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Open Access Highly Accessed Study protocol

Evaluating the impact of depression, anxiety & autonomic function on health related quality of life, vocational functioning and health care utilisation in acute coronary syndrome patients: the ADVENT study protocol

John C Oldroyd1*, Sheila Cyril1, Bhanuja S Wijayatilaka1, Adrienne O’Neil23, Dean P McKenzie3, Silva Zavarsek4, Kristy Sanderson5, David L Hare6, Aaron J Fisher7, Andrew B Forbes3, C Barr Taylor8, David M Clarke9, Ian T Meredith10 and Brian Oldenburg1

Author Affiliations

1 Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia

2 IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC 3220, Australia

3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia

4 Centre for Health Economics, Monash University, Clayton, VIC 3800, Australia

5 Menzies Research Institute, University of Tasmania, Hobart, TAS 7000, Australia

6 University of Melbourne School of Medicine, Parkville, Melbourne, VIC Australia

7 University of California, Berkeley, CA 94720, USA

8 School of Medicine, Stanford University, Stanford, CA 94305, USA

9 Department of Psychiatry, Monash University, Monash Health, Clayton, VIC 3168, Australia

10 MonashHeart, Monash Health, Clayton, VIC 3168, Australia

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BMC Cardiovascular Disorders 2013, 13:103  doi:10.1186/1471-2261-13-103

Published: 17 November 2013

Abstract

Background

Depression and anxiety are highly prevalent and co-morbid in acute coronary syndrome patients. Somatic and cognitive subtypes of depression and anxiety in acute coronary syndrome have been shown to be associated with mortality although their association with patient outcomes is unknown, as are the mechanisms that underpin these associations. We are conducting a prospective cohort study which aims to examine in acute coronary syndrome patients: (1) the role of somatic subtypes of depression and anxiety as predictors of health related quality of life outcomes; (2) how somatic subtypes of depression and anxiety relate to long term vocational functioning and healthcare utilisation; and (3) the role of the autonomic nervous system assessed by heart rate variability as a moderator of these associations.

Methods

Patients are being screened after index admission for acute coronary syndrome at a single, high volume centre, MonashHeart, Monash Health, Victoria, Australia. The inclusion criterion is all patients aged > 21 years old and fluent in English admitted to MonashHeart, Monash Health with a diagnosis of acute coronary syndrome. The primary outcome is mean health related quality of life (Short Form-36) Physical and Mental Health Summary scores at 12 and 24 months in subtypes with somatic symptoms of depression and anxiety. Depressive domains are assessed by the Beck Depression Inventory II and the Cardiac Depression Scale. Anxiety is measured using the Speilberger State-Trait Anxiety Inventory and the Crown Crisp Phobic Anxiety questionnaire. Secondary outcomes include clinical variables, healthcare service utilisation and vocational functioning.

Discussion

This manuscript presents the protocol for a prospective cohort study which will investigate the role of somatic subtypes of depression and anxiety as predictors of health related quality of life, long-term vocational functioning and health service use, and the role of the autonomic nervous system in moderating these associations. Findings from the study have the potential to inform more effective pharmacological, psychological and behavioural interventions and better guide health policy on the use of health care resources.

Keywords:
Depression; Anxiety; Heart rate variability; Protocol