Skip to main content

Advertisement

SpringerLink
Log in

Quality of life in patients with coronary artery disease and the impact of depression

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Depression has been shown to be a risk factor for the development of coronary artery disease, and also is associated with greater risk of mortality in patients with coronary disease. Treatment of depression may or may not prove to alter depression as a risk factor, but improving the quality of life (QOL) of patients with coronary disease also should be considered a primary outcome. Quality of life is a difficult concept to define and measure. However, recent investigations in patients with coronary disease have examined the relationship of QOL to mortality risk and depression. This article will review the concept and measurement of QOL, discuss studies of factors that predict QOL in patients with coronary artery disease, and focus on the impact of depression on QOL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Wulsin LR, Singal BM: Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med 2003, 65:201–210.

    Article  PubMed  Google Scholar 

  2. Lespérance F, Frasure-Smith N, Talajic M, Bourassa MG: Fiveyear risk of cardiac mortality in relation to initial severity and one year changes in depression symptoms after myocardial infarction. Circulation 2002, 105:1049–1053.

    Article  PubMed  Google Scholar 

  3. Bush DE, Ziegelstein RC, Tayback M, et al.: Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 2001, 88:337–341.

    Article  PubMed  CAS  Google Scholar 

  4. Ariyo AA, Haan M, Tangen CM, et al.: Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Circulation 2000, 102:1773–1779.

    PubMed  CAS  Google Scholar 

  5. Wassertheil-Smoller S, Shumaker S, Ockene J, et al.: Depression and cardiovascular sequelae in postmenopausal women. The Women’s Health Initiative (WHI). Arch Intern Med 2004, 164:289–298.

    Article  PubMed  Google Scholar 

  6. Lespérance F, Frasure-Smith N, Juneau M, Théroux P: Depression and 1-year prognosis in unstable angina. Arch Intern Med 2000, 160:1354–1360.

    Article  PubMed  Google Scholar 

  7. Connerney I, Shapiro PA, McLaughlin JS, et al.: Relation between depression after coronary artery bypass surgery and 12 month outcome: A prospective study. Lancet 2001, 358:1766–1771.

    Article  PubMed  CAS  Google Scholar 

  8. Blumenthal JA, Lett HS, Babyak MA, et al.: Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 2003, 362:604–609.

    Article  PubMed  Google Scholar 

  9. Writing Committee for the ENRICHD Investigators: Effects of treating depression and low perceived social support on clinical events after myocardial infarction. The Enhancing Recovery in Coronory Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003, 289:3106–3116.

    Article  Google Scholar 

  10. Glassman AH, O’Connor CM, Califf RM, et al.: Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002, 288:701–709.

    Article  PubMed  CAS  Google Scholar 

  11. Lane D, Carroll D, Lip GYH: Anxiety, depression, and prognosis after myocardial infarction. Is there a causal association? J Am Coll Cardiol 2003, 42:1808–1810.

    Article  PubMed  Google Scholar 

  12. Lespérance F, Frasure-Smith N: The seduction of death (editorial comment). Psychosom Med 1999, 61:18–20.

    PubMed  Google Scholar 

  13. Swenson JR, Clinch JJ: Assessment of quality of life in patients with cardiac disease. The role of psychosomatic medicine. J Psychosom Res 2000, 48:405–415. This study reviews the concept of quality of life and its relationship to psychologic and social factors in patients with cardiac disease.

    Article  PubMed  CAS  Google Scholar 

  14. Jiang W, Blumenthal JA: Depression and ischemic heart disease: Overview of the evidence and treatment implications. Curr Psychiatry Rep 2003, 5:47–54.

    Article  PubMed  CAS  Google Scholar 

  15. Jiang W, Krishnan RR: Should selective serotonin reuptake inhibitors be prescribed to all patients with ischemic heart disease? Curr Psychiatry Rep 2004, 6:202–209.

    Article  PubMed  Google Scholar 

  16. Kaplan RM: The significance of quality of life in health care. Qual Life Res 2003, 12(suppl 1):3–16. This is a well-written overview comparing the traditional biomedical model with an outcomes model, which emphasizes life expectancy and quality of life for evaluating health care.

    Article  PubMed  Google Scholar 

  17. McDowell I, Newall C: Measuring Health. In A Guide to Rating Scales and Questionnaires, Second Edition. New York: Oxford University Press; 1996:380–492.

    Google Scholar 

  18. Mayou R, Bryant B: Quality of life in cardiovascular disease. Br Heart J 1993, 69:460–466.

    PubMed  CAS  Google Scholar 

  19. Schipper H, Clinch JJ, Olweny CLM: Quality of life studies: definitions and conceptual issues. In Quality of Life and Pharmacoeconomics in Clinical Trials, Second Edition. Edited by Spilker B. Philadelphia: Lippincott-Raven; 1996:11–23.

    Google Scholar 

  20. Wenger NK: Improvement of quality of life in the framework of cardiac rehabilitation. In Clinical Cardiac Rehabilitation: A Cardiologist’s Guide, Second Edition. Edited by Pashkow FJ, Dafoe WA. Baltimore: Williams & Wilkins; 1999:43–51.

    Google Scholar 

  21. Wenger NK, Naughton MJ, Furberg CD: Cardiovascular disorders. In Quality of Life and Pharmacoeconomics in Clinical Trials, Second Edition. Edited by Spilker B. Philadelphia: Lippincott-Raven; 1996:883–891.

    Google Scholar 

  22. Wenger NK, Mattson ME, Furgerg CD, Elinson J: Assessment of quality of life in clinical trials of cardiovascular therapies. Am J Cardiol 1984, 54:908–913.

    Article  PubMed  CAS  Google Scholar 

  23. Guyatt GH, Veldhuyzen van Zanten SJO, Feeny DH, Patrick DL: Measuring quality of life in clinical trials: A taxonomy and review. CMAJ 1989, 140:1441–1448.

    PubMed  CAS  Google Scholar 

  24. Hunt SM, McKenna SP, McEwan J, et al.: A quantitative approach to perceived health status: A validation study. J Epidemiol Commun Health 1980, 34:281–286.

    Article  CAS  Google Scholar 

  25. Bergner M, Bobbitt RA, Carter WB, Gilson BS: The sickness impact profile: Development and final revision of a health status measure. Med Care 1981, 19:787–805.

    Article  PubMed  CAS  Google Scholar 

  26. Ware JE, Sherbourne CD: The MOS 36-item Short-form Health Survey (SF-36). I. Conceptual framework and item selection. Med Care 1992, 30:473–483.

    Article  PubMed  Google Scholar 

  27. Hlatky MA, Boineau RE, Higginbotham MB, et al.: A brief selfadministered questionnaire to determine functional status (The Duke Activity Status Index). Am J Cardiol 1989, 64:651–654.

    Article  PubMed  CAS  Google Scholar 

  28. Spertus JA, Winder JA, Dewhurst TA, et al.: Monitoring the quality of life in patients with coronary artery disease. Am J Cardiol 1994, 74:1240–1244.

    Article  PubMed  CAS  Google Scholar 

  29. Rector TS, Kubo SH, Cohn JN: Patients’ self-assessment of their congestive heart failure. Part 2: content, reliability, and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure 1987, 3:198–209.

    Google Scholar 

  30. Valenti L, Lim L, Heller RF, Knapp J: An improved questionnaire for assessing quality of life after acute myocardial infarction. Qual Life Res 1996, 5:151–161.

    Article  PubMed  CAS  Google Scholar 

  31. Juniper EJ, Guyatt GH, Willan A, Griffith LE: Determining a minimally important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994, 47:81–87.

    Article  PubMed  CAS  Google Scholar 

  32. Tarlov AR, Ware JE, Greenfield S, et al.: The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA 1989, 262:925–930.

    Article  PubMed  CAS  Google Scholar 

  33. Stewart AL, Greenfield S, Hays RD, et al.: Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. JAMA 1989, 262:907–913.

    Article  PubMed  CAS  Google Scholar 

  34. Spertus JA, Jones P, McDonell, et al.: Health status predicts long-term outcome in outpatients with coronary disease. Circulation 2002, 106:43–49. This large study shows the value of a disease-specific QOL measure as predictor of all cause mortality and cardiac morbidity during a 1-year follow-up period.

    Article  PubMed  Google Scholar 

  35. Rumsfeld JS, MaWhinney S, McCarthy M, et al.: Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. JAMA 1999, 281:1298–1303.

    Article  PubMed  CAS  Google Scholar 

  36. Brown N, Melville M, Gray D, et al.: Quality of life four years after acute myocardial infarction: Short form 36 scores compared with a normal population. Heart 1999, 81:352–358.

    PubMed  CAS  Google Scholar 

  37. Coyne KS, Lundergan CF, Boyle D, et al.: Relationship of infarct artery patency and left ventricular ejection fraction to health-related quality of life after myocardial infarction. The GUSTO-I angiographic study experience. Circulation 2000, 102:1245–251.

    PubMed  CAS  Google Scholar 

  38. Rinfret S, Grines CL, Cosgrove RS, et al.: Quality of life after balloon angioplasty or stenting for acute myocardial infarction. One-year results from the Stent-PAMI trial. J Am Coll Cardiol 2001, 38:1614–621.

    Article  PubMed  CAS  Google Scholar 

  39. Coronary Artery Surgery Study (CASS): A randomized trial of coronary artery bypass surgery. Quality of life in patients randomly assigned to treatment groups. Circulation 1983, 68:951–960.

    Google Scholar 

  40. Hlatky MA, Rogers WJ, Johnstone I, et al.: Medical care costs and quality of life after randomizataion to coronary angioplasty or coronary artery bypass surgery. N Engl J Med 1997, 336:92–99.

    Article  PubMed  CAS  Google Scholar 

  41. Bute BP, Mathew J, Blumenthal JA, et al.: Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery. Psychosom Med 2003, 65:944–951.

    Article  Google Scholar 

  42. Duits AA, Boeke S, Taams MA, et al.: Prediction of quality of life after coronary artery bypass graft surgery: A review and evaluation of multiple, recent studies. Psychosom Med 1997, 59:257–268.

    PubMed  CAS  Google Scholar 

  43. Frasure-Smith N, Lespérance F, Talajic M: Depression and 18-month prognosis after myocardial infarction. Circulation 1995, 91:999–1005.

    PubMed  CAS  Google Scholar 

  44. Lane D, Carroll D, Ring C, et al.: Mortality and quality of life 12 months after myocardial infarction: Effects of depression and anxiety. Psychosom Med 2001, 63:221–230.

    PubMed  CAS  Google Scholar 

  45. Ladwig KH, Roll G, Briethardt G, et al.: Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet 1994, 343:20–23.

    Article  PubMed  CAS  Google Scholar 

  46. Mayou RA, Gill D, Thompson DR, et al.: Depression and anxiety as predictors of outcome after myocardial infarction. Psychosom Med 2000, 62:212–219.

    PubMed  CAS  Google Scholar 

  47. Pirraglia PA, Peterson JC, Williams-Russo P, et al.: Depressive symptomatology in coronary artery bypass graft surgery patients. Int J Geriatr Psychiatry 1999, 14:668–680.

    Article  PubMed  CAS  Google Scholar 

  48. Ladwig KH, Lehmacher W, Roth R, et al.: Factors which provoke post infarction depression: Results from the Post-Infarction Late Potential Study (PILP). J Psychosom Res 1992, 36:723–729.

    Article  PubMed  CAS  Google Scholar 

  49. Brummett BH, Babyak MA, Barefoot JC, et al.: Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: A prospective study. Psychosom Med 1998, 60:707–713.

    PubMed  CAS  Google Scholar 

  50. Gonzalez MB, Snyderman TB, Colket JT, et al.: Depression in patients with coronary artery disease. Depression 1996, 4:57–62.

    Article  PubMed  CAS  Google Scholar 

  51. Lespérance F, Frasure-Smith N, Talajic M: Major depression before and after myocardial infarction: Its nature and consequences. Psychosom Med 1996, 58:99–110.

    PubMed  Google Scholar 

  52. Koenig HG: Differences in psychosocial and health correlates of major and minor depression in medically ill older adults. J Am Geriatr Soc 1997, 45:1487–1495.

    PubMed  CAS  Google Scholar 

  53. Wells KB, Stewart A, Hays RD, et al.: The functioning and wellbeing of depressed patients. Results from the Medical Outcomes Study. JAMA 1989, 262:914–919. Although it is not recent, this classic paper shows the additive effect of depression in decreasing QOL in patients with chronic medical illness.

    Article  PubMed  CAS  Google Scholar 

  54. Hopman WM, Towheed T, Anastassiades T, et al.: Canadian normative data for the SF-36 health survey. CMAJ 2000, 163:265–271.

    PubMed  CAS  Google Scholar 

  55. Miller IW, Keitner GI, Schatzberg AF, et al.: The treatment of chronic depression, part 3: Psychosocial functioning before and after treatment with sertraline or imipramine. J Clin Psychiatry 1998, 59:608–619.

    PubMed  CAS  Google Scholar 

  56. Komaroff AL, Fagioli LR, Doolittle TH, et al.: Health status in patients with chronic fatigue syndrome and in general population and disease comparison groups. Am J Med 1996, 101:281–290.

    Article  PubMed  CAS  Google Scholar 

  57. Pilote L, Lauzon C, Huynh T, et al.: Quality of life after acute myocardial infarction among patients treated at sites with and without on-site availability of angiography. Arch Intern Med 2002, 162:553–559.

    Article  PubMed  Google Scholar 

  58. Swenson JR, O’Connor CM, Barton D, et al.: Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome. Am J Cardiol 2003, 92:1271–1276. This is a SADHART substudy which examines the effect of antidepressant treatment on quality of life in a 24-week randomized, controlled trial of sertraline in patients with acute myocardial infarction or unstable angina.

    Article  PubMed  CAS  Google Scholar 

  59. Swenson JR: Depression and quality of life in patients with coronary artery disease. Exp Rev Pharmacoeconomics Outcomes Res 2004, 4:89–98.

    Article  Google Scholar 

  60. Ruo B, Rumsfeld JS, Hlatky MA, et al.: Depressive symptoms and health-related quality of life. The Heart and Soul Study. JAMA 2003, 290:215–221. This study shows that depressive symptoms in patients with coronary disease are strongly associated with cardiac symptom burden, physical limitations, quality of life, and overall health, whereas the traditional measures of cardiac function (ejection fraction and myocardial ischemia) are not.

    Article  PubMed  Google Scholar 

  61. Rumsfeld JS, Magid DJ, Plomondon ME, et al.: History of depression, angina, and quality of life after acute coronary syndromes. Am Heart J 2003, 145:493–499. This study found a strong association between a history of depression and heavier angina burden and worse QOL 7 months after acute myocardial infarction or unstable angina.

    Article  PubMed  Google Scholar 

  62. Rumsfeld JS, Magid DJ, Plomondon ME, et al.: Predictors of quality of life following acute coronary syndromes. Am J Cardiol 2001, 88:781–784.

    Article  PubMed  CAS  Google Scholar 

  63. Sullivan MD, LaCroix AZ, Spertus JA, Hecht J: Five-year prospective study of the effects of anxiety and depression in patients with coronary artery disease. Am J Cardiol 2000, 86:1135–1138.

    Article  PubMed  CAS  Google Scholar 

  64. Spertus JA, McDonell M, Woodman CL, Fihn SD: Association between depression and worse disease-specific functional status in outpatients with coronary artery disease. Am Heart J 2000, 140:105–110.

    Article  PubMed  CAS  Google Scholar 

  65. Lane D, Carroll D, Ring C, et al.: Mortality and quality of life 12 months after myocardial infarction: Effects of depression and anxiety. Psychosom Med 2001, 63:221–230.

    PubMed  CAS  Google Scholar 

  66. Fogel J, Fauerbach JA, Ziegelstein RC, Bush DE: Quality of life in physical health domains predicts adherence among myocardial infarction patients even after adjusting for depressive symptoms. J Psychosom Res 2004, 56:75–82. This is an interesting study which correlates low scores on physical QOL measures or higher levels of depression with adherence to cardiac risk factor modification.

    Article  PubMed  Google Scholar 

  67. Coulehan JL, Schulberg HC, Block MR, et al.: Treating depressed primary care patients improves their physical, mental, and social functioning. Arch Intern Med 1997, 157:1113–1120.

    Article  PubMed  CAS  Google Scholar 

  68. Endicott J, Nee J, Harrison W, Blumenthal R: Quality of life, enjoyment and satisfaction questionnaire: A new measure. Psychopharmacol Bull 1993, 29:321–236.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, The Ottawa Hospital, General Campus, University of Ottawa, 501 Smyth Road, Box 400, K1H 8L6, Ottawa, Ontario, Canada

    J. Robert Swenson MD

Authors
  1. J. Robert Swenson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Swenson, J.R. Quality of life in patients with coronary artery disease and the impact of depression. Curr Psychiatry Rep 6, 438–445 (2004). https://doi.org/10.1007/s11920-004-0008-x

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-004-0008-x

Keywords

Search

Navigation