Unit:
Τομέας ΠαθολογίαςLibrary of the School of Health Sciences
Author:
Samartzis Lampros
Dissertation committee:
Σ. Νανάς, Καθηγητής, Ιατρική, ΕΚΠΑ
Χ. Παπαγεωργίου, Καθηγητής, Ιατρική, ΕΚΠΑ
Σ. Τουμανίδης, Καθηγητής, Ιατρική, ΕΚΠΑ
Α. Κοτανίδου, Καθηγητής, Ιατρική, ΕΚΠΑ
Χ. Ρούτση, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Σ. Τσιόδρας, Καθηγητής, Ιατρική, ΕΚΠΑ
Ι. Βασιλειάδης. Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Η ποιότητα ζωής του βαρέως πάσχοντα
Translated title:
The Quality of Life in the severely ill.
Summary:
Title: The Quality of Life in the severely ill.
Introduction
Patients with chronic heart failure suffer from physical and psychosocial problems that lead to dyspnea, easy fatigue, reduced daily life functionality and eventually experiencing poor quality of life. The above is part of the vicious circle of heart failure that includes autonomic nervous system dysfunction, left ventricular dysfunction, decreased exercise capacity but also anxiety, depression, decreased quality of life, which are closely interrelated with the patient's quality of life.
Quality of life as experienced by the patient itself consists a very useful non-invasive way of evaluating and monitoring patients over time as a disease severity index and as a predictor of the risk of re-admission to hospital and of mortality. It is measured by the use of specific psychometric questionnaires answered by the patient, which give us quantified answers to each of the dimensions of quality of life, ie, physical, emotional, mental, social, spiritual, environmental, economic, professional. This study discusses the relationship between the patient's quality of life and the severity of the illness, anxiety, depression and the personality of the patient. Regarding the role of psychological factors in the quality of life of patients with chronic heart failure, it has been found that patients with chronic heart failure and depression and/or anxiety have a poor quality of life. But the role of personality in their quality of life has not been sufficiently studied.
Personality is a set of characteristics that develop during adolescence and stabilize with adulthood and then remain relatively unchanged over the course of life. Human personality has generally been associated with total morbidity, the incidence of depression and anxiety, but also with quality of life regardless of the presence or absence of mental illness. In patients with chronic heart failure it has been found that exercise rehabilitation programs improve depression as well as quality of life.
Aim of the study
We hypothesized that in the population of patients with chronic heart failure: 1) personality, anxiety and depression are independently correlated with the quality of life of the patient with CHF, 2) that the degree of Neuroticism affects the quality of life of patients with chronic heart failure independently of severity of the disease, 3) that during exercise rehabilitation program, psychosocial interventions affect the quality of life of patients with CHF regardless of exercise and 4) that exercise reduces light depression in patients with CHF to a degree comparable to commonly used antidepressant medication (Selective Serotonin Reuptake Inhibitors, SSRIs).
The purpose of our study was: 1)the study of psychological factors that affect the quality of life of the patient with Chronic Heart Failure, 2) the investigation of the role of Personality in Quality of Life in patients with Chronic Heart Failure, 3) the meta-analysis of studies that investigated the role of psychosocial interventions to improve the Quality of Life of patients with Chronic Heart Failure during rehabilitation and 4) the meta-analysis of studies comparing antidepressant drugs with exercise in Chronic Heart Failure.
Methods
In order to answer the above questions, we performed a prospective observational study in patients with chronic heart failure with an ejection fraction of ≤45% who were under the maximum medication dosage. Excluded from the study were patients who had a contraindication of Cardiopulmonary Exercise Testing, those with a history of severe mental disorder or current psychiatric treatment as well as those with a cognitive impairment to the extent that it is impossible to perform psychometric evaluation.
Statistical analysis was carried out using the multiple linear regression method. The Quality of Life psychometric scales scores were used as the dependent variable, and the cardiopulmonary exercise testing parameters were evaluated as independent variables. The analysis was performed with the SPSS-17 software, and the desired statistical significance level was defined as p <0.05.
Subsequently, we performed a meta-analysis to investigate the role of psychosocial interventions in improving the quality of life in chronic heart failure, in a population of 1074 patients and 1106 healthy controls, from 16 double-blind studies.
We also performed meta-analysis to compare exercise with antidepressant drugs for lowering depression levels in chronic heart failure, in a population of 1718 patients and 1707 healthy controls , from 13 double-blind studies.
Results/Conclusion
The findings of our study showed that: 1) personality affects Quality of Life regardless of the severity of the disease in the patients with Chronic Heart Failure, 2) that of the 5 basic characteristics of the personality (Neuroticism, Extraversion, Openness, Conscientiousness, Agreeableness) only Neuroscience is related to the Quality of Life in the patient with Chronic Heart Failure, 3) that depression, anxiety, personality are independently related to the quality of life of the patient with Chronic Heart Failure, 4) that exercise reduces depression to a level comparable to SSRIs in patients with Chronic Heart Failure, and 5) that psychosocial interventions during exercise rehabilitation programs improve the quality of life of the patients with Chronic Heart Failure.
The psychiatric assessment of the patients with Chronic Heart Failure can help the rehabilitation, the personalization of psychosocial interventions, and the further improvement of the Quality of Life of the patients.
Main subject category:
Health Sciences
Keywords:
Psychiatry, Medicine, Μeta-analysis, Quality of Life, Cardiology, Rehabilitation, Sports, Sports Psychology, Cardiopulmonary, Personality, Depression, Neuroticism, Extraversion, Openness, Conscientiousness, Agreeableness, Chronic, Heart, Failure, Anxiety, STAI, Beck, KCCQ, NEO-FFI
Number of references:
159
