Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH
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Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are life-threatening diseases with a high burden of symptoms. Although depression, anxiety, and reduced health related quality of life (HRQOL) have also been reported, a comparative analysis which explores these traits and their underlying factors was lacking.
A retrospective analysis of depression, anxiety, and health related QOL was conducted using a Hospital anxiety and depression scale (HADS) as well as the SF-36 HRQOL questionnaire. Results from these tools were compared with haemodynamic and functional parameters in 70 PAH and 23 CTEPH outpatients from a German tertiary care center specializing in pulmonary hypertension.
Although HRQOL was reduced in both cohorts of patients, individuals diagnosed with CTEPH scored lower in nearly all SF-36 parameters. Significance was noted in both “mental health” (p = 0.01) and “mental component summary score” (MCS) (p = 0.02). Depression was also more frequent in patients with CTEPH (56%) than in patients with PAH (30%), (p = 0.03). Overall, depression and anxiety correlated with most SF-36 scales in both PAH and CTEPH. In CTEPH, depression also correlated with the Borg Dyspnea Scale (r = 0.44, p = 0.01). These patients also had significantly lower pCO2 levels than the PAH cohort reflecting more severe ventilation/perfusion mismatch. All other haemodynamic and functional parameters did not differ across the groups.
While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort. This suggests a strong effort to improve early detection, especially in dyspneic patients with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.
KeywordsDepression Quality of life Mental health CTEPH PAH Pulmonary hypertension Hyperventilation
There was no funding of the presented work.
Compliance with Ethical Standards
Conflict of interest
Dr. Elena Pfeuffer has nothing to disclose. Dr. Krannich has nothing to disclose. Dr. Halank reports personal fees for lectures and consultations and travel/accommodation, meeting expenses from Actelion, AstraZeneca, Bayer, BERLIN CHEMIE, GILEAD, GSK, Lilly, MSD, Novartis, OMT, and Pfizer, outside the submitted work. Prof. Dr. Wilkens reports grants and personal fees from Actelion, personal fees from Bayer Vital, Glaxo Smith Kline, Pfizer, Biotest, Boehringer Ingelheim, and Roche outside the submitted work. Philipp Kolb has nothing to disclose. Prof. Dr. Jany has nothing to disclose. Dr. Held reports grants from Actelion, honoraria for lectures from Actelion, Bayer HealthCare, Berlin Chemie, Boehringer Ingelheim, GSK, Novartis, Pfizer, honoraria for advisory board activities from Actelion, Bayer HealthCare, GSK, MSD, and partizipation in clinical trials of Actelion, Bayer HealthCare, GSK, Pfizer, United Therapeutics, outside the submitted work.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Research Involving Human and Animal Rights
This article does not contain any studies with animals performed by any of the authors.
- 1.Galie N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119PubMedCrossRefGoogle Scholar
- 22.Galie N, Hoeper MM, Humbert M et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J 30(20):S2493–S2537CrossRefGoogle Scholar
- 23.Remillard C, Yuan J (2008) Characterization of hemodynamics in patients with idiopathic and thromboembolic pulmonary hypertension. Clin Med Insights 2:59–68Google Scholar
- 29.Gihl A (2010) Health-related quality of life in pulmonary arterial hypertension. Adv Pulm Hypertens 8(4):215–222Google Scholar
- 35.Rudski LG, Lai WW, Afilalo J et al (2010) Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 23(7):685–713 quiz 786-8 PubMedCrossRefGoogle Scholar
- 40.Borg G (1998) Borg’s perceived exertion and pain scales. Human Kinetics, ChampaignGoogle Scholar
- 41.Snaith RP, Zigmond AS, Herrmann-Lingen C et al (1995) Hospital anxiety and depression scale: deutsche Version; HADS-D; ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin; Testdokumentation und Handanweisung. 1. Aufl (ed), Bern [u.a.]: Huber. 43, III SGoogle Scholar
- 42.Bullinger M, Kirchberger I (1998) Fragebogen zum Gesundheitszustand: SF-36; Handanweisung. Göttingen [u.a.]: Hogrefe. 155 SeitenGoogle Scholar
- 62.Bass JJ (1990) Dyspnea. In: Walker HK, Hall WD, Hurst JW (eds) Clinical methods: the history, physical, and laboratory examinations. Butterworths, BostonGoogle Scholar