Interrelationship of psychological and sociological factors after a first percutaneous coronary intervention (PCI) : Implications for secondary prevention
Authors: Jonsson T M , Sigurdsson J F , Karlsson H D , Svansdottir E 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): This study is supported with a young investigator grant from Vísindaráð Landspítala [the science committee of Landspitali-University Hospital] awarded to dr. Erla Svansdóttir.

Background
Coronary artery disease (CAD) is a leading cause of death, disability, and health-care burden worldwide. Advances in medical technology combined with identification of CAD risk factors has resulted in lower CAD mortality rates in western countries in the past decades. Secondary prevention constitutes a crucial factor for hindering further CAD development by helping patients with risk factor modification. Psychological and sociological factors have been identified as risk factors for progression of CAD and adverse well-being following adverse CAD events, and should be given consideration in secondary prevention.

Purpose
The aim of this study was to assess the prevalence of psycho- and sociological factors in patients undergoing a first Percutaneous Coronary Intervention (PCI) and to explore how the interrelationship of these factors affect patients’ well-being. This study is a part of a larger study investigating the psychological well-being and rehabilitation success of patients after an initial PCI procedure up to six months post-PCI.

Methods
Participants were 97 patients (mean age 60±7.6 years) who underwent a PCI in Iceland from December 2021 to May 2022. Questionnaires assessing somatic symptoms, anxiety, depression, perceived stress, cardiac anxiety, and distress personality were administered during hospitalization.

Results
Majority of participants were male (79%), in a relationship (79%), had secondary/higher education (83%), worked full time (72%) and lived in the capital area (69%). Overall, nearly half of PCI patients showed some depression symptoms (47%) and 38% some anxiety symptoms. Of these, 15% and 10% had moderate or severe symptoms of depression and anxiety, respectively. Women scored higher than men on cardiac anxiety and cardiac-related avoidance (p’s&lt;0.05). Age had a negative correlation with somatic symptom scores (r=-0.26, p&lt;0.05), anxiety (r=-0.32, p&lt;0.01), cardiac anxiety (r=-0.24, p&lt;0.01), cardiac fear and worry (r=-0.39, p&lt;0.01) and social inhibition (r=-0.26, p&lt;0.01). Higher education level was linked with lower anxiety, depression, perceived stress, negative affectivity and social inhibition (table 1). Not being in a relationship was associated with more somatic symptoms (ß=0.27), perceived stress (ß=0.24) and cardiac-related avoidance (ß=0.25), independent of age, gender, and education status (see table 2, all p’s&lt;0.05). In secondary analyses patients not in a relationship had higher odds of current smoking (OR 5.4, 95% CI:1.7-17.6) and of having some depression symptoms (OR 2.7, 95% CI:1.0-7.4).

Conclusion
Nearly half of PCI patients in Iceland had some depression or anxiety symptoms, and psychological distress was higher among patients of younger age or lower education levels. Single patients may pose a group in need of specific support in secondary prevention given their elevated somatic symptoms, cardiac-related avoidance and perceived stress which may hinder rehabilitation efforts.