CTEPH Patients Suffer Depression, Anxiety, Poorer Quality of Life Than Those with PAH, Study Finds

A retrospective study found that patients with chronic thromboembolic pulmonary hypertension (CTEPH) have more pronounced decreases in mental health than those with pulmonary arterial hypertension (PAH).

The German study, “Anxiety, Depression, and Health-Related QOL in Patients Diagnosed with PAH or CTEPH,” appeared in the journal Lung.

PAH and CTEPH are two subgroups of pulmonary hypertension (PH). In PAH, cells lining the pulmonary arteries overgrow, resulting in narrow and stiff blood vessels. CTEPH is caused by chronic obstruction of major pulmonary arteries, the result of blood clots that travel to the lungs.

Both diseases are characterized by high blood pressure in the lungs, an elevated pulmonary vascular resistance, a poor prognosis and shortness of breath (dyspnea) leading to physical limitations. Often there’s a delay from first symptoms to diagnosis, meaning that by the time they’re diagnosed, patients already suffer many symptoms.

Patients with PAH and CTEPH both show reduced health-related quality of life (HRQOL), anxiety and depression. However, these traits remain under-reported, especially for CTEPH, which is more common than PAH among the elderly.

Researchers did a comparative analysis exploring these traits in 70 PAH and 23 CTEPH patients from a German tertiary care center specializing in PH, using data from the Hospital Anxiety and Depression Scale (HADS-D, German version) and a Short Form-36 (SF-36) questionnaire. HADS-D measures anxiety and depression, while SF-36 evaluates qualify of life. Results were compared with patients’ blood circulation and functional parameters.

The study revealed that although both groups had lower health-related quality of life scores as well as depression and anxiety, decreases in mental health parameters were more prominent in CTEPH patients. For example, 56.5 percent of CTEPH patients were depressed, compared to 30 percent of those with PAH. Likewise, 43.5 percent of CTEPH patients had high anxiety scores, compared to 32.9 percent of PAH patients.

When it came to HRQOL, both CTEPH and PAH patients displayed low scores in the SF-36 questionnaire, suggesting decreased QOL. However, those with CTEPH had consistently lower mean values than those with PAH. This difference was significant for both ‘‘mental health’’ and ‘‘mental component summary score’’ parameters.

Depression and anxiety correlated with most QOL parameters (SF-36) in both PAH and CTEPH patients.

In the CTEPH group, depression also correlated with high levels of dyspnea. Hyperventilation (fast breathing) was also more frequent in these patients, suggesting that in these patients, hyperventilation as a consequence of dyspnea may be linked to lower HRQOL. All other blood circulation and functional parameters were similar across the groups.

“While both cohorts of patients suffer from a reduced HRQOL as well as depression and anxiety, decreases in mental health parameters are more pronounced in the CTEPH cohort,” researchers concluded. “This suggests a strong effort to improve early detection, especially in dyspneic patients [with breathing difficulties] with classical risk factors for CTEPH and PAH and argues for mental illness interventions alongside routine clinical care provided to patients diagnosed with PAH or CTEPH.”