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Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Correspondence to Matthias Held.

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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.

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Pfeuffer, E., Krannich, H., Halank, M. et al. Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH. Lung 195, 759–768 (2017). https://doi.org/10.1007/s00408-017-0052-z

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Keywords

  • Depression
  • Quality of life
  • Mental health
  • CTEPH
  • PAH
  • Pulmonary hypertension
  • Hyperventilation