Du CS, Hao BC, Mao S, Yin Z, Chen SS, Zhao B, Xia HH. Post-percutaneous coronary intervention psychological disorders predict poor adherence and cardiovascular events in elderly heart failure patients. World J Psychiatry 2025; 15(10): 111039 [DOI: 10.5498/wjp.v15.i10.111039]
Corresponding Author of This Article
Hui-Hui Xia, Department of Cardiology, The Ninth Medical Center, Chinese PLA General Hospital, No. 9 Anxiang Beili, Chaoyang District, Beijing 100101, China. xhh.0607@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Oct 19, 2025; 15(10): 111039 Published online Oct 19, 2025. doi: 10.5498/wjp.v15.i10.111039
Post-percutaneous coronary intervention psychological disorders predict poor adherence and cardiovascular events in elderly heart failure patients
Chao-Sheng Du, Ben-Chuan Hao, Shuai Mao, Zhao Yin, Shan-Shan Chen, Bei Zhao, Hui-Hui Xia
Chao-Sheng Du, Ben-Chuan Hao, Shuai Mao, Zhao Yin, Shan-Shan Chen, Bei Zhao, Hui-Hui Xia, Department of Cardiology, The Ninth Medical Center, Chinese PLA General Hospital, Beijing 100101, China
Co-first authors: Chao-Sheng Du and Ben-Chuan Hao.
Co-corresponding authors: Bei Zhao and Hui-Hui Xia.
Author contributions: Du CS and Hao BC designed the research study; Mao S and Yin Z collected and organized the clinical data; Xia HH and Zhao B performed the statistical analysis and interpreted the results; all authors reviewed and approved the final version of the manuscript. Du CS and Hao BC drafted the manuscript, and contributed equally to this work as co-first authors. We have designated both Author Zhao B and Xia HH as co-corresponding authors because they contributed equally but in different capacities to the success of the study. Specifically, Xia HH was responsible for the study concept, protocol design, and supervision of data analysis. Zhao B oversaw patient recruitment, data collection, and played a leading role in manuscript drafting and revision. Both authors have full access to the data and agree to take joint responsibility for the integrity of the work. Given their complementary roles and equal contributions, we believe it is appropriate to list them as co-corresponding authors.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Strategic Support Force Characteristic Medical Center of the Chinese People’s Liberation Army (Approval No. LL-LCSY-2023-05).
Informed consent statement: Due to the retrospective design and use of anonymized clinical data, the requirement for signed informed consent was waived by the ethics committee.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Hui Xia, Department of Cardiology, The Ninth Medical Center, Chinese PLA General Hospital, No. 9 Anxiang Beili, Chaoyang District, Beijing 100101, China. xhh.0607@163.com
Received: July 11, 2025 Revised: August 12, 2025 Accepted: August 22, 2025 Published online: October 19, 2025 Processing time: 77 Days and 0.1 Hours
Abstract
BACKGROUND
Post-procedural psychological disorders are frequently overlooked in elderly patients undergoing percutaneous coronary intervention (PCI), despite their potential impact on long-term cardiovascular outcomes.
AIM
To evaluate the incidence and prognostic significance of post-PCI psychological disorders in elderly patients with heart failure, and to examine their association with medication adherence and major adverse cardiovascular events (MACE).
METHODS
This retrospective cohort study included 330 consecutive patients aged ≥ 60 years with heart failure who underwent PCI between 2018 and 2021 at a single center, excluding those with prior psychiatric diagnoses. Psychological status within six months post-discharge was assessed using validated Chinese versions of the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale, and medication adherence was measured by the 8-item Morisky Medication Adherence Scale (MMAS-8) scale. A subset of 145 patients with ≥ 24 months of follow-up were analyzed for MACEs. Multivariate logistic regression and Kaplan-Meier survival analyses were performed.
RESULTS
Post-PCI psychological disorders were identified in 40% of patients, with anxiety (36%), depression (32%), and comorbid symptoms (22%) being most prevalent. Affected patients had lower MMAS-8 scores [median 5 (IQR 4-6) vs 6 (IQR 5-7), P = 0.002] and a higher rate of low adherence (51.5% vs 30.3%, P < 0.001). Among the 145 patients followed longitudinally, MACEs occurred in 17.9%, with 65.4% of events in those with psychological disorders. Psychological disorders (OR = 2.66, 95%CI: 1.11-6.41, P = 0.028) and low adherence (OR = 2.77, 95%CI: 1.17-6.56, P = 0.021) were independently associated with increased MACE risk. Kaplan-Meier analysis showed reduced MACE-free survival in patients with psychological disorders (HR = 2.68, 95%CI: 1.25-5.73; log-rank P = 0.008).
CONCLUSION
Post-PCI psychological disorders are common in elderly patients with heart failure and independently predict poorer adherence and worse cardiovascular outcomes. Routine psychological assessment and adherence interventions may improve prognosis in this vulnerable population.
Core Tip: This retrospective study highlights the high prevalence (40%) of psychological disorders within 6 months after percutaneous coronary intervention (PCI) in elderly heart failure patients. These disorders-particularly depression and anxiety-were significantly associated with poor medication adherence, as measured by the 8-item Morisky Medication Adherence Scale. Moreover, both psychological morbidity and low adherence independently predicted major adverse cardiovascular events during 2-year follow-up. The findings support routine psychological screening and adherence-focused interventions as essential components of post-PCI management in older adults to reduce long-term cardiovascular risk.
