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First IoPPN programme grant study to be published in NIHR Library

A large programme grant study led by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) is the first at the IoPPN to be added to the National Institute for Health Research (NIHR) library. The study shows a stronger link between anxiety and adverse cardiac outcomes in patients with coronary heart disease (CHD), than in those experiencing depression. Published in the Journal of Programme Grants for Applied Research, the research followed a cohort of 803 GP patients with CHD, and found that although depression was common, anxiety disorder was more common and was a stronger predictor of cardiac symptoms and mortality. The research also piloted a model of personalised care (PC), which was effective at reducing reported chest pain and was less costly. 

Professor André Tylee, programme lead, says: “Our findings are important because they strengthen the evidence base about the role of anxiety in worsening cardiac outcomes in people with CHD, and confirm that an approach which integrates biological, psychological and social factors to the management of care in general practice could reap wider benefits, and may reduce overall costs at a time of austerity.” 

The UPBEAT NIHR Programme is the first study to examine the links between depression, anxiety, reported chest pain and coronary heart disease (CHD) over three years in a large South London general practice population. It is known from previous hospital-based studies that depression in people with CHD can lead to more heart attacks. However most patients with CHD are cared for in general practice, and incentive payments to encourage GPs and nurses to screen CHD patients for depression were recently removed due to a lack of evidence to support it. The aim of the research was to improve the evidence base in this area to inform future care models. 

The research followed 803 people with CHD from 16 GP practices for up to three years, to investigate how they experience depression, anxiety, chest pain and worsening of heart disease, and measure care costs. Nearly half of all patients on GP CHD registers were found to have current chest pain and this was strongly associated with concurrent social problems. In the sample, anxiety was more common than depression and was an independent predictor of heart attacks and cardiovascular death; however depression did not influence any cardiac outcomes. 

Patients, GPs and nurses were also asked how people with CHD and depression should be treated. From this a model of ‘personalised care’ (PC) was developed involving self-management of social, psychological and biological factors over 6 months. This was tested in 41 people (while 40 people received their usual care from GPs) with chest pain and depression. The new model improved patient self-efficacy, and reduced reported chest pain, an effect which persisted six months after care finished. The new treatment was also associated with fewer overall costs than usual care (such as fewer A&E attendances). However the difference was not statistically significant, and larger studies are needed to confirm these findings. 

The implications of the study are that a more personalised approach to treating any reported chest pain, anxiety and depression in people with CHD may be beneficial. Patients on GP CHD registers could benefit from receiving regular anxiety assessments and care that includes addressing psychological and social factors. Further research is needed to understand the links between anxiety, chest pain and heart disease, and to develop findings that the PC model can be helpful in reducing chest pain in general practice, including methods for effective implementation of the intervention such as staff training needs and changes to practice.

Notes to editors

Tylee, A et al, (2016) UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients Journal of Programme Grants for Applied Research ISSN 2050-4322

For further information please contact Jo Rixom, Research Information & Communications Administrator, Institute of Psychiatry, Psychology & Neuroscience, King’s College London / 020 7848 0063.