All Title Author
Keywords Abstract


Classification and regression tree analysis in acute coronary syndrome patients

DOI: 10.4236/wjcd.2012.23030, PP. 177-183

Keywords: CART, Stepwise Regression, Acute Coronary Syndrome, Anxiety, Quality of Life

Full-Text   Cite this paper   Add to My Lib

Abstract:

Objectives: The objectives of this study are to use CART (Classification and regression tree) and step-wise regression to 1) define the predictors of quality of life in ACS (acute coronary syndrome) patients, using demographics, ACS symptoms, and anxiety as independent variables; and 2) discuss and compare the results of these two statistical approaches. Back- ground: In outcome studies of ACS, CART is a good alternative approach to linear regression; however, CART is rarely used. Methods: A descriptive survey design was used with 100 samples recruited. Result and Conclusions: Anxiety is the most significant predictor and also a stronger predictor than symptoms of ACS for the quality of life. The anxiety level patients experienced at the time heart attack occurred can be used to predict quality of life a month later. Furthermore, the majority of ACS patients experienced a moderate to high level of anxiety during a heart attack.

References

[1]  Lloyd-Jones, D., Adams, R., Carnethon, M., et al. (2009) Heart Disease and Strok Statistic—2009 Update: A report from the American Heart Association statistics committee and stroke statistic. Circulation, 119, 21-181. doi:10.1161/CIRCULATIONAHA.108.191261
[2]  Department of Health, Executive Yuan. R.O.C (Taiwan) (2010) Average number of cases occurred every day. http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=11964&class_no=440&level_no=5.
[3]  Kumar, A. and Cannon, C.P. (2009) Acute coronary syndromes: Diagnosis and management, part I. Mayo Clinic Proceedings, 84, 917-938. doi:10.4065/84.10.917
[4]  DeVon, H.A., Ryan, C.J., Ochs, A.L., et al. (2008) Symptoms across the continuum of acute coronary syndromes: Differences between women and men. American Journal of Critical Care, 17, 14-24.
[5]  Shin, J.Y., Martin, R. and Suls, J. (2009) Meta-analytic evaluation of gender differences and symptom measurement strategies in acute coronary syndromes. Heart & Lung, 39, 283-295. doi:10.1016/j.hrtlng.2009.10.010
[6]  Koivula, M., Hautamaki-Lamminen, K. and Astedt-Kurki, P. (2009) Predictors of fear and anxiety nine years after coronary artery bypass grafting. Journal of Advanced Nursing, 66, 595-606. doi:10.1111/j.1365-2648.2009.05230.x
[7]  Gudykunst, W.B. and Nishida, T. (2001) Anxiety, uncertainty, and perceived effectiveness of communication across relationships and cultures. International Journal of Intercultural Relations, 25, 55-71. doi:10.1016/S0147-1767(00)00042-0
[8]  Wang, W., Chair, S.Y., Thompson, D.R., et al. (2009) A psychometric evaluation of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease. Journal of Clinical Nursing, 18, 1908-1915. doi:10.1111/j.1365-2702.2008.02736.x
[9]  Townsend, M.C. (2008) Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Davis Company, Philadelphia.
[10]  Koivula, M., Paunonen-Ilmonen, M., Tarkka, M.T., et al. (2001) Fear and anxiety in patients awaiting coronary artery bypass grafting. Heart & Lung, 30, 302-311. doi:10.1067/mhl.2001.116134
[11]  Karlsson, I., Berglin, E. and Larsson, P.A. (2000) Sense of coherence: Quality of life before and after coronary artery bypass surgery—A longitudinal study. Journal of Advanced Nursing, 30, 1383-1392. doi:10.1046/j.1365-2648.2000.01408.x
[12]  Koivula, M., Tarkka, M.T., Tarkka, M., et al. (2002) Fear and anxiety in patients at different time-points in the coronary artery bypass process. International Journal of Nursing Studies, 39, 811-822. doi:10.1016/S0020-7489(02)00022-6
[13]  Andrew, M.J., Baker, R.A., Kneebone, A.C., et al. (2000) Mood state as a predictor of neuropsychological deficits following cardiac surgery. Journal of Psychosomatic Research, 48, 537-546. doi:10.1016/S0022-3999(00)00089-1
[14]  Hoyera, J., Eifertb, G.H., Einslec, F., et al. (2008) Heart- focused anxiety before and after cardiac surgery. Journal of Psychosomatic Research, 64, 291-297. doi:10.1016/j.jpsychores.2007.09.009
[15]  Tung, H.H., Hunter, A., Wei, J., et al. (2009) Gender differences in coping and anxiety in patients after coronary artery bypass graft surgery in Taiwan. Heart & Lung, 38, 469-479. doi:10.1016/j.hrtlng.2009.01.006
[16]  Chan, D.S.K., Chau, J.P.C. and Chang, A.M. (2005) Acute coronary syndromes cardiac rehabilitation programmers and quality of life. Journal of Advanced Nursing, 49, 591-599. doi:10.1111/j.1365-2648.2004.03334.x
[17]  Treat-Jacobson, D.J. and Lindquist, R. (2007) Exercise, quality of life, and symptoms in men and women five to six years after coronary artery bypass graft surgery. Heart & Lung, 36, 387-297. doi:10.1016/j.hrtlng.2007.01.002
[18]  Rantanen, A., Kaunonen, M., Sintonen, H., et al. (2008) Factors associated with health-related quality of life in patients and significant others one month after coronary artery bypass grafting. Journal of Clinical Nursing, 17, 1742-1753. doi:10.1111/j.1365-2702.2007.02195.x
[19]  Ulvik, B., Nygard, O., Hanestad, B.R., et al. (2008) Associated between disease severity, coping and dimensions of health-related quality of life in patients admitted for elective coronary angiography—A cross sectional study. Health and Quality of Life Outcomes, 6, 38. doi:10.1186/1477-7525-6-38
[20]  Mayou, R.A., Gill, D., Thompson, D.R., et al. (2000) Depression and anxiety as predictors of outcome after myocardial infarction. Psychosomatic Medicine, 62, 212- 219.
[21]  Szekely, A., Balog, P., Benko, E., et al. (2007) Anxiety predicts mortality and morbidity after coronary artery and valve surgery—A 4-year follow-up study. Psychosomatic Medicine, 69, 625–631. doi:10.1097/PSY.0b013e31814b8c0f
[22]  Benedetto, M.D., Lindner, H., Hare, D.L., et al. (2007) The role of coping, anxiety, and stress in depression post- acute coronary syndrome. Psychology, Health & Medicine, 12, 460-469. doi:10.1080/13548500601109334
[23]  Tully, P.J., Baker, R.A., Turnbull, D.A., et al. (2009) Negative emotion and quality of life six mouths after cardiac surgery: The dominant role of depression not anxiety symptoms. Journal of Behavioral Medicine, 32, 512-522. doi:10.1007/s10865-009-9225-4
[24]  Carmeli, E., Barak, S., Morad, M., et al. (2009) Physical exercise can reduce anxiety and improve quality of life among adults with intellectual disability. International SportMed Journal, 10, 77-85.
[25]  Tung, H.H., Hunter, A. and Wei, J. (2008) Coping, anxiety and quality of life after coronary artery bypass graft surgery. Journal of Advanced Nursing, 61, 651-663. doi:10.1111/j.1365-2648.2007.04557.x
[26]  Lewis, R.J. (2000) An introduction to classification and regression tree (CART) analysis. Annual Meeting of the Society for Academic Emergency Medicine, San Francisco.
[27]  Phelps, M.C. and Merkle, E.C. (2008) Classification and regression tree as alternative to regression. Proceedings of the 4th GRASP Symposium, Wichita State University.
[28]  Sheu, S. (2001) Uncertainty and anxiety in patients with initial attack of myocardial infarction: The effect of coping methods. Nursing Research, 9, 159-171.
[29]  Souza, R.C., Pinheiro, R.S., Coeli, C.M., et al. (2006) The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: Analysis of the importance of recording econdary diagnoses. Cadernos de Saúde Pública, 24, 315-322.
[30]  McGregor, J.C., Kim, P.W., Perencevich, E.N., et al. (2005) Utility of the chronic disease score and charlson comorbidity index as comorbidity ceasures for use in epidemiologic studies of antibiotic-resistant organisms. American Journal of Epidemiology, 161, 483-493. doi:10.1093/aje/kwi068
[31]  Seo, H.J., Yoon, S.J., Lee, S.I., et al. (2010) A comparison of the Charlson comorbidity index derived from medical records and claims data from patients undergoing lung cancer surgery in Korea: A population-based investigation. BMC Health Services Research, 10, 236. doi:10.1186/1472-6963-10-236
[32]  McGregor, J.C., Kim, P.W., Perencevich, E.N., Bradham, D.D., Furuno, J.P., Kaye, K.S., et al. (2005) Utility of the chronic disease score and Charlson comorbidity index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. American Journal of Epidemiology, 161, 483-493. doi:10.1093/aje/kwi068
[33]  Ware, J.E.J., Kosinski, M. and Keller, S.D. (1994) SF-36 Physical & mental health summary scales: A user’s manual. Health Assessment Lab. New England Medical Center, Boston.
[34]  Tseng, H.M., Lu, J.F., Tsai, Y.J. (2003) Assessment of health-related quality of life in Taiwan (II): Norming and validation of SF-36 Taiwan version. Taiwan Journal of Public Health, 22, 512-518.
[35]  Brian, S.E. (2004) Morden medical statistics. Hodder Arnold, Oxford, New York.
[36]  Konstam, V., Moser, D.K. and De Jong, M.J. (2005). Depression and anxiety in heart failure. Journal of Heart Failure, 11, 455-463.
[37]  Hoehn-Sark, R., McLeod, D., Funderburk, F., et al. (2004). Somatic symptoms and physiologic responses in generalized anxiety disorder and panic disorder. Archives of General Psychiatry, 61, 913-921. doi:10.1001/archpsyc.61.9.913
[38]  Tung, H.H., Chen, Y.C., Wei, J., et al. (2010) Leisure physical activity and quality of life after coronary artery bypass graft surgery for patients with metabolic syndrome in Taiwan. Heart & Lung, 39, 410-420. doi:10.1016/j.hrtlng.2009.10.004
[39]  Tung, H.H., Chen, H.L., Wei, J., et al. (2010) Predictors of quality of life in heart-transplant recipients in Taiwan. Heart & Lung, 40, 320-330. doi:10.1016/j.hrtlng.2009.11.003

Full-Text

comments powered by Disqus