Hospital Anxiety and Depression Scale in patients undergoing extracorporeal circulation: an Italian cross-sectional study

Globally, cardiovascular diseases (CVDs) are the major leading cause of death. Medical literature shows an association between CVDs and depressive symptoms, anxiety, low social support, and optimism. Also, cardiac surgery, even if the progress in extracorporeal circulation (ECC) ensures the patient's recovery "ad integrum", can provoke strong emotional processes, including states of anxiety and fear, leading to true depression disorders. The aim of this study is to identify the degree of anxiety and depression detected by means of the validated Hospital Anxiety and Depression Scale (HADS) following cardiac surgery with ECC. This is a single-center, cross-sectional, observational study that was conducted from 26/04/2023 to 23/10/2024. It involved patients who had undergone ECC for several reasons (coronary bypass, valve replacement, aortic root and arch replacement, trans-apical transcatheter aortic valve implantation) at Marche's Polytechnic University Hospital, who were subsequently admitted to the Rehabilitation Cardiology Unit of the "Madonna del Soccorso" Hospital in San Benedetto del Tronto. The study procedure involved the administration of the HADS questionnaire by a registered psychologist. We enrolled 100 patients with an average age of 71±4 years, predominantly male (64%) rather than female (35%). The results show that at the first administration of the HADS scale questionnaire (T0), the overall mean score is 14.54±5.86. In detail, the first subscale relating to anxiety reveals a mean value of 7.18±3.54, while the second subscale relating to depression shows a mean value of 7.36±3.09. At the second administration of the HADS scale questionnaire (T1), after a medium time interval of 22 days, the overall mean score is 4.09±4.11. In detail, the first subscale relating to anxiety reveals a mean value of 2.03±2.25, while the second subscale relating to depression shows a mean value of 2.87±2.39. A two-tailed test (t-test) was performed and showed a significant reduction of HADS values between the first (T0) and the second (T1) questionnaire administration [p<0.05 (df=99) (t-stat=25)]. The study shows a significant reduction of anxiety and depressive status in patients who underwent ECC and were subsequently admitted to a short-term psycho-educational intervention by a registered psychologist included in a multi-professional team of a Rehabilitation Cardiology Unit.