Cardiology - Original Articles
10 July 2025
Early Access
https://doi.org/10.4081/monaldi.2025.3425

Hospital Anxiety and Depression Scale in patients undergoing extracorporeal circulation: an Italian cross-sectional study

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Extracorporeal circulation, psychological distress, cardiovascular disease, anxiety, depression, cardiac rehabilitation
10
Views
5
Downloads

Authors

Gloria D’Angelo
g.dangelo@staff.univpm.it
https://orcid.org/0009-0005-2255-4244
Nursing Course, School fo Medicine, Università Politecnica delle Marche, “Mazzoni” Hospital, Ascoli Piceno, Italy.
Silvia Caucci
Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.
Alessandra Carminucci
Rehabilitation Medicine Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.
Giuliana Ciapanna
Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.
Sara Sfredda
Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.
Elisa Baldoni
https://orcid.org/0009-0007-8010-7703
Rehabilitation Medicine Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.
Alfredo Fioroni
Rehabilitation Medicine Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.
Vito Maurizio Parato
https://orcid.org/0000-0002-3958-1848
Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital (AST-Ascoli Piceno), San Benedetto del Tronto, Italy.

Globally, cardiovascular diseases (CVDs) are the major leading cause of death. Medical literature shows an association between CVDs and depressive symptoms, anxiety, low social support, and optimism. Also, cardiac surgery, even if the progress in extracorporeal circulation (ECC) ensures the patient's recovery “ad integrum”, can provoke strong emotional processes, including states of anxiety and fear, leading to true depression disorders. The aim of this study is to identify the degree of anxiety and depression detected by means of the validated Hospital Anxiety and Depression Scale (HADS) following cardiac surgery with ECC. This is a single-center, cross-sectional, observational study that was conducted from 26/04/2023 to 23/10/2024. It involved patients who had undergone ECC for several reasons (coronary bypass, valve replacement, aortic root and arch replacement, trans-apical transcatheter aortic valve implantation) at Marche’s Polytechnic University Hospital, who were subsequently admitted to the Rehabilitation Cardiology Unit of the “Madonna del Soccorso” Hospital in San Benedetto del Tronto. The study procedure involved the administration of the HADS questionnaire by a registered psychologist. We enrolled 100 patients with an average age of 71±4 years, predominantly male (64%) rather than female (35%). The results show that at the first administration of the HADS scale questionnaire (T0), the overall mean score is 14.54±5.86. In detail, the first subscale relating to anxiety reveals a mean value of 7.18±3.54, while the second subscale relating to depression shows a mean value of 7.36±3.09. At the second administration of the HADS scale questionnaire (T1), after a medium time interval of 22 days, the overall mean score is 4.09±4.11. In detail, the first subscale relating to anxiety reveals a mean value of 2.03±2.25, while the second subscale relating to depression shows a mean value of 2.87±2.39. A two-tailed test (t-test) was performed and showed a significant reduction of HADS values between the first (T0) and the second (T1) questionnaire administration [p<0.05 (df=99) (t-stat=25)]. The study shows a significant reduction of anxiety and depressive status in patients who underwent ECC and were subsequently admitted to a short-term psycho-educational intervention by a registered psychologist included in a multi-professional team of a Rehabilitation Cardiology Unit.

Altmetrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
World Health Organization. Cardiovascular diseases. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
Centers for Disease Control and Prevention. Lead causes death. Available from: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm.
Roth GA, Mensah GA, Fuster V. The global burden of cardiovascular diseases and risks: a compass for global action. J Am Coll Cardiol 2020;76:2980-1. DOI: https://doi.org/10.1016/j.jacc.2020.11.021
World Heart Federation. World heart report 2023: confronting the world’s number one killer. 2023. Available from: https://world-heart-federation.org/wp-content/uploads/World-Heart-Report-2023.pdf.
Li C, Ma R, Zhang X, et al. Risk of coronary heart disease in the rural population in Xinjiang: a nested case-control study in China. PLoS One 2020;15:e0229598. DOI: https://doi.org/10.1371/journal.pone.0229598
Roberts R, Campillo A, Schmitt M. Prediction and management of CAD risk based on genetic stratification. Trends Cardiovasc Med 2020;30:328-34. DOI: https://doi.org/10.1016/j.tcm.2019.08.006
Narendrula A, Ajani K, Lang J, et al. Psychological distress and health perception in patients with a previous myocardial infarction or stroke: a national cross-sectional study. BMC Cardiovasc Disord 2023;23:430. DOI: https://doi.org/10.1186/s12872-023-03422-5
Kuruppu S, Ghani M, Pritchard M, et al. A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: a retrospective cohort study using a large mental health database in South London. Eur Psychiatry 2021;64:e13. DOI: https://doi.org/10.1192/j.eurpsy.2021.2
Visseren FLJ, Mach F, Smulders YM, et al. 2020 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2022;43:4468. DOI: https://doi.org/10.1093/eurheartj/ehac458
Smaardiijk VR, Maas AHEM, Lodder P, et al. Sex and gender-stratified risks of psychological factors for adverse clinical outcomes in patients with ischemic heart disease: a systematic review and meta-analysis. Int J Cardiol 2020;302:21-9. DOI: https://doi.org/10.1016/j.ijcard.2019.12.014
Bouchard V, Robitaille A, Perreault S, et al. Psychological distress, social support, and use of outpatient care among adult men and women with coronary artery disease or other non-cardiovascular chronic disease. J Psychosom Res 2023;165:111131. DOI: https://doi.org/10.1016/j.jpsychores.2022.111131
Vaccarino V, Badimon L, Bremner JD, et al. Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. Eur Heart J 2020;41:1687-96. DOI: https://doi.org/10.1093/eurheartj/ehy913
Su SF, Chang MY, He CP. Social support, unstable angina, and stroke as predictors of depression in patients with coronary heart disease. J Cardiovasc Nurs 2018;33:179-86. DOI: https://doi.org/10.1097/JCN.0000000000000419
De Heer EW, Palacios JE, Adèr HJ, et al. Chest pain, depression and anxiety in coronary heart disease: consequence or cause? A prospective clinical study in primary care. J Psychosom Res 2020;129:109891. DOI: https://doi.org/10.1016/j.jpsychores.2019.109891
Ricci M, Pozzi G, Caraglia N, et al. Psychological distress affects performance during exercise-based cardiac rehabilitation. Life 2024;14:236. DOI: https://doi.org/10.3390/life14020236
Płotek W, Pielok J, Cybulski M, Samborska R. Emotional processes in patients undergoing coronary artery bypass graft surgeries with extracorporeal circulation in view of selected indicators of the inflammatory condition. Med Sci Monit 2015;21:105-17. DOI: https://doi.org/10.12659/MSM.892372
Voltolini A, Minotti A, Verde A, et al. Valutazione e supporto psicologico del paziente portatore di dispositivo di assistenza ventricolare sinistra: dati preliminari a 6 mesi. G Ital Cardiol 2016;17:940-6. [Article in Italian].
Girgenti R, Buttafarro MA, Ammirata M, et al. Qualità della vita e disagio psicologico in un gruppo di pazienti con dispositivo di assistenza ventricolare sinistra. G Ital Cardiol 2021;22:233-8. [Article in Italian].
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70. DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Vingerhoets G, Van Nooten G, Vermassen F, et al. Short-term and long-term neuropsychological consequences of cardiac surgery with extracorporeal circulation. Eur J Cardiothorac Surg 1997;11:424-31. DOI: https://doi.org/10.1016/S1010-7940(96)01031-7
Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med 2007;120:799-806. DOI: https://doi.org/10.1016/j.amjmed.2007.03.026
Pizzi C, Santarella L, Manfrini O, et al. Cardiopatia ischemica e depressione: una realtà sottostimata. G Ital Cardiol 2013;14:526-37. [Article in Italian].
Celano CM, Suarez L, Mastromauro C, et al. Feasibility and utility of screening for depression and anxiety disorders in patients with cardiovascular disease. Circ Cardiovasc Qual Outcomes 2013;6:498-504. DOI: https://doi.org/10.1161/CIRCOUTCOMES.111.000049
Sommaruga M, Tramarin R, Angelino E, et al. Guidelines on psychological intervention in cardiac rehabilitation-methodological process. Monaldi Arch Chest Dis 2003;60:40-4.
Giuliani M, Baldi Santagostino G, Capra N, et al. The heart-mind relationship in women cardiovascular primary prevention: the role of depression, anxiety, distress and Type-D personality in the 10-years cardiovascular risk evaluation. Front Cardiovasc Med 2024;11:1308337. DOI: https://doi.org/10.3389/fcvm.2024.1308337

How to Cite



“Hospital Anxiety and Depression Scale in Patients Undergoing Extracorporeal Circulation: An Italian Cross-Sectional Study”. 2025. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2025.3425.
Copyright (c) 2025 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.