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Vital exhaustion in women with chest pain and no obstructive coronary artery disease: the iPOWER study

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@article{640a01ab69a64a5db6eb0ab628a26962,
title = "Vital exhaustion in women with chest pain and no obstructive coronary artery disease: the iPOWER study",
abstract = "Background: More than half of women with symptoms suggestive of myocardial ischaemia have no obstructive coronary artery disease (CAD), yet they face a higher risk of cardiovascular mortality and morbidity. Both vital exhaustion (VE) and depression have been linked to adverse cardiovascular prognosis in patients with CAD. We aimed to assess whether symptomatic women with no obstructive CAD are more vitally exhausted compared with asymptomatic women. Furthermore, we investigated the overlap between the constructs of VE and depression. Methods: Prevalence and burden of VE was assessed in symptomatic women with no obstructive CAD (n=1.266) and asymptomatic women (n=2.390). Among symptomatic women, we also assessed chest pain characteristics and symptoms of Hospital Anxiety and Depression Questionnaire. Findings: Median (IQR) VE score was 4 (1-9) and 2 (0-5) in symptomatic and asymptomatic women, respectively (age adjusted, p<0.001). The risk of severe VE was significantly higher in symptomatic women compared with asymptomatic women (OR 3.3, 95% CI 2.5 to 4.4), independent of age and risk factors, and was associated with symptom severity. VE and depression scores were correlated but principal component cluster analysis (PCCA) showed clear distinctiveness between the two constructs. Conclusions: Women with chest pain and no obstructive CAD are more vitally exhausted compared with asymptomatic women. PCCA showed that VE is distinct from depression in symptomatic women. Clinical implications: Mental health screening focusing on depressive symptomatology in women with chest pain presenting with symptoms of mental and physical exhaustion may overlook VE in these patients.",
keywords = "Depression & mood disorders, depression & mood disorders",
author = "Bechsgaard, {Daria Frestad} and Ida Gustafsson and Michelsen, {Marie Mide} and Mygind, {Naja Dam} and Adam Pena and Suhrs, {Hannah Elena} and Kira Bove and Hove, {Jens Dahlgaard} and Eva Prescott",
note = "{\textcopyright} Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2021",
month = may,
doi = "10.1136/ebmental-2020-300175",
language = "English",
volume = "24",
pages = "49--55",
journal = "Evidence-Based Mental Health",
issn = "1362-0347",
publisher = "B M J Group",
number = "2",

}

RIS

TY - JOUR

T1 - Vital exhaustion in women with chest pain and no obstructive coronary artery disease

T2 - the iPOWER study

AU - Bechsgaard, Daria Frestad

AU - Gustafsson, Ida

AU - Michelsen, Marie Mide

AU - Mygind, Naja Dam

AU - Pena, Adam

AU - Suhrs, Hannah Elena

AU - Bove, Kira

AU - Hove, Jens Dahlgaard

AU - Prescott, Eva

N1 - © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/5

Y1 - 2021/5

N2 - Background: More than half of women with symptoms suggestive of myocardial ischaemia have no obstructive coronary artery disease (CAD), yet they face a higher risk of cardiovascular mortality and morbidity. Both vital exhaustion (VE) and depression have been linked to adverse cardiovascular prognosis in patients with CAD. We aimed to assess whether symptomatic women with no obstructive CAD are more vitally exhausted compared with asymptomatic women. Furthermore, we investigated the overlap between the constructs of VE and depression. Methods: Prevalence and burden of VE was assessed in symptomatic women with no obstructive CAD (n=1.266) and asymptomatic women (n=2.390). Among symptomatic women, we also assessed chest pain characteristics and symptoms of Hospital Anxiety and Depression Questionnaire. Findings: Median (IQR) VE score was 4 (1-9) and 2 (0-5) in symptomatic and asymptomatic women, respectively (age adjusted, p<0.001). The risk of severe VE was significantly higher in symptomatic women compared with asymptomatic women (OR 3.3, 95% CI 2.5 to 4.4), independent of age and risk factors, and was associated with symptom severity. VE and depression scores were correlated but principal component cluster analysis (PCCA) showed clear distinctiveness between the two constructs. Conclusions: Women with chest pain and no obstructive CAD are more vitally exhausted compared with asymptomatic women. PCCA showed that VE is distinct from depression in symptomatic women. Clinical implications: Mental health screening focusing on depressive symptomatology in women with chest pain presenting with symptoms of mental and physical exhaustion may overlook VE in these patients.

AB - Background: More than half of women with symptoms suggestive of myocardial ischaemia have no obstructive coronary artery disease (CAD), yet they face a higher risk of cardiovascular mortality and morbidity. Both vital exhaustion (VE) and depression have been linked to adverse cardiovascular prognosis in patients with CAD. We aimed to assess whether symptomatic women with no obstructive CAD are more vitally exhausted compared with asymptomatic women. Furthermore, we investigated the overlap between the constructs of VE and depression. Methods: Prevalence and burden of VE was assessed in symptomatic women with no obstructive CAD (n=1.266) and asymptomatic women (n=2.390). Among symptomatic women, we also assessed chest pain characteristics and symptoms of Hospital Anxiety and Depression Questionnaire. Findings: Median (IQR) VE score was 4 (1-9) and 2 (0-5) in symptomatic and asymptomatic women, respectively (age adjusted, p<0.001). The risk of severe VE was significantly higher in symptomatic women compared with asymptomatic women (OR 3.3, 95% CI 2.5 to 4.4), independent of age and risk factors, and was associated with symptom severity. VE and depression scores were correlated but principal component cluster analysis (PCCA) showed clear distinctiveness between the two constructs. Conclusions: Women with chest pain and no obstructive CAD are more vitally exhausted compared with asymptomatic women. PCCA showed that VE is distinct from depression in symptomatic women. Clinical implications: Mental health screening focusing on depressive symptomatology in women with chest pain presenting with symptoms of mental and physical exhaustion may overlook VE in these patients.

KW - Depression & mood disorders

KW - depression & mood disorders

UR - http://www.scopus.com/inward/record.url?scp=85097874038&partnerID=8YFLogxK

U2 - 10.1136/ebmental-2020-300175

DO - 10.1136/ebmental-2020-300175

M3 - Journal article

C2 - 33310735

VL - 24

SP - 49

EP - 55

JO - Evidence-Based Mental Health

JF - Evidence-Based Mental Health

SN - 1362-0347

IS - 2

M1 - 300175

ER -

ID: 61502445