| 1. |
- Mourad, Ghassan, 1974-, et al.
(author)
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Guided Internet-delivered cognitive behavioural therapy in patients with non-cardiac chest pain: -a pilot randomized controlled study
- 2016
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In: Abstract book. - : Sage Publications. ; , s. S44-S44
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Conference paper (other academic/artistic)abstract
- Background: Patients with recurrent episodes of non-cardiac chest pain (NCCP) suffer from cardiac anxiety as they misinterpret the pain as being cardiac-related and avoid physical activity that they think could threaten their life. This could lead to increased healthcare utilization and costs. These patients might benefit from help and support to evaluate the perception and management of their chest pain. Objective: To test the feasibility of a short guided Internet-delivered cognitive behavioural intervention and the effects on chest pain, cardiac anxiety, fear of body sensations and depressive symptoms in patients with NCCP compared to usual care.Methods: A pilot randomized controlled study was conducted. Fifteen patients, 9 men and 6 women between the age of 22 and 76 (median age of 66 years, q1-q3 57-73) were randomly assigned to either intervention (n=7) or control (n=8) group. Patients had recurrent NCCP and suffered from cardiac anxiety or fear of body sensations. The intervention consisted of a 4-session guided Internet-delivered cognitive behavioural therapy program containing psychoeducation, exposure to physical activity, and relaxation. The control group received usual care. All patients completed a web-based questionnaire on socio-demographic variables, chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms. Results: Five out of the 7 patients in the intervention group completed all sessions as planned and two completed only parts of the program. The program was perceived as user-friendly with comprehensible language, adequate and varied content, and manageable homework assignments. The patients were engaged in the program for about 45-60 minutes per day and about 22 minutes’ therapist time was required to guide, support and give feedback to each patient throughout the program. Participating in the program empowered and motivated many of the patients to be active and complete the program. In general, patients in both the intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but there were no significant differences between the groups. Conclusions: A short guided Internet-delivered cognitive behavioural therapy program was feasible. Patients in both the intervention and control groups improved with regard to chest pain frequency, cardiac anxiety, fear of body sensations, and depressive symptoms, but no significant differences were found between the groups. Patients should be followed-up for longer periods to measure the long-term effects of the intervention.
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| 2. |
- Mourad, Ghassan, 1974-, et al.
(author)
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Hälsorelaterad livskvalitet och psykisk ohälsa hos patienter med icke-kardiell bröstsmärta
- 2020
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In: BestPractice Nordic, Primärvård. ; :2
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Journal article (pop. science, debate, etc.)abstract
- Återkommande icke-kardiell bröstsmärta har negativ inverkan på psykiskt välmående och hälsorelaterad livskvalitet (HRQoL). Detta gäller i synnerhet patienter med tidigare hjärtsjukdom vilka visar signifikant lägre HRQoL än patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom.Många patienter som söker akut på grund av bröstsmärta blir utskrivna utan någon förklaring, annat än att akut hjärtsjukdom uteslutits, så kallad icke-kardiell bröstsmärta.1,2 Återkommande bröstsmärta kan påverka patienternas psykiska välbefinnande och hälsorelaterade livskvalitet (HRQoL) negativt.3-6 En stor andel av dessa patienter kan ha haft hjärtsjukdom sedan tidigare.7 Det råder i dag brist på studier som undersökt HRQoL bland patienter med icke-kardiell bröstsmärta samt hur tidigare erfarenhet av hjärtsjukdom påverkar sambandet mellan psykiskt välbefinnande och HRQoL hos dessa patienter. Syftet med denna studie var därför att beskriva HRQoL bland patienter med icke-kardiell bröstsmärta, med eller utan tidigare hjärtsjukdom. Vidare var syftet att undersöka sambandet mellan HRQoL och psykisk ohälsa, vilket i denna studie omfattade hjärtrelaterad ångest, depressiva symtom, rädsla för kroppsliga sensationer och somatisering. Metod Sammanlagt 552 patienter som vårdats för bröstsmärta och skrivits ut från fyra sjukhus i sydöstra Sverige med icke-kardiell bröstsmärta som diagnos (ICD 10–diagnoskoder: R07.2, R07.3, R07.4 och Z03.4) deltog i studien. Patienterna var 64 ± 17 år gamla, huvudsakligen gifta/sambo och jämnt fördelade avseende kön. Patienter med tidigare hjärtsjukdom var äldre än de utan (71 år respektive 60 år) och bestod av fler män än kvinnor (60 procent respektive 44 procent). HRQoL undersöktes med frågeformuläret EuroQol-5D-5L (EQ-5D),8 hjärtrelaterad ångest med Cardiac Anxiety Questionnaire (CAQ),9 depressiva symtom med Patient Health Questionnaire-9 (PHQ-9),10 rädsla för kroppsliga sensationer med Body Sensations Questionnaire (BSQ)11 och somatisering med Patient Health Questionnaire-15 (PHQ-15).12 Resultat Omkring hälften av patienterna rapporterade minst måttliga problem avseende smärtor/besvär och en av fyra rapporterade minst måttliga problem i HRQoL–dimensionerna rörlighet, vanliga aktiviteter och oro/nedstämdhet. Avseende personlig vård var det åtta procent som rapporterade problem. EQ-5D VAS och EQ-5D index var 0,7 ± 0,2 respektive 0,7 ± 0,3 för den totala studiepopulationen. Patienter med icke-kardiell bröstsmärta och tidigare hjärtsjukdom rapporterade signifikant lägre HRQoL (p ≤0,05) jämfört med patienter med icke-kardiell bröstsmärta utan tidigare hjärtsjukdom. Hjärtrelaterad ångest, depressiva symtom och somatisering hade i den totala studiepopulationen svaga signifikanta negativa samband (beta = 0,187–0,284, p <0,001) med HRQoL. Hos patienter med tidigare hjärtsjukdom var sambandet mellan depressiva symtom och HRQoL måttligt (beta = -0,339, p <0,001), jämfört med svagt samband hos patienter utan tidigare hjärtsjukdom (beta = -0,193, p <0,001). Å andra sidan var sambandet mellan hjärtrelaterad ångest och HRQoL svagt hos både patienter med tidigare hjärtsjukdom (beta = -0,156, p = 0,05) och patienter utan tidigare hjärtsjukdom (beta = -0,229, p <0,001). Slutsatser Patienter med icke-kardiell bröstsmärta, särskilt de med tidigare hjärtsjukdom, rapporterade låga nivåer av HRQoL och en stor andel uppvisade problem med smärtor/besvär och oro/nedstämdhet. Hjärtrelaterad ångest, depressiva symtom och somatisering hade negativ inverkan på HRQoL, men skiljde sig en del mellan dem som haft eller inte haft hjärtsjukdom sedan tidigare. Detta bör beaktas vid utveckling av psykologiska interventioner som syftar till att förbättra HRQoL hos patienter med icke-kardiell bröstsmärta.Referenser 1. spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. Journal of the Royal Society of Medicine. 2003;96(3):122-125. 2. Leise MD, Locke GR, 3rd, Dierkhising RA, et al. Patients dismissed from the hospital with a diagnosis of noncardiac chest pain: cardiac outcomes and health care utilization. Mayo Clinic proceedings. Mayo Clinic. 2010;85(4): 323-330. 3. Eslick GD. Health care seeking behaviors, psychological factors, and quality of life of noncardiac chest pain. Disease-a-month : DM. 2008;54(9): 604-612. 4. Mol KA, Smoczynska A, Rahel BM, et al. Non-cardiac chest pain: prognosis and secondary healthcare utilisation. Open Heart. 2018;5(2): e000859. 5. Mourad G, Stromberg A, Johansson P, et al. Depressive Symptoms, Cardiac Anxiety, and Fear of Body Sensations in Patients with Non-Cardiac Chest Pain, and Their Relation to Healthcare-Seeking Behavior: A Cross-Sectional Study. The Patient. 2016;9(1): 69-77.6. Fagring AJ, Gaston-Johansson F, Kjellgren KI, et al. Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women. European journal of cardiovascular nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. 2007;6(4): 329-336. 7. Mourad G, Jaarsma T, Stromberg A, et al. The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter? BMC Psychiatry. 2018;18(1): 172. 8. EuroQolGroup. EQ-5D 2017. Available from: www.euroqolgroup.org, accessed 2017-11-06. 9. Eifert GH, Thompson RN, Zvolensky MJ, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behaviour Research and Therapy. 2000;38(10): 1039-1053. 10. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. 2001;16(9): 606-613.11. Chambless DL, Caputo GC, Bright P, et al. Assessment of fear of fear in agoraphobics: the body sensations questionnaire and the agoraphobic cognitions questionnaire. Journal of Consulting and Clinical Psychology. 1984;52(6): 1090-1097. 12. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine. 2002;64(2): 258-266.
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| 3. |
- Mourad, Ghassan, 1974-, et al.
(author)
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Psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?
- 2017
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In: Abstract book. - : Sage Publications. ; , s. S3-S3
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Conference paper (other academic/artistic)abstract
- Background: Patients with non-cardiac chest pain (NCCP) suffer psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms, which can increase healthcare use. It is unknown how these variables are related and whether the relationships differ between patients with or without history of cardiac disease.Objective: To explore and model the associations between somatization, fear of body sensations, cardiac anxiety, depressive symptoms, and healthcare use in patients with NCCP with or without history of cardiac disease.Methods: Data were collected in Sweden in 670 patients (mean age 65±16 years, 51% women) within one month from discharge using the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, and Patient Health Questionnaire-9. Structural Equation Modelling analyses were used to explore the relationships between somatization, fear of body sensations, cardiac anxiety, depressive symptoms and healthcare use in NCCP patients with or without history of cardiac disease.Results: About 40% of the NCCP patients had previous diagnosis of cardiac disease. Patients with NCCP and a history of cardiac disease were older (71 vs. 60 years), had more comorbidities (4.7 vs. 2.8), and reported significantly higher scores in somatization (p=0.02), cardiac anxiety (p<0.001), and depressive symptoms (p=0.02), and greater healthcare use (p<0.001). Depressive symptoms were not directly associated with healthcare use (Chi-Square=68.28, df=10, P-value=0.000, RMSEA=0.099, CFI=0.96). In patients with history of cardiac disease, the impact of depressive symptoms on healthcare use was mediated by somatization, fear of body sensations, and cardiac anxiety (Chi-Square=7.61, df=8, P-value=0.48, RMSEA=0.000, CFI=0.99). In patients with no history of cardiac disease, the impact of depressive symptoms on healthcare use was directly mediated by cardiac anxiety (Chi-Square=4.17, df=7, P-value=0.76, RMSEA=0.000, CFI=0.99).Conclusions: The associations between psychological distress and healthcare use were different for patients with or without cardiac disease. In both groups depressive symptoms had no direct association with healthcare use.
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| 4. |
- Mourad, Ghassan, 1974-, et al.
(author)
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Somatization in women and men with non-cardiac chest pain compared to the general Swedish population
- 2022
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In: Psychiatry Research Communications. - : Elsevier. - 2772-5987. ; 2:2
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Journal article (peer-reviewed)abstract
- We compare the prevalence of somatization in women and men with NCCP in relation to the general Swedish population, analyze the overlap between somatization, cardiac anxiety, and depressive symptoms, and explore variables associated with somatization. A cross sectional design is implemented with data collected between late October 2013 and early January 2014 from 552 patients with NCCP (mean age of 64 ± 17 years, 51% women) from four hospitals in southeast Sweden. Somatization was measured with the Patient Health Questionnaire-15, cardiac anxiety with the Cardiac Anxiety Questionnaire, and depressive symptoms with the Patient Health Questionnaire-9. Data were self-reported. The general population consists of 1898 females and 1508 males. Compared to the general population, somatization was significantly (p < .001) more common in both women and men with NCCP. Women with NCCP had significantly (p = .003) higher prevalence of somatization than men with NCCP. In patients with NCCP, 12% had only somatization, whereas 39% also reported cardiac anxiety and depressive symptoms. Younger age in women tended to be associated with somatization (OR = 0.98, p < .073), but also being non-worker (OR = 0.40, p = .024). In men, somatization tended to be associated with increased healthcare contacts (OR = 1.82, p = .051). Furthermore, in both women and men, number of co-morbidities (OR = 9.69 p < .001 and OR = 3.45, p = .002), cardiac anxiety (OR = 2.93 and OR = 2.09, p < .001), and depressive symptoms (OR = 8.71 and OR = 4.44, p < .001) were significantly associated with somatization. Our study demonstrates that somatization is very common among patients with NCCP, especially in women. Patients with NCCP have higher somatization and greater overlap with psychological distress compared to the general population.
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| 5. |
- Mourad, Ghassan, 1974-, et al.
(author)
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The association between somatization and health care utilization in patients with non-cardiac chest pain
- 2015
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In: Abstracts. - : Oxford University Press. ; , s. 283-283
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Conference paper (other academic/artistic)abstract
- Background: Chest pain is one of the most common reasons for care-seeking, but often patients are diagnosed as non-cardiac (NCCP). NCCP patients suffer from cardiac anxiety, defined as fear of cardiac-related stimuli and sensations, which is strongly associated with increased healthcare utilization. Research indicates that somatization, defined as report of somatic symptoms that have no pathophysiological cause, is a relatively common cause in chest pain patients. The prevalence of somatization in NCCP patients and its association with cardiac anxiety and healthcare utilization needs further investigation.Purpose: To describe the prevalence of somatization and its association with cardiac anxiety and healthcare utilization in NCCP patients.Methods: Data in this cross sectional study was collected from 552 patients diagnosed with NCCP in four Swedish hospitals within one month from discharge. Patients had a mean age of 64±17 years, and 51% were women. Somatization was measured with the Patient Health Questionnaire-15 and cardiac anxiety with the Cardiac Anxiety Questionnaire. Healthcare utilization, i.e. number of healthcare contacts the year before study inclusion was self-reported by the patients. To determine the association between somatization, cardiac anxiety and healthcare utilization, a logistic hierarchical regression analysis was used with cardiac anxiety inserted in the first block, somatization in the second block, and a variable where these two were multiplied in the third block.Results: In total, 283 (51%) patients reported at least moderate levels of somatization and 229 (42%) patients reported cardiac anxiety. Of the total, 89 (16%) had only somatization; 88 (16%) had only cardiac anxiety; and 194 (35%) had both somatization and cardiac anxiety. Somatization was strongly related to cardiac anxiety (r=.54, p<.010). About 26% of the patients reported 2-3 healthcare contacts and 14% reported more than 3 healthcare contacts due to chest pain. Both somatization (r=.37, p<.010) and cardiac anxiety (r=.46, p<.010) were significantly related to number of healthcare contacts. The logistic hierarchical regression showed that cardiac anxiety (OR=1.09, CI=1.07-1.11, p< .001) and somatization (OR=1.08, CI=1.03-1.13, p< .001) were associated with increased healthcare utilization. The multiplicative interaction term between these variables was not significant (OR=1.09, CI=0.996-1.00, p .901).Conclusions: Somatization was frequently reported by NCCP patients and associated with cardiac anxiety and increased healthcare contacts. Somatization may therefore be important to target with interventions.
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| 6. |
- Mourad, Ghassan, 1974-, et al.
(author)
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The associations between psychological distress and healthcare use in patients with non-cardiac chest pain : does a history of cardiac disease matter?
- 2018
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In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 18:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms is common among patients with non-cardiac chest pain, and this may lead to increased healthcare use. However, the relationships between the psychological distress variables and healthcare use, and the differences in relation to history of cardiac disease in these patients has not been studied earlier. Therefore, our aim was to explore and model the associations between different variables of psychological distress (i.e. somatization, fear of body sensations, cardiac anxiety, and depressive symptoms) and healthcare use in patients with non-cardiac chest pain in relation to history of cardiac disease.METHODS: In total, 552 patients with non-cardiac chest pain (mean age 64 years, 51% women) responded to the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9 and one question regarding number of healthcare visits. The relationships between the psychological distress variables and healthcare visits were analysed using Structural Equation Modeling in two models representing patients with or without history of cardiac disease.RESULTS: A total of 34% of the patients had previous cardiac disease. These patients were older, more males, and reported more comorbidities, psychological distress and healthcare visits. In both models, no direct association between depressive symptoms and healthcare use was found. However, depressive symptoms had an indirect effect on healthcare use, which was mediated by somatization, fear of body sensations, and cardiac anxiety, and this effect was significantly stronger in patients with history of cardiac disease. Additionally, all the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with history of cardiac disease.CONCLUSIONS: In patients with non-cardiac chest pain, in particular those with history of cardiac disease, psychological mechanisms play an important role for seeking healthcare. Development of interventions targeting psychological distress in these patients is warranted. Furthermore, there is also a need of more research to clarify as to whether such interventions should be tailored with regard to history of cardiac disease or not.
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| 7. |
- Mourad, Ghassan, 1974-, et al.
(author)
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The relationship between depressive symptoms, cardiac anxiety and fear of body sensations, and healthcare seeking behaviour in patients with non-cardiac chest pain
- 2015
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In: EuroHeartCare 2015. - : Sage Publications. ; , s. 41-41
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Conference paper (other academic/artistic)abstract
- Background: Chest pain is one of the most common reasons for hospital admissions and more than 50 % of the patients admitted are diagnosed as non-cardiac and discharged without a clear explanation of the underlying cause for the chest pain. A number of patients with non-cardiac chest pain (NCCP) suffer from recurrent chest pain and use a substantial amount of healthcare resources leading to high healthcare and societal costs. Although depressive symptoms, anxiety, and fear of body sensations are prevalent in these patients and may have an impact on patients´ healthcare seeking behaviour, the relationship between these psychological factors and healthcare seeking behaviour is not fully elucidated. Objective: To investigate the prevalence of depressive symptoms, cardiac anxiety and fear of body sensations in patients acutely admitted to hospital due to chest pain and discharged with a NCCP diagnosis. Additionally, to explore how depressive symptoms, cardiac anxiety and fear of body sensations are related to each other and to healthcare seeking behaviour. Methods: Cross-sectional descriptive design. Data were collected from 552 patients diagnosed with NCCP in four Swedish hospitals within one month from discharge using the Patient Health Questionnaire-9, Cardiac Anxiety Questionnaire and Body Sensations Questionnaire. Healthcare seeking behaviour the year before study inclusion (i.e. the number of healthcare contacts) was self-reported by the patients. Results: Of the study population, 141 (26 %) reported at least moderate depressive symptoms, 229 (42 %) reported at least moderate cardiac anxiety, and 337 (62 %) reported some degree of fear of body sensations. There were strong positive relationships between depressive symptoms and cardiac anxiety (rs=.49, p<.01), depressive symptoms and fear of body sensations (rs=.50, p<.01), and cardiac anxiety and fear of body sensations (rs=.56, p<.01). 26 % of the study participants reported 2-3 healthcare contacts and 14 % reported more than 3 healthcare contacts due to chest pain. In a multivariable regression analysis, cardiac anxiety was the only variable independently associated with healthcare seeking behaviour. Conclusions: Symptoms of psychological distress were more frequently reported by the patients with NCCP that had more healthcare contacts. Especially cardiac anxiety was associated with healthcare seeking behaviour, and may therefore be an important target for intervention. The results from this study will guide the development of a web-based intervention targeting cardiac anxiety to improve patient outcomes and reduce healthcare use and costs.
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| 8. |
- Mourad, Ghassan, 1974-, et al.
(author)
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What are patients with heart failure willing to pay for an exergame intervention?
- 2019
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Conference paper (peer-reviewed)abstract
- Background: Regular physical activity in patients with heart failure (HF) improves physical capacity and quality of life, and may reduce health care utilization. One low-cost effective physical activity intervention to increase exercise capacity is exergaming. Exploring patients’ willingness to pay (WTP) for treatments/interventions is a way to obtain a monetary value for the health consequences of an intervention. This can further be used in economic evaluations.Aim: The aim of this study was to describe patients´ WTP for an exergame intervention and to determine factors influencing the WTP.Methods: This is a substudy of the Swedish cohort of the HF-Wii study (evaluating the effect of exergaming on exercise capacity in patients with HF; clinicaltrial.gov NCT01785121) including 34 patients who finished the 1-year follow-up. Structured telephone interviews were conducted focusing on WTP for the exergame intervention they received during the study including an exergame platform, an introduction lesson, installation of the exergame computer, and telephone follow-ups, and with an estimated cost of ∼€440 per patient. The WTP methodology used was adjusted for this specific study.Patients were also asked to rate their level of satisfaction with the intervention on a Numeric Rating Scale (NRS) from 0-10. In addition, information on background variables and income was collected during the interview, while data on six minute walk test (6MWT) and quality of life was retrieved from previous data collection in the main study.Results: In total, 29 patients with HF participated in this substudy, mean age 68±9 years, 69% males, and with a mean household disposable income/month of ∼€2700 (±1360). Ten patients (34.5%) had a clinically significant effect of the exergaming and improved more than 30 meters on the 6MWT.The average WTP for the exergame intervention was ∼€160 (range €0-580). Most patients were satisfied with the exergame intervention and the median score was 8 on the NRS. The satisfaction level was significantly related to WTP (rs=0.468, p=0.012). Patients with higher satisfaction levels were willing to pay more (€210±165) for the exergame intervention than those with lower satisfaction levels (€60±70), p=0.015. Income, changes in 6MWT, and quality of life showed no significant relationship to WTP.Conclusions: The WTP for an exergame intervention varied largely in patients with HF despite high satisfaction level with the intervention. The satisfaction level was the only factor influencing patients´ WTP. On average, patients were willing to pay about one-third of the cost of the exergame intervention. Future studies should focus on the cost-effectiveness of this intervention.
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| 9. |
- Verheijden Klompstra, Leonie, 1982-, et al.
(author)
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Costs of an Off-the-Shelve Exergame Intervention in Patients with Heart Failure
- 2023
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In: Games for Health Journal. - : MARY ANN LIEBERT, INC. - 2161-783X .- 2161-7856. ; 12:3, s. 242-248
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Journal article (peer-reviewed)abstract
- Objectives: Exergaming is promising for patients with heart failure who are less inclined to start or maintain exercise programs involving traditional modes of physical activity. Although no effect on exercise capacity was found for an off-the-shelf exergame, it is important to gain insights into aspects related to costs to develop such interventions further.Materials and Methods: In a randomized controlled trial, the Heart Failure Wii study (HF-Wii study), the intervention group (exergame group) received an introduction to the exergame, the exergame was installed at home and help was offered when needed for 3 months. Patients received telephone follow-ups at 2, 4, 8, and 12 weeks after the installation. The control group (motivational support group) received activity advice and telephone follow-ups at 2, 4, 8, and 12 weeks. We collected data on hospital use and costs, costs of the exergame intervention, patient time-related costs, and willingness to pay.Results: No significant differences were found between the exergame group (n = 300) versus the motivational support group (n = 305) in hospital use or costs (1-year number of hospitalizations: P = 0.60, costs: P = 0.73). The cost of the intervention was 190 Euros, and the patient time-related costs were 98 Euros. Of the total estimated costs for the intervention, 287 Euros, patients were willing to pay, on average, 58%.Conclusion: This study shows that the costs of an intervention using an off-the-shelve exergame are relatively low and that the patients were willing to pay for more than half of the intervention costs. The trial is registered in ClinicalTrials.gov (NCT01785121).
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