The impact of shock therapy on depression development and remote prognosis in cardiac resynchronization therapy recipients
, 3, 2, 2, 2, 2, 12, 12
Abstract
Background: The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study was also to evaluate the impact of shock therapy on depression development and long-term prognosis.
Methods: The prospective study encompassed 396 consecutive heart failure (HF) patients implanted with CRT-D. All patients completed the Beck Depression Inventory (BDI-II) and underwent a psychiatric examination at baseline. 221 patients free of depressive symptoms at baseline were included into the final analysis. The assessment of psychiatric status was routinely repeated every 6 months as well as after the shock delivery. The primary outcome was a composite endpoint of death or hospitalization for HF.
Results: During long-term observation (median 37.1 months) 52 (23.5%) patients suffered from an implantable cardioverter-defibrillator (ICD) shock, whereas 48 (21.8%) subjects developed depression. The incidence of new-onset depression was significantly higher in patients after shock delivery (Shock Group), CRT non-responders and subjects with atrial fibrillation. The risk for a composite endpoint was higher in the Shock Group than subjects without an ICD intervention: 57.7% vs. 25.4% and in patients with new-onset depression compared to the population free of this disorder: 62.5% vs. 24.9% (all p < 0.001). New-onset depression (HR 1.7) and an ICD shock (HR 2.1) were strong independent predictors of poor prognosis.
Conclusions: Depression is a common mental disorder in CRT-D recipients, that adversely affects long-term prognosis. Subjects suffering from ICD shocks and those with HF progression are at higher risk of experiencing depressive symptoms.
Keywords: depressionchronic heart failureresynchronization therapyimplantable cardioverter-defibrillatorshock therapy
References
- Havranek EP, Spertus JA, Masoudi FA, et al. Predictors of the onset of depressive symptoms in patients with heart failure. J Am Coll Cardiol. 2004; 44(12): 2333–2338.
- Rutledge T, Reis VA, Linke SE, et al. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol. 2006; 48(8): 1527–1537.
- Havranek EP, Ware MG, Lowes BD. Prevalence of depression in congestive heart failure. Am J Cardiol. 1999; 84(3): 348–50, A9.
- Kindermann I, Wedegärtner SM, Bernhard B, et al. Changes in quality of life, depression, general anxiety, and heart-focused anxiety after defibrillator implantation. ESC Heart Fail. 2021; 8(4): 2502–2512.
- Ploux S, Verdoux H, Whinnett Z, et al. Depression and severe heart failure: benefits of cardiac resynchronization therapy. J Cardiovasc Electrophysiol. 2012; 23(6): 631–636.
- Friedmann E, Thomas SA, Liu F, et al. Sudden Cardiac Death in Heart Failure Trial Investigators. Relationship of depression, anxiety, and social isolation to chronic heart failure outpatient mortality. Am Heart J. 2006; 152(5): 940.e1–940.e8.
- Faris R, Purcell H, Henein MY, et al. Clinical depression is common and significantly associated with reduced survival in patients with non-ischaemic heart failure. Eur J Heart Fail. 2002; 4(4): 541–551.
- Jiang W, Kuchibhatla M, Clary GL, et al. Relationship between depressive symptoms and long-term mortality in patients with heart failure. Am Heart J. 2007; 154(1): 102–108.
- Sherwood A, Blumenthal JA, Hinderliter AL, et al. Worsening depressive symptoms are associated with adverse clinical outcomes in patients with heart failure. J Am Coll Cardiol. 2011; 57(4): 418–423.
- Moss AJ, Zareba W, Hall WJ, et al. Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002; 346(12): 877–883.
- Bristow MR, Saxon LA, Boehmer JD, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004; 350(21): 2140–2150.
- Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008; 359(10): 1009–1017.
- Powell BD, Saxon LA, Boehmer JP, et al. Survival after shock therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator recipients according to rhythm shocked. The ALTITUDE survival by rhythm study. J Am Coll Cardiol. 2013; 62(18): 1674–1679.
- Thylén I, Dekker RL, Jaarsma T, et al. Characteristics associated with anxiety, depressive symptoms, and quality-of-life in a large cohort of implantable cardioverter defibrillator recipients. J Psychosom Res. 2014; 77(2): 122–127.
- Knackstedt C, Arndt M, Mischke K, et al. Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy. Heart Vessels. 2014; 29(3): 364–374.
- Pedersen SS, Hoogwegt MT, Jordaens L, et al. Relation of symptomatic heart failure and psychological status to persistent depression in patients with implantable cardioverter-defibrillator. Am J Cardiol. 2011; 108(1): 69–74.
- Perini AP, Kutyifa V, Veazie P, et al. Effects of implantable cardioverter/defibrillator shock and antitachycardia pacing on anxiety and quality of life: A MADIT-RIT substudy. Am Heart J. 2017; 189: 75–84.
- McMurray JJV, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012; 33(14): 1787–1847.
- Ponikowski P, Voors A, Anker S, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2016; 37(27): 2129–2200.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Press, Washington, DC 1994.
- Ford J, Sears S, Ramza B, et al. The Registry Evaluating Functional Outcomes of Resynchronization Management (REFORM): quality of life and psychological functioning in patients receiving cardiac resynchronization therapy. J Cardiovasc Electrophysiol. 2014; 25(1): 43–51.
- Johansen JB, Pedersen SS, et al. Symptomatic heart failure is the most important clinical correlate of impaired quality of life, anxiety, and depression in implantable cardioverter-defibrillator patients: a single-centre, cross-sectional study in 610 patients. Europace. 2008; 10(5): 545–551.
- Luyster FS, Hughes JW, Waechter D, et al. Resource loss predicts depression and anxiety among patients treated with an implantable cardioverter defibrillator. Psychosom Med. 2006; 68(5): 794–800.
- Jacq F, Foulldrin G, Savouré A, et al. A comparison of anxiety, depression and quality of life between device shock and nonshock groups in implantable cardioverter defibrillator recipients. Gen Hosp Psychiatry. 2009; 31(3): 266–273.
- Kapa S, Rotondi-Trevisan D, Mariano Z, et al. Psychopathology in patients with ICDs over time: results of a prospective study. Pacing Clin Electrophysiol. 2010; 33(2): 198–208.
- Li A, Kaura A, Sunderland N, et al. The Significance of Shocks in Implantable Cardioverter Defibrillator Recipients. Arrhythm Electrophysiol Rev. 2016; 5(2): 110–116.
- Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008; 359(10): 1009–1017.
- Moss AJ, Schuger C, Beck CA, et al. MADIT-RIT Trial Investigators. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012; 367(24): 2275–2283.
- Kleemann T, Strauss M, Kouraki K, et al. Clinical course and prognostic relevance of antitachycardia pacing-terminated ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients. Europace. 2015; 17(7): 1068–1075.
- Rumsfeld JS, Havranek E, Masoudi FA, et al. Cardiovascular Outcomes Research Consortium. Depressive symptoms are the strongest predictors of short-term declines in health status in patients with heart failure. J Am Coll Cardiol. 2003; 42(10): 1811–1817.
- Podolecki T, Pudlo R, Mazurek M, et al. The Incidence, Clinical Significance, and Treatment Effects of Depression in Cardiac Resynchronization Therapy Recipients. Cardiology. 2017; 138(2): 115–121.
- O'Connor CM, Jiang W, Kuchibhatla M, et al. SADHART-CHF Investigators. Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. J Am Coll Cardiol. 2010; 56(9): 692–699.
