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Anxiety reduction after pre-procedure meetings in patients with CHD

Published online by Cambridge University Press:  05 June 2020

Preston J. Boyer
University of Arizona, Department of Pediatrics, Tucson, AZ, USA
Joshua A. Yell
University of Arizona, College of Medicine, Tucson, AZ, USA
Jennifer G. Andrews
University of Arizona, Department of Pediatrics, Division of Cardiology, Tucson, AZ, USA
Michael D. Seckeler*
University of Arizona, Department of Pediatrics, Division of Cardiology, Tucson, AZ, USA
Author for correspondence: Michael D. Seckeler, MD, MSc, Department of Pediatrics (Cardiology), The University of Arizona, 1501 N. Campbell Ave, PO Box 245073, Tucson, AZ85724, USA. Tel: +1 520 626 6508; Fax: +1 520 626 6571. E-mail: mseckeler@peds.arizonaedu



Cardiac catheterisations for CHD produce anxiety for patients and families. Current strategies to mitigate anxiety and explain complex anatomy include pre-procedure meetings and educational tools (cardiac diagrams, echocardiograms, imaging, and angiography). More recently, three-dimensionally printed patient-specific models can be added to the armamentarium. The purpose of this study was to evaluate the efficacy of pre-procedure meetings and of different educational tools to reduce patient and parent anxiety before a catheterisation.


Prospective study of patients ≥18 and parents of patients <18 scheduled for clinically indicated catheterisations. Patients completed online surveys before and after meeting with the interventional cardiologist, who was blinded to study participation. Both the pre- and post-meeting surveys measured anxiety using the State-Trait Anxiety Inventory. In addition, the post-meeting survey evaluated the subjective value (from 1 to 4) of individual educational tools: physician discussion, cardiac diagrams, echocardiograms, prior imaging, angiograms and three-dimensionally printed cardiac models. Data were compared using paired t-tests.


Twenty-three patients consented to participate, 16 had complete data for evaluation. Mean State-Trait Anxiety Inventory scores were abnormally elevated at baseline and decreased into the normal range after the pre-procedure meeting (39.8 versus 31, p = 0.008). Physician discussion, angiograms, and three-dimensional models were reported to be most effective at increasing understanding and reducing anxiety.


In this pilot study, we have found that pre-catheterisation meetings produce a measurable decrease in patient and family anxiety before a procedure. Discussions of the procedure, angiograms, and three-dimensionally printed cardiac models were the most effective educational tools.

Original Article
© The Author(s), 2020. Published by Cambridge University Press

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Gallagher, R, Trotter, R, Donoghue, J. Preprocedural concerns and anxiety assessment in patients undergoing coronary angiography and percutaneous coronary interventions. Eur J Cardiovasc Nurs 2010; 9: 3844.CrossRefGoogle ScholarPubMed
Trotter, R, Gallagher, R, Donoghue, J. Anxiety in patients undergoing percutaneous coronary interventions. Hear Lung J Acute Crit Care 2011; 40: 185192.CrossRefGoogle ScholarPubMed
Delewi, R, Vlastra, W, Rohling, WJ, et al.Anxiety levels of patients undergoing coronary procedures in the catheterization laboratory. Int J Cardiol 2017; 228: 926930.CrossRefGoogle ScholarPubMed
Pederson, C. Effect of imagery on children’s pain and anxiety during cardiac catheterization. J Pediatr Nurs 1995; 10: 365374.CrossRefGoogle ScholarPubMed
Kobayashi, D, Turner, DR, Forbes, TJ, Aggarwal, S. Parental anxiety among children undergoing cardiac catheterisation. Cardiol Young 2018; 28: 315321.CrossRefGoogle ScholarPubMed
Üzger, A, Başpinar, O, Bülbül, F, Yavuz, S, Kilinç, M. Evaluation of depression and anxiety in parents of children undergoing cardiac catheterization. Turk Kardiyol Dern Ars 2015; 43: 536541.Google ScholarPubMed
Rigatelli, G, Magro, B, Ferro, S, et al.Education, and obtaining of informed consent, using multimedia before adults with congenitally malformed hearts are submitted to transcatheter interventions. Cardiol Young 2009; 19: 6063.CrossRefGoogle ScholarPubMed
Gupta, S, Giuffre, RM, Crawford, S, Waters, J. Covert fears, anxiety and depression in congenital heart disease. Cardiol Young 1998; 8: 491499.CrossRefGoogle ScholarPubMed
Gupta, S, Mitchell, I, Michael Giuffre, R, Crawford, S. Covert fears and anxiety in asthma and congenital heart disease. Child Care Health Dev 2001; 27: 335348.CrossRefGoogle ScholarPubMed
Kovacs, AH, Saidi, AS, Kuhl, EA, et al.Depression and anxiety in adult congenital heart disease: predictors and prevalence. Int J Cardiol 2009; 137: 158164.CrossRefGoogle ScholarPubMed
Celano, CM, Millstein, RA, Bedoya, CA, Healy, BC, Roest, AM, Huffman, JC. Association between anxiety and mortality in patients with coronary artery disease: a meta-analysis. Am Heart J 2015; 170: 11051115.CrossRefGoogle ScholarPubMed
Flory, J, Emanuel, E. Interventions to improve research in informed consent for research. J Am Med Assoc 2004; 292: 15931601.CrossRefGoogle ScholarPubMed
Carroll, DL, Malecki-Ketchell, A, Astin, F. Non-pharmacological interventions to reduce psychological distress in patients undergoing diagnostic cardiac catheterization: a rapid review. Eur J Cardiovasc Nurs 2017; 16: 92103.CrossRefGoogle ScholarPubMed
Kendall, PC, Williams, L, Pechacek, TF, Graham, LE, Shisslak, C, Herzoff, N. Cognitive-behavioral and patient education interventions in cardiac catheterization procedures: the Palo Alto medical psychology project. J Consult Clin Psychol 1979; 47: 4958.CrossRefGoogle Scholar
Freeman, WR, Pichard, AD, Smith, H. Effect of informed consent and educational background on patient knowledge, anxiety, and subjective responses to cardiac catheterization. Cathet Cardiovasc Diagn 1981; 7: 119134.CrossRefGoogle ScholarPubMed
Teishima, J, Takayama, Y, Iwaguro, S, et al.Usefulness of personalized three-dimensional printed model on the satisfaction of preoperative education for patients undergoing robot-assisted partial nephrectomy and their families. Int Urol Nephrol 2018; 50: 10611066.CrossRefGoogle ScholarPubMed
Bernhard, JC, Isotani, S, Matsugasumi, T, et al.Personalized 3D printed model of kidney and tumor anatomy: a useful tool for patient education. World J Urol 2016; 34: 337345.CrossRefGoogle ScholarPubMed
Loke, YH, Harahsheh, AS, Krieger, A, Olivieri, LJ. Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease. BMC Med Educ 2017; 17: 18.CrossRefGoogle ScholarPubMed
Jones, TW, Seckeler, MD. Use of 3D models of vascular rings and slings to improve resident education. Congenit Heart Dis 2017; 12: 578582.CrossRefGoogle ScholarPubMed
Marteau, TM, Bekker, H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992; 31: 301306.CrossRefGoogle Scholar
Spielberger, CD. The State-Trait Anxiety Inventory [Test Manual]. Consulting Psychologists Press, Palo Alto, California, 1970.Google Scholar
Julian, LJ. Measures of anxiety. Arthritis Care Res 2011; 63: 111.CrossRefGoogle ScholarPubMed
Knight, RG, Waal Manning, HJ, Spears, GF. Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating depression scale. Br J Clin Psychol 1983; 22: 245249.CrossRefGoogle ScholarPubMed
Wu, KL, Chen, SR, Ko, WC, et al.The effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction of patients undergoing cardiac catheterisation. J Clin Nurs 2014; 23: 20632073.CrossRefGoogle ScholarPubMed
Harkness, K, Morrow, L, Smith, K, Kiczula, M, Arthur, HM. The effect of early education on patient anxiety while waiting for elective cardiac catheterization. Eur J Cardiovasc Nurs 2003; 2: 113121.CrossRefGoogle ScholarPubMed
Biglino, G, Capelli, C, Wray, J, et al.3D-manufactured patient-specific models of congenital heart defects for communication in clinical practice: feasibility and acceptability. BMJ Open 2015; 5: e007165.CrossRefGoogle ScholarPubMed
Biglino, G, Koniordou, D, Gasparini, M, et al.Piloting the use of patient-specific cardiac models as a novel tool to facilitate communication during clinical consultations. Pediatr Cardiol 2017; 38: 813818.CrossRefGoogle Scholar
Lau, I, Sun, Z. Three-dimensional printing in congenital heart disease: a systematic review. J Med Radiat Sci 2018; 65: 226236.CrossRefGoogle ScholarPubMed
Uzark, K, Jones, K. Parenting stress and children with heart disease. J Pediatr Heal Care 2003; 17: 163168.CrossRefGoogle ScholarPubMed
Lawoko, S, Soares, JJF. Quality of life among parents of children with congenital heart disease, parents of children with other diseases and parents of healthy children. Qual Life Res 2003; 12: 655666.CrossRefGoogle ScholarPubMed
Wang, Q, Hay, M, Clarke, D, Menahem, S. Associations between knowledge of disease, depression and anxiety, social support, sense of coherence and optimism with health-related quality of life in an ambulatory sample of adolescents with heart disease. Cardiol Young 2014; 24: 126133.CrossRefGoogle Scholar