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Effect of depressive symptoms on survival after heart transplantation
Stephan Zipfel1, Antonius Schneider, Beate Wild
1Department of Internal Medicine II, General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, Heidelberg, Germany. stephan_zipfel@med.uni-heidelberg.de
Insights
Preoperative depression screening in heart transplant (HTx) candidates may identify patients at higher risk for mortality. This is particularly relevant for patients with ischemic cardiomyopathy (ICMP), suggesting targeted interventions.
Area of Science:
- Cardiology
- Psychology
- Transplantation Science
Background:
- End-stage heart disease necessitates heart transplantation (HTx).
- Psychological factors like depression and anxiety may influence post-transplant outcomes.
- Distinguishing between ischemic (ICMP) and dilated cardiomyopathy (DCMP) is crucial.
Purpose of the Study:
- To evaluate the predictive value of preoperative self-reported depression and anxiety in HTx patients.
- To investigate the impact of these psychological factors on pre- and postoperative mortality.
- To compare outcomes between ICMP and DCMP subgroups.
Main Methods:
- A longitudinal study assessed 152 end-stage heart disease patients (57 ICMP, 95 DCMP).
- Psychological and somatic variables were measured pre-transplant.
- 103 patients underwent HTx and were followed for a mean of 4.4 years using proportional hazard models.
Main Results:
- Patients with ICMP exhibited higher preoperative depression and state anxiety scores.
- Preoperative depression, along with donor/recipient age, predicted significantly higher post-HTx mortality in ICMP patients.
- This association remained significant after adjusting for sociodemographic and somatic factors.
Conclusions:
- Self-reported depression, not anxiety, can identify HTx patients with poorer outcomes.
- Screening for depression is recommended, especially for ICMP patients awaiting HTx.
- Development and evaluation of targeted intervention programs for at-risk patients are warranted.
Objective:
This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated.
Method:
An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome.
Results:
Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables.
Conclusions:
Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.