Influence of psychological care on anxiety and depression in older adult patients with coronary heart disease complicated by arrhythmia

Abstract

BACKGROUND

Coronary heart disease (CHD) has shown a consistent upward trend in global incidence in recent years. Notably, older adults with CHD complicated by arrhythmia exhibit significantly higher susceptibility to psychological distress compared with the general CHD population. This increased vulnerability has garnered growing clinical and research interest in the potential therapeutic benefits of structured psychological interventions for alleviating comorbid depressive and anxiety symptoms in this high-risk demographic.

AIM

To evaluate the efficacy of psychological care in reducing anxiety and depressive symptoms among older adult patients with CHD and comorbid arrhythmia.

METHODS

This retrospective analysis included 100 patients with CHD and arrhythmia admitted to the First Affiliated Hospital of Jinzhou Medical University from June 2024 to December 2024. Of these, 49 patients in the control group received routine care, whereas 51 patients in the observation group received psychological care in addition to routine care. Therapeutic outcomes were compared between the two groups. Psychological distress was assessed before and after providing nursing care. A treatment compliance scale developed by the hospital was used to assess adherence. Complication rates were also compared. Quality of life was evaluated using the Short Form-36 Health Survey after providing nursing care. Patient satisfaction with nursing care was assessed using a self-designed questionnaire.

RESULTS

The observation group demonstrated a higher overall treatment effectiveness compared with the control group (P < 0.05). After nursing care, both groups showed reduced scores on the Self-Rating Anxiety Scale and Self-Rating Depression Scale compared with baseline (P < 0.05), with significantly greater improvements in the observation group (P < 0.05). Treatment compliance was higher and complication rates were lower in the observation group (P < 0.05). Additionally, the observation group demonstrated better quality of life after 1 month of care and higher satisfaction with nursing services (P < 0.05).

CONCLUSION

Psychological care for patients with CHD and comorbid arrhythmia effectively enhanced therapeutic outcomes, reduced anxiety and depression, improved treatment compliance and quality of life, and lowered the risk of complications. These findings support the broader implementation of psychological care for patients with CHD in clinical practice.

Key Words: Psychological care; Coronary heart disease; Arrhythmia; Anxiety; Depression

Core Tip: Psychological care interventions have led to statistically significant improvements in both emotional distress and treatment compliance among older adult patients with coronary heart disease. These interventions are associated with clinically meaningful reductions in depressive and anxiety symptoms while enhancing treatment adherence and overall care. The implementation of structured psychological care protocols provides substantial long-term benefits for this patient population. Our findings indicate that such interventions are linked to a measurable reduction in cardiovascular event rates and significant improvements across multiple quality-of-life domains, including physical functioning, social functioning, and both emotional and physical role performance.

INTRODUCTION

Coronary heart disease (CHD), also known as ischemic heart disease, is a common cardiovascular disorder that primarily affects older adults, with a steadily increasing incidence in recent years[1]. The underlying pathophysiology involves the accumulation of atherosclerotic plaques within the coronary arteries, leading to luminal narrowing, vascular obstruction, and spasms. These changes cause myocardial ischemia and hypoxia, which may progress to tissue necrosis[2].

Arrhythmia is a common condition and complication in patients with CHD, primarily caused by CHD-induced abnormalities in rhythm and pulse conduction at the onset of cardiac activity. The presence of arrhythmia in CHD indicates severe myocardial ischemia, which significantly increases the risk of acute myocardial infarction, cardiogenic shock, and sudden death[3,4]. Therefore, timely and effective treatment should be administered to patients with CHD complicated by arrhythmia.

Compared with the general patient population, older adult patients with CHD complicated by arrhythmia are more likely to experience negative emotions such as anxiety, depression, and fear. These emotions often manifest as treatment noncompliance, persistent low mood, and a lack of trust in medical care and treatment[4,5]. Therefore, to improve prognosis, nursing care during treatment should be enhanced to alleviate both psychological and physiological discomfort and to improve patient adherence to treatment and nursing protocols[6].

The professional psychological care model is a holistic, interdisciplinary, and phased approach to psychological nursing, tailored to each patient’s specific condition. It helps patients adjust their psychological state and mitigate the impact of negative emotions on their illness through the appropriate application of individual and group psychotherapies[7]. Psychological care interventions reduce anxiety and depression in patients with CHD[8]. However, the interaction between psychological and physiological factors is complex[9], and the effects of psychological interventions on alleviating anxiety and depression in patients with CHD remain unclear. Furthermore, a comprehensive analysis of the role of psychological care in older adult patients with CHD complicated by arrhythmia is currently lacking. This study aimed to systematically evaluate the therapeutic benefits of a structured psychological care protocol for reducing anxiety and depressive symptoms in this high-risk population.

MATERIALS AND METHODS

Patient selection and inclusion criteria

This retrospective cohort study analyzed clinical data from 100 consecutive patients diagnosed with CHD and comorbid arrhythmia who were admitted between June and December 2024. Participants were categorized into a control group (n = 49), which received conventional care protocols, and an observation group (n = 51), which received supplemental psychological care interventions in addition to conventional treatment. Inclusion criteria were as follows: (1) Patients who met the diagnostic criteria for CHD complicated by arrhythmia[10]; (2) Age > 60 years; and (3) Availability of complete medical records. We excluded patients with (1) Malignant tumors; (2) Other serious organ diseases; or (3) Severe coagulation disorders.

Methods of data extraction

Patients in the control group received routine care, which primarily included monitoring of vital signs after admission, communicating with patients about their treatment, and providing guidance on diet and medication. Patients in the observation group received routine care combined with psychological care interventions as follows: (1) Nursing staff assessed each patient’s condition, education level, living habits, and other relevant factors to develop tailored psychological care plans. They actively established a positive nurse–patient relationship, communicated with patients to gain their trust, and listened attentively to patient concerns to understand their psychological needs. Nurses also monitored emotional and psychological changes for timely counseling. The pathogenesis, treatment, and prognosis of CHD were explained to help patients develop a correct understanding of their condition. To improve confidence and treatment compliance, patients were reassured that arrhythmia is manageable and could be effectively controlled through timely treatment. Additionally, patients were informed that negative emotions may increase cardiac workload and reduce treatment efficacy; (2) Anxiety and depression were regularly assessed to monitor each patient’s psychological state. Nurses identified the triggers of adverse emotions and provided timely psychological counseling. Patients underwent cognitive behavioral therapy combined with mindfulness training twice a week, with each session lasting 60 minutes. Communication with patients was further enhanced to help them maintain a positive outlook and understand the beneficial role of optimism in recovery; (3) Medical staff performed daily disinfection, window ventilation, and waste disposal to ensure a clean, hygienic, and safe ward environment; (4) To prevent excessive intake of high-sugar and high-calorie foods, nurses assessed patients’ dietary preferences and developed personalized nutrition plans. Patients also received appropriate vitamin supplementation; and (5) Based on physicians’ instructions, nurses provided medication guidance, ensuring that patients took medications on time and at the correct dose. Medication doses were adjusted appropriately according to the patient’s condition. Patients were instructed not to alter the dosage or discontinue medication without medical supervision and were encouraged to promptly report any adverse reactions. They were also advised to maintain adequate sleep and rest. The treatment duration for all patients was 1 month.

Outcome measures

Primary outcome measures: (1) Therapeutic effectiveness was assessed and categorized as marked effectiveness [complete resolution of clinical symptoms and normal electrocardiograph (ECG) findings], effectiveness (alleviation of clinical symptoms and improved ECG findings), or ineffectiveness (no improvement in clinical symptoms or ECG findings). The total effective rate was calculated using the formula: (markedly effective cases + effective cases)/total number of cases × 100%; (2) Psychological distress was evaluated before and after nursing care using the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)[11]; and (3) A treatment compliance scale developed by the hospital was used to assess adherence to treatment and nursing care. Based on a 100-point scale, scores < 60 indicated noncompliance, 60-90 indicated partial compliance, and > 90 indicated complete compliance. The total compliance rate was calculated as follows: (partial compliance cases + complete compliance cases)/total number of cases × 100%.

Secondary outcome measures

Measures: (1) Complications during hospitalization, including heart failure, myocardial infarction, and death, were recorded and compared between groups; (2) Quality of life was assessed using the validated Short Form-36 Health Survey[12], covering domains such as physical functioning, social functioning, and emotional and physical role performance. Higher scores indicated better quality of life; and (3) Patient satisfaction with nursing care was assessed using a questionnaire with three response categories: very satisfied, satisfied, and dissatisfied.

Statistical analysis

Statistical analysis was performed using Statistical Package for the Social Sciences version 20.0 (Beijing ND Times Technology Co., Ltd., Beijing, China). Continuous variables are expressed as mean ± SD, and between-group and within-group comparisons (before and after providing nursing care) were conducted using the independent samples t-test and paired t-test, respectively. The χ² test was used to analyze categorical data. A P value of < 0.05 was considered statistically significant.

RESULTS

General information

No statistically significant differences were observed between the two groups in terms of sex, age, body mass index, or other general characteristics (P > 0.05), indicating comparability (Table 1).

Table 1 General information, n (%).

Factors	Observation group (n = 51)	Control group (n = 49)	χ2	P value
Sex			0.141	0.707
Male	30 (58.82)	27 (55.10)
Female	21 (41.18)	22 (44.90)
Age (years)			0.051	0.822
≤ 65	23 (45.10)	21 (42.86)
> 65	28 (54.90)	28 (57.14)
BMI (kg/m2)			0.001	0.997
≤ 23	26 (50.98)	25 (51.02)
> 23	25 (49.02)	24 (48.98)
Smoking history			0.123	0.726
With	36 (70.59)	33 (67.35)
Without	15 (29.41)	16 (32.65)
Educational level			0.157	0.692
Below junior high school	27 (52.94)	24 (48.98)
Junior high school or above	24 (47.06)	25 (51.02)
Drinking history			0.055	0.814
With	22 (43.14)	20 (40.82)
Without	29 (56.86)	29 (59.18)

BMI: Body mass index.

Therapeutic effectiveness

Therapeutic effectiveness after nursing care was compared between groups. In the observation group, 35 cases were markedly effective, 13 were effective, and 3 were ineffective, resulting in a total effective rate of 94.12%. In the control group, 26, 12, and 11 cases were recorded in the same respective categories, yielding a total effective rate of 77.55%. Comparative analysis indicated superior therapeutic effectiveness in the observation group (P < 0.05) (Table 2).

Table 2 Comparison of clinical efficacy, n (%).

Groups	Observation group (n = 51)	Control group (n = 49)	χ2	P value
Marked effectiveness	35 (68.63)	26 (53.06)	-	-
Effectiveness	13 (25.49)	12 (24.49)	-	-
Ineffectiveness	3 (5.88)	11 (22.45)	-	-
Total effective rate	48 (94.12)	38 (77.55)	5.696	0.017

Negative emotion scores

Standardized evaluation using the SAS and SDS revealed comparable baseline scores between groups (P > 0.05). After nursing care, both groups showed significant reductions in SAS and SDS scores, indicating alleviated negative emotions, with more pronounced improvements in the observation group (P < 0.05) (Figure 1).

Figure 1 Comparison of negative emotions between two groups of patients. ^aP < 0.05 comparison before and after treatment for patients within the group; ^bP < 0.05 comparison between the two groups of patients after treatment. A: Comparison of self-rating anxiety scale scores between two groups of patients; B: Comparison of self-rating depression scale scores between two groups of patients. SAS: Self-rating anxiety scale; SDS: Self-rating depression scale.

Treatment compliance

Treatment compliance was recorded and compared after nursing care. In the observation group, 31 patients were completely compliant, 19 were partially compliant, and 1 was noncompliant, resulting in a compliance rate of 98.04%. In the control group, 20, 19, and 10 patients were categorized into the respective categories, with a compliance rate of 79.59%. These results indicate higher treatment compliance in the observation group (Table 3).

Table 3 Comparison of treatment compliance, n (%).

Groups	Observation group (n = 51)	Control group (n = 49)	χ2	P value
Complete compliance	31 (60.78)	20 (40.82)	-	-
Partial compliance	19 (37.25)	19 (38.78)	-	-
Noncompliance	1 (1.96)	10 (20.41)	-	-
Total compliance rate	50 (98.04)	39 (79.59)	8.687	0.003

Complications during hospitalization

In the observation group, complications included heart failure in one patient and myocardial infarction in one patient, with no reported deaths, yielding an overall complication rate of 5.88%. In contrast, the control group had three patients with heart failure, five with myocardial infarction, and two deaths, resulting in a complication rate of 20.41%. The complication rate was significantly lower in the observation group than in the control group (P < 0.05) (Table 4).

Table 4 Comparison of the complication rate, n (%).

Complications	Observation group (n = 51)	Control group (n = 49)	χ2	P value
Heart failure	1 (1.96)	3 (6.12)	-	-
Myocardial infarction	2 (3.92)	5 (10.20)	-	-
Death	0	2 (4.08)	-	-
Total	3 (5.88)	10 (20.41)	4.662	0.031

Quality of life 1 month after discharge

Assessment using the Short Form 36-Item Health Survey revealed significantly higher scores in physical functioning, social functioning, and emotional and physical role domains in the observation group compared with the control group, indicating a better quality of life in the observation group (P < 0.05) (Table 5).

Table 5 Comparison of quality of life, n (%).

Project	Observation group (n = 51)	Control group (n = 49)	t	P value
Physical functioning	15.39 ± 1.1	11.12 ± 1.15	18.98	< 0.001
Social functioning	16.18 ± 1.18	12.04 ± 1.17	17.61	< 0.001
Role-emotional	16.24 ± 1.12	12.24 ± 0.99	18.89	< 0.001
Role-physical	13.76 ± 1.12	10.18 ± 1.03	16.62	< 0.001

Nursing satisfaction

In the observation group, 40 patients were very satisfied, 10 were satisfied, and 1 was dissatisfied, resulting in a nursing satisfaction rate of 98.04%. In the control group, 23 were very satisfied, 14 were satisfied, and 12 were dissatisfied, with a satisfaction rate of 75.51%. Nursing satisfaction was significantly higher in the observation group than in the control group (P < 0.05) (Table 6).

Table 6 Comparison of nursing satisfaction, n (%).

Groups	Observation group (n = 51)	Control group (n = 49)	χ2	P value
Very satisfied	40 (78.43)	23 (46.94)	-	-
Satisfied	10 (19.61)	14 (28.57)	-	-
Dissatisfied	1 (1.96)	12 (24.49)	-	-
Nursing satisfaction	50 (98.04)	37 (75.51)	11.21	< 0.001

DISCUSSION

As a common cardiovascular disease, CHD has become one of the major health threats worldwide[13]. Coronary atherosclerosis in patients with CHD leads to partial or complete occlusion of the coronary arteries, resulting in atrial fibrillation and arrhythmia, as well as hypoxic and ischemic necrosis of cardiomyocytes[14]. Epidemiological studies have shown that approximately 75% of patients with CHD develop arrhythmia[15]. Notably, due to the need for long-term treatment and the recurrent nature of the disease, patients with CHD are psychologically vulnerable and prone to developing negative emotions[16]. More than 80% of older adult patients with CHD and comorbid arrhythmia exhibit significant psychological disturbances, primarily anxiety and depression. These symptoms are often manifested as social withdrawal, low mood, crying spells, frustration, and noncompliance with treatment[17]. Consequently, there is increasing clinical interest in implementing psychological interventions for this patient population to enhance treatment outcomes and improve overall efficacy.

Psychological care, an emerging nursing modality grounded in evidence-based medicine, offers more scientific, effective, and targeted support tailored to a patient’s condition and physical status[18]. Our findings revealed that patients in the observation group who received psychological care showed more significant improvements in clinical symptoms and ECG results compared with those receiving routine care. This suggests that the implementation of psychological care contributes to improved therapeutic outcomes. Patients with CHD complicated by arrhythmia experience not only a range of physical symptoms but also considerable psychological distress. This is especially pronounced in older adults, who often experience anxiety, fear, and depression due to diminished physical function, uncertainty about their prognosis, limited social support, absence of family companionship, and concerns about treatment costs[19]. In our study, both groups exhibited significant reductions in anxiety and depression scores after nursing care; however, the improvements were more pronounced in the observation group. Furthermore, patients in the observation group demonstrated higher compliance with follow-up treatment and care. This outcome can be attributed to the comprehensive measures provided through psychological care, particularly the explanation of CHD and arrhythmia-related knowledge and emotional counseling, which helped alleviate negative emotions and enhance adherence. In contrast, the conventional care model - primarily limited to basic daily interactions - lacked structured psychological assessment or intervention. This shortfall in emotional support may lead to a worsening of negative emotional states, ultimately impairing treatment outcomes. Supporting our findings, previous evidence has highlighted that effective nursing interventions can enhance therapeutic efficacy by alleviating psychological distress and increasing treatment cooperation[20].

Furthermore, statistical analysis of complications revealed a lower complication rate in the observation group. A comprehensive understanding and prediction of the patient’s condition during psychological care facilitated more accurate monitoring and assessment, thereby enhancing treatment compliance and reducing the risk of complications[21]. We also evaluated patients’ quality of life after discharge. As expected, the observation group demonstrated significantly better quality of life compared to the control group, suggesting that psychological care not only alleviates negative emotions and improves therapeutic outcomes but also enhances overall well-being. This finding aligns with those of a previous study, which reported significant improvements in quality of life among patients with CHD following long-term psychological care[22]. Conversely, patients receiving routine care exhibited substantial psychological comorbidities that remained unaddressed throughout the treatment process. This unmanaged emotional distress—characterized by persistent disease-related anxiety and maladaptive fear responses—was associated with poor treatment adherence, which in turn increased the risk of disease progression and complications. Lastly, nursing care satisfaction was significantly higher in the observation group than in the control group. Our study consistently follows a patient-centered nursing philosophy, emphasizing comprehensive, individualized care, which contributes to reduced nursing-related disputes and improved patient satisfaction.

CONCLUSION

The application of psychological care in patients with CHD complicated by arrhythmia is effective in enhancing therapeutic outcomes, alleviating depression and anxiety, increasing treatment compliance, reducing complication rates, and improving quality of life. These findings support the broader adoption of psychological care in clinical practice.

However, this study has some limitations. First, the relatively small sample size may limit the generalizability of the results, warranting further validation through multicenter, large-scale studies. Second, the retrospective study design introduces potential methodological biases, including selection bias, information bias, and residual confounding from unmeasured variables. Additionally, deviations in the implementation of psychological care interventions may have occurred. To address these limitations, we plan to conduct prospective randomized controlled trials in future research to further validate our findings.