Despite recent advances in the recognition of pathophysiology and cardiovascular risk factors, these diseases are still the leading cause of death in the world [1]. According to the American Heart Association, cardiovascular disease causes an annual death toll of 17.3 million out of 54 million people (31.5%) worldwide. Coronary artery disease is one of the most common cardiovascular diseases, and angiography is widely used to diagnose them [4].
Cardiovascular patients, on the other hand, suffer from anxiety levels before coronary artery angiography due to fear of death, especially in people who have not had angiography [13]. Therefore, due to the effect of anxiety on the patient's condition and disruption of the angiographic process, special study and management is required [16].
Complementary therapies, including massage therapy, acupuncture, and aromatherapy, are widely used to reduce patient anxiety [17]. Aromatherapy is one of the most common complementary therapies [18]. Aromatherapy is the use of essential oils for medicinal purposes [19-21].
The rose belongs to the Rosaceae family [23]. In several studies, the effects of rose essential oil with a suppressive effect on the sympathetic system and lowering blood adrenaline levels have been reported to improve sleep [24] and improve stress and hemodynamic status [26, 25]. Other studies have shown that aromatherapy is not effective [27, 20]. Therefore, it seems that more studies are needed in this field; the present study was conducted to determine the effect of aromatherapy with rose essential oil on the anxiety of patients under coronary angiography. 

 

The present study is a clinical trial in which the research community was all clients who were admitted to the angiography department of Hamadan Besat Educational Hospital in the post-angiography department for coronary angiography. This study was performed using the available sampling method in two groups of aromatherapy and control on 98 patients. Entry criteria included knowledge of time, place, and person, no previous history of asthma and angiography, and no known psychological, thyroid, pituitary, or adrenal disorders, and no use of modern psychiatric medications. The criteria for leaving the study were sensitivity to inhalation of rose essential oil and lack of conditions for continuing to participate in the study.
During the study, patients were usually at rest and did not enter the angiography room. In the intervention group, the aromatherapy was performed with the help of an absorbent cloth with a length and width of 2 cm, impregnated with 5 drops of rose essential oil, 40% of which was attached to the patients' shirts for 20 minutes. In the control group, intervention was performed with the help of an absorbent cloth with a length and width of 2 cm, impregnated with 5 drops of distilled water attached to the patients' shirts for 20 minutes. Two minutes after the intervention, the researcher read the STAI questionnaire again to the patients and recorded the answers to the questions. Data collection tools included 10 demographic questions and 20 STAI situational anxiety questions. In this study, the situational anxiety section of the questionnaire (STAI) was used before and 2 minutes after the intervention to determine the patient's anxiety level.
In order to randomly assign patients to two groups of aromatic and inhaled aromatherapy groups and control and equality of sample numbers in two groups, the method of six randomized blocks was used as follows. Dedicated to the inhaled aromatherapy group and the control group to the letters A and B were randomly assigned by the researcher's assistant and the researcher made the blocking and execution of the study. The intervention was performed as a sock; in a way that the data recording researcher was not aware of the type of treatment prescribed. For this purpose, during the intervention, the researcher used a mask with a small amount of fragrant scent to divert the diagnosis of rose essential oil. After collecting the data, they were summarized using descriptive statistics. To compare the characteristics of the two groups t-student test, paired t-test and Chi-square were used. SPSS 16 (SPSS Inc., Chicago, IL., USA) was also used to analyze the data. The significance level of the tests was also considered to be 5%.

The mean age of patients under angiography in the aromatic, inhalation therapy group was 59.47 ±10.16, and in the control group it was 62.67±13.26 (P=0.273). There was no statistically significant difference between the two groups of aroma, inhalation therapy and control in terms of population and cognitive characteristics (P<0.05) (Table 1).
 

The aim of this study was to determine the effect of aromatherapy with rose essential oil on the anxiety of patients under coronary angiography. The results of this study showed that the use of aromatherapy with 40% rose essential oil can reduce the anxiety of patients under coronary angiography. According to the comparison of anxiety, the anxiety of the aroma-treatment group, unlike the control group, had a significant decrease.
In their study, Kheirkhah, Neisani, and Haghani examined the effect of inhaled aroma and treatment with rose essential oil and warm spray on the anxiety of first-time women during the first phase of labor and concluded that the inhaled aroma of rose therapy has a significant effect on reducing anxiety in the first phase of labor [30]. The results of a similar study by Hamdamian et al. also showed a significant effect of rose aromatherapy on anxiety and pain in the first phase of labor in primary women [31]. The results of these studies are consistent with the results of the present study.
In contrast, the results of a study by Babaii et al. showed that the scent of rose therapy did not affect the anxiety of patients under coronary angiography [35]. To justify the difference between the two studies, we can use the scent of 10% rose for 18 minutes in the Babaii study and the use of the 40% scent for 20 minutes in the present study. The percentage of aroma used and the duration of the aromatherapy treatment are significantly related to the effect of the aroma-therapy.
The limitations of the present study are related to its low sample size. Also, the combination of smell with people's memory causes inhaling a particular scent to affect a person's emotions. Inhaling odors with unpleasant memories also has negative consequences, including increased anxiety. In order to improve this study and further research, the aroma, inhalation therapy with rose essential oil should be examined in different doses, more often, longer duration, as well as in different diseases and larger statistical population.
 

The aroma of the 40% rose essential oil significantly reduces the anxiety of patients undergoing coronary angiography. The aroma of 40% rose essential oil can be used as an easy and inexpensive way to reduce patients' anxiety before coronary angiography along with medication.

 

This article is part of the results of the Master's Thesis in Internal Medicine, Surgery, approved by the Research Council of Hamadan University of Medical Sciences, No. 9605103132. This study was registered in the ethics committee with the code IR.UMSHA.REC.1396.249 and with the number IRCT201702019759N8 in the Iran Randomized Clinical Center. Patients and nurses, as well as all the staff of the post-angiography department and the managers of the Besat Educational and Medical Center in Hamadan, are thanked and appreciated.

 

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.