational, prospectively randomized NORDIC ICD trial (N=1067) with real-word patients implanted with a single, dual or triple chamber ICD for primary or secondary prevention. Since all outcome adjudication was performed by an independent Clinical Event Committee supported by full telemonitoring data transmission, a high validity of ICD interventions could be achieved. To investigate the impact of baseline characteristics on time to first appropriate shock, death without prior appropriate shock therapy and death after appropriate shock therapy, a multi-state Cox model was computed. Missing data have been multiply imputed before analysis. Results At 36 months follow-up, 86.4% of the patients were alive (7.8% after appropriate shock). 11.0% and 2.6% patients died without or after a foregoing appropriate shock, respectively. The primary randomization allocation showed no significant effect on the 3 outcome types. Higher age (per 5 years) and NYHA functional class (≥III vs. ≤II) were associated with an increased risk of death without appropriate shock (HR 1.31, 95% CI 1.14–1.50, p<0.001, and HR 2.17, 95% CI 1.26–3.74, p=0.005, fig.1, accordingly). The presence of diabetes mellitus at baseline was associated with the reduced risk of the occurrence of an appropriate shock (HR 0.57, 95% CI 0.35–0.92, p=0.022). Patients with secondary prevention indication for an ICD had very high risk for an appropriate shock after ICD implantation (HR 3.21, 95% CI 2.02–5.11, p<0.001), but not for death without or with previous appropriate shock (HR 1.42, 95% CI 0.72–2.79, p=0.306, or HR 0.73, 95% CI 0.23–2.34, p=0.594 after ICD shock). Renal insufficiency and ischemic vs. nonischemic disease showed a significantly increased global effect on all three transitions (HR 1.63, 95% CI 1.18–2.24, p=0.003 and HR 1.53, 95% CI 1.06–2.20, p=0.025, respectively). Conclusion The new multi-state model shows the interrelation between appropriate shocks and death, as well a remarkable variation of risk factors for the transitions. Specifically, the presence of higher age and NYHA functional class ≥III at baseline were strong prognostic factors for all-cause mortality without a foregoing shock therapy, but were not predictive for an appropriate shock therapy. In this all-comer study, a significant discriminator predictive for appropriate shock therapy, but not for death was an indication for secondary prevention of sudden cardiac death. Multi-state graph for NYHA class Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This work was supported by Biotronik SE & Co. KG (Berlin, Germany)

Download Full-text

Abstract 17077: Functional Class, Biomarker Stability, and Clinical Outcomes of Patients With Transthyretin Cardiac Amyloidosis Treated With Tafamidis

Circulation ◽

10.1161/circ.142.suppl_3.17077 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Pranav Chandrashekar ◽

Zack Dale ◽

Lana Rashdan ◽

Miriam Elman ◽

Babak Nazer ◽

...

Keyword(s):

Clinical Outcomes ◽

Real World ◽

Cardiac Amyloidosis ◽

Troponin I ◽

Nyha Class ◽

Functional Class ◽

Wilcoxon Test ◽

World Population ◽

Class Iii ◽

Nyha Functional Class

Introduction: Tafamidis has been shown to improve survival and decrease heart failure (CHF) hospitalizations in transthyretin cardiac amyloidosis (ATTR-CM). In the ATTR-ACT trial, survival benefit emerged after approximately 18 months of treatment, with less clear benefit in those with NYHA class III symptoms. We sought to evaluate the short-term changes in NYHA class, biomarkers, and clinical outcomes in a real-world cohort of patients treated with tafamidis. Methods: A single center retrospective observational study of patients with ATTR-CM who were prescribed tafamidis since its FDA approval in May 2019. We collected data on prospectively assessed NYHA class, NTproBNP, Troponin I, and outcomes of CHF hospitalizations and death. Results: Fifty-one patients with ATTR-CM (mean age 73.3±7 years, 100.0% male) were prescribed tafamidis. Forty-five patients had wild-type and 6 had hereditary ATTR-CM. At the visit when tafamidis was initiated 6 (11.8%) patients were NYHA Class I, 24 (47.1%) Class II, 20 (39.2%) Class III, and 1 (2%) Class IV. Over a median follow up of 8 (IQR 6.0-11) months after starting tafamidis, there were no significant differences before and after tafamidis treatment in time-averaged median NYHA functional class (paired Wilcoxon test, p=0.1610; Figure 1A), time-averaged median NTproBNP (paired exact Wilcoxon test, p > 0.9999; Figure 1B), and time-averaged median troponin I (paired exact Wilcoxon test, p=0.9400; Figure 1C). Following initiation of tafamidis, 13 patients (25.5%) were admitted for CHF hospitalization. A total of 8 patients (15.7%) died a median of 9.5 (IQR 2.5-12.5) months after initiation of tafamidis. Conclusions: ATTR-CM patients taking tafamidis were observed to have stable functional status and biomarkers, including those with NYHA class III symptoms. Despite a higher proportion of worse NYHA functional class, the rate of death at 10 months appears comparable to the ATTR-ACT trial in this real-world population.

Download Full-text

Elevated depression and anxiety among pregnant individuals during the COVID-19 pandemic

10.31234/osf.io/gdhkt ◽

2020 ◽

Cited By ~ 8

Author(s):

Catherine Lebel ◽

Anna MacKinnon ◽

Mercedes Bagshawe ◽

Lianne Tomfohr-Madsen ◽

Gerald Giesbrecht

Keyword(s):

Social Support ◽

Psychological Distress ◽

Mental Health Problems ◽

Psychological Symptoms ◽

Anxiety And Depression ◽

Depression And Anxiety ◽

Standardized Measures ◽

Symptoms Of Depression ◽

Related Stress

Mental health problems are common in pregnancy, typically affecting between 10-25% of pregnant individuals. Elevated symptoms of depression and anxiety can negatively impact both the pregnant individual and developing fetus. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants were surveyed across Canada in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, sleep and social support. We found substantially elevated psychological distress compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression, 57% reporting clinically relevant symptoms of anxiety, and 68% reporting elevated pregnancy-related anxiety. Higher levels of social support and longer sleep duration were associated with lower psychological symptoms across domains. This study shows concerningly elevated levels of psychological distress among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential intervention targets are needed in addition to improving protective factors related to increased social support and sleep -- these should be urgently considered to mitigate long-term negative outcomes.

Download Full-text