Clinical picture patterns of coronary heart disease and the life quality of patients with depressive disorders

Abstract

Aim: to identify the patterns of coronary heart disease (CHD) clinical course and life quality of patients with comorbid depressive disorders (DD).Patients and Methods: an open-label clinical controlled study was conducted using a parallel comparison method. 93 patients with CHD (angina pectoris of the functional class II–III) were examined, 59 of them had DD (group 1), and 34 had no DD (group 2). The presence and level of depression, anxiety, and social adaptation were assessed using Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), Sheehan Anxiety Rating Scale (ShARS), social adaptation (Bosc), exercise tolerance (6-minute walk test, bicycle ergometry), and heart rate variability (HRV) during Holter monitoring.Results: patients with DD versus patients without DD showed the following indications: increased levels of depression (HADS — 8.8±2.4 points vs. 4.8±1.9 points, p=0.000001; BDI — 21.2±4.4 points vs. 16.0±5.1 points, p=0.0000003) and anxiety (HADS — 9±3.2 points vs. 5.5±2.8 points, p=0.000002; ShARS — 37.3±19.2 points vs. 22.1±2.8 points, p=0.0006); a lower level of social functioning (Bosc — 33.4±6.4 points vs. 36.5±6.6 points, p=0.03); a greater number of anginal episodes (8 [6; 12] vs. 6 [4; 7], p=0.0005) and a greater need for nitroglycerin during the week (3.6±4.8 tablets vs. 1.6±2.3 tablets, p=0.0005); reduced exercise tolerance (according to bicycle ergometry — 52.8±26.8 W vs. 69±30.4 W, p=0.03; 6-minute walk test — 375.7±128.9 m vs. 410±100.3 m, p=0.09), HRV parameters reduction: pNN50% (5.2±4.8 vs. 8.8±7.5, p=0.03), SDANN (81.3±22.4 ms vs. 91±16.9 ms, p=0.04), SDNNindx (46 [36; 56] ms vs. 55 [48; 66] ms, p=0.005), rMSSD (29 [23; 38] ms vs. 33 [29; 41] ms, p=0.04), SDNN (98.2±24.7 MS vs. 112±20 MS, p=0.01).Conclusion: patients with CHD in combination with DD were characterized by an increased level of anxiety, a lower life quality, and a worsening of the coronary disease clinical course, which requires timely diagnosis and correction of mental disorders.KEYWORDS: depressive disorders, heart rate variability, coronary heart disease, myocardial infarction, life quality, angina of effort.FOR CITATION: Nonka T.G., Lebedeva E.V., Repin A.N. Clinical picture patterns of coronary heart disease and the life quality of patients with depressive disorders. Russian Medical Inquiry. 2020;4(7):412–417. DOI: 10.32364/2587-6821-2020-4-7-412-417.