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Published on: February 28, 2012
Prevalence and persistence of depression in patients with implantable cardioverter defibrillator: a 2-year
Tsuyoshi Suzuki1, Tsuyoshi Shiga, Kazue Kuwahara
1Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Insights
Depression is common in implantable cardioverter defibrillator (ICD) patients and often persists. Depressed ICD patients experience more shocks, highlighting the need for mental health support.
Area of Science:
- Cardiology
- Psychiatry
- Medical Devices
Background:
- Depression prevalence and persistence in patients with implantable cardioverter defibrillators (ICDs) is not well understood.
- This study investigated depression in ICD patients over a two-year period.
Purpose of the Study:
- To evaluate the prevalence and persistence of depression in patients receiving implantable cardioverter defibrillators (ICDs).
- To explore the association between depression and ICD therapies.
Main Methods:
- Ninety hospitalized patients undergoing ICD implantation or related procedures were assessed.
- The Zung Self-Rating Depression Scale (SDS) was used at baseline and 2-year follow-up.
- Implantable cardioverter defibrillator (ICD) therapies delivered were tracked over two years.
Main Results:
- Depression was present in 32% of patients at baseline, with higher rates in specific subgroups like those with electrical storm (50%) or acute decompensated heart failure (66%).
- At 2-year follow-up, depression persisted in 72% of initially depressed patients.
- Depressed patients received significantly more ICD shocks (36%) compared to non-depressed patients (9%) over the two years.
Conclusions:
- Depression is a significant and persistent issue in implantable cardioverter defibrillator (ICD) patients, especially those with impaired functional status.
- Depression is linked to an increased incidence of shock therapy in ICD recipients.
Background:
It is unclear whether depression persists in patients with implantable cardioverter defibrillators (ICDs). We evaluated the prevalence and persistence of depression in ICD patients over a 2-year period.
Methods:
The study included 90 consecutively hospitalized patients. Patients underlying heart disease was 24% coronary artery disease, 29% idiopathic dilated cardiomyopathy, 24% hypertrophic cardiomyopathy, 13% idiopathic VF/long QT syndrome and miscellaneous conditions 11%. A secondary indication for ICD implantation was present in 20 patients. All patients completed the Zung Self-Rating Depression Scale (SDS) at study baseline and at the their routine follow-up visit 2 years after the baseline questionnaire. Delivery of ICD therapies was tracked throughout the 2 years.
Results:
Depression, indicated by a Zung SDS index score exceeding 60, was present in 29 (32%) of patients at study baseline. Depression was present in 11/51 (21%) patients scheduled to undergo ICD implantation, 2/2 (100%) patients whose device was upgraded to a CRT-D, 3/14 (21%) patients who had undergone pulse generator replacement, 7/14 (50%) patients who experienced electrical storm and 6/9 (66%) patients hospitalized with acute decompensated heart failure. NYHA functional class III was significantly associated with depression at baseline (HR 6.7, 95% CI 1.68-27.2, p = 0.0007). No differences were noted for female gender, demographics, β-blocker use, or LVEF ≤35% (p = ns). Depression was present in 25 (28%) of patients at 2 years follow-up, persisting in 21 (72%) of patients whose Zung SDS scores were elevated at baseline. The median time from ICD shock therapy to completion of the 2 year questionnaire was 9 months (range, 1-22). Patients who were depressed (9/25, 36%) experienced more shocks than non-depressed patients (6/65, 9%) after 2 years (p = 0.002).
Conclusions:
Depression is not uncommon among patients who meet criteria for ICD implantation and persists over time particularly when functional status is impaired. Depression is associated with a higher incidence shock therapy.
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