Depression, Anxiety and Quality of Life in Patients with Acute Coronary Syndrome and Their Relationship with Cardiac Functional Class

Background: Individuals who experience acute coronary syndrome (ACS) are at an increased risk of depression and anxiety. Objectives: This research was conducted to investigate the relationship between depression, anxiety, and quality of life (QOL) with cardiac functional class in patients with ACS. Methods: This cross-sectional study was carried out among adult inpatients with newly diagnosed ACS during 2022 - 2023 in a state hospital in northern Iran. The patients were included through convenience sampling. The Hospital Anxiety and Depression Scale (HADS), the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF), plasma concentration of troponin, left ventricular ejection fraction (LVEF), and the New York Heart Association (NYHA) functional class were examined as the main research variables at baseline and follow-up visits. Results: In total, 139 patients with a mean age of 63.82 ± 12.58 years were included. Multivariate linear regression models to explore the effect of research variables, including the baseline QOL score, different NYHA classes, levels of LVEF, and positive serum troponin on the total QOL score during the follow-up period, revealed that baseline QOL (P < 0.001) and NYHA class 4 (P < 0.001). Significantly reduced the QOL score at the follow-up examination. Additionally, in the model where the effect of age was adjusted, an LVEF level of 40 - 50 significantly reduced the overall QOL score at the follow-up assessment (P = 0.008). Conclusions: A significant association was found between LVEF and baseline QOL with anxiety, depression, and the QOL score at the follow-up assessment. Proper screening and early intervention are recommended for patients with ACS who have depressive or anxiety symptoms and a low QOL at the baseline examination.