Letter to the Editor ‘Parallel Mediating Roles of Social Support and Self‐Efficacy in the Relationship Between Frailty and Depression in Elderly Patients After Percutaneous Coronary Intervention’

It was with great interest that we read the article published in Journal of Clinical Nursing. Wang et al. (2024) used a convenience sample technique and a cross-sectional study design with 241 senior patients. The results demonstrated a direct correlation between depression and frailty in older PCI patients, as well as an indirect correlation through self-efficacy or social support. Coronary heart disease (CHD) is the leading cause of death globally, accounting for almost eight million fatalities each year. According to reports, CHD is the cause of death for almost 85% of adults 65 and over (Shimono et al. 2023). Well-established treatment methods for stable CAD include optimal medical therapy, including lipid-lowering medication, nicorandil, nitrates, β-blockers, calcium channel blockers and antiplatelet medicines. On the other hand, revascularisation therapy, which includes coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), is thought to enhance the clinical results of patients with stable CAD. However, in individuals with stable CAD, no randomised controlled trial has shown that PCI improves prognosis when compared to the best conventional treatment. The short-term prognostic effectiveness and symptom alleviation of revascularisation therapy (PCI or CABG) and the best medical treatment for elderly stable CAD patients were compared in a prior study (Zhou et al. 2022). Depressed CHD patients are less likely to follow treatment plans that include medication, exercise and cardiac rehabilitation, at least in part. Research indicates that depression symptoms may be a factor in CHD patients' poor medication adherence (Guo et al. 2023). Up to 51% of patients with CHD have depression16, and more than one-third of them experience severe depression. Frailty is a sign of susceptibility, which raises the possibility of poor health or mortality while under stress. Between 10% and 60% of people with cardiovascular disease are frail, and a twofold or greater relative increase in frailty raises the risk of death and morbidity compared to those who are not fragile. The evaluation of frailty in patients with cardiovascular disease is crucial and can be done with a variety of methods; however, there is some ambiguity surrounding the tool selection (Murali-Krishnan et al. 2015). This study looked at the chain mediating roles of self-efficacy and social support between depression and frailty quality in older adults who have undergone percutaneous coronary intervention (PCI). This novel approach provides insightful advice and inspiration for the ongoing development of this field of study. There were limitations. There are a few potential complicating factors. The clinical outcome might have been impacted by selection bias with relation to PCI procedures and medicines because of the discretionary disparities across surgeons. However, no notable variations in clinical treatment approach were anticipated because this investigation was carried out at a single institution. The results have limited generalisability because the convenience sample method used to select the participants may not have been adequate to reflect the population in that single region. Due to time constraints, only a small number of individuals were enrolled in this study; therefore, our results should be confirmed in a larger and more varied group of CHD patients. Future research may therefore be required to validate the results presented, using a larger, randomised sample and more robust statistical parametric analysis. Furthermore, in order to determine the causal linkages between depression, medication adherence, self-efficacy and social support in the future, longitudinal study designs that gather data across multiple waves are advised. The authors have nothing to report. The authors declare no conflicts of interest. No data were used in this Letter to the Editor.