Cardiomyopathy
Depression, Anxiety, and Quality of Life in Patients With Obstructive Hypertrophic Cardiomyopathy Three Months After Alcohol Septal Ablation

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Patients with obstructive hypertrophic cardiomyopathy are presumed to have poor quality of life (QOL) and distress related to their cardiac symptoms and functional limitations. Alcohol septal ablation (ASA) is designed to improve heart function and reduce cardiac symptoms. The purpose of this study was to examine psychosocial factors and QOL in patients with obstructive hypertrophic cardiomyopathy before and 3 months after ASA. Twenty-two adult participants (mean age 57 ± 14 years, 59% women, 100% Caucasian, 67% married) were recruited during their initial evaluations or scheduled index hospitalizations for ASA. Psychosocial and medical measures were collected before and 3 months after ASA. The results indicated that before ASA, 57% of patients reported clinically relevant levels of depression (Center for Epidemiologic Studies Depression Scale score >16), symptoms of anxiety, and reduced QOL. Repeated-measures analyses of variance revealed that ASA is an effective procedure in reducing disease severity (i.e., peak left ventricular outflow tract gradient, septal thickness, posterior wall thickness) (p = 0.001 to 0.05), depression (p = 0.005), and anxiety (p = 0.029) and improving cardiac-specific QOL (p < 0.001) and generic physical health-related QOL (p = 0.009). Changes in satisfaction with life, optimism, and generic mental health-related QOL were not significant (p = 0.143 to 0.899). In conclusion, significant psychological distress and compromised well-being were present in this sample of pre-ASA patients with obstructive hypertrophic cardiomyopathy. After ASA, significant reductions in psychological distress and improvements in well-being and echocardiographic parameters indicating disease severity were demonstrated. These results suggest that patients perceived broad health benefits from ASA in short-term follow-up.

Section snippets

Methods

There were 22 adult participants with obstructive HC from 2 sites: Shands Teaching Hospital at the University of Florida (n = 9) and the Medical University of South Carolina (n = 13). Patients were recruited during their initial outpatient clinic evaluations or scheduled index hospitalizations for ASA. To be eligible for ASA, patients had to meet the following criteria: asymmetrical septal hypertrophy, septal wall thickness ≥1.6 cm or a septal wall/posterior wall ratio of 1.3, systolic anterior

Results

Thirty-four participants enrolled in the study and completed baseline questionnaires. Twelve participants were lost to follow-up because they did not return to the clinics for their standard cardiology clinic follow-up appointments and therefore did not receive and complete the packet of questionnaires, nor did they undergo echocardiography. Reasons for attrition included no-shows and cancellations for 3-month follow-up appointments (15% [n = 5]) and loss for unknown reasons (21% [n = 7]).

Discussion

This study demonstrated that significant psychological distress and compromised well-being were present in a sample of patients with obstructive HC before ASA. After ASA, significant reductions in psychological distress and disease severity (measured using echocardiographic parameters) and improvements in well-being were established, suggesting that patients perceived broad health benefits from ASA in short-term follow-up. Although these data do not address the recent dialogue regarding the

Acknowledgment

We thank Christine N. Slifka, RN, BSN, research and clinical nurse coordinator at Medical University of South Carolina, and Gwen M. Thomas, RN, clinical coordinator, and Evette Hutchinson, interventional cardiology assistant at the University of Florida, without whom patient recruitment and data collection would not have been possible.

References (21)

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