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Published on: February 28, 2012
Depressive Symptoms and Quality of Life in Patients With Heart Failure and an Implantable Cardioverter-Defibrillator
Christos Zormpas1, Kai G Kahl2, Stephan Hohmann1
1Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Insights
Depressive symptoms in heart failure (HF) patients with an implantable cardioverter-defibrillator (ICD) correlate with reduced quality of life and functional status. Early assessment and treatment of depression are crucial for better patient outcomes.
Area of Science:
- Cardiology
- Psychiatry
- Quality of Life Research
Background:
- Heart failure (HF) is frequently linked to depressive symptoms and diminished quality of life (QoL).
- Patients with HF and an implantable cardioverter-defibrillator (ICD) require specific evaluation for these comorbidities.
Purpose of the Study:
- To assess the prevalence of depressive symptoms in HF patients with an ICD.
- To investigate the relationship between depressive symptoms, QoL, and functional status in this population.
Main Methods:
- 446 patients with HF and an ICD were assessed.
- Depressive symptoms were measured using the Patient Health Questionnaire 9 (PHQ-9).
- QoL was evaluated with the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and functional ability with the 6-min walking test (6MWT).
Main Results:
- 43.2% of patients exhibited depressive symptoms, with 16.8% having moderate to severe depression.
- Depressive symptoms were independently associated with lower QoL and reduced 6-month functional status (6MWT).
- Smoking and higher BMI correlated with increased depressive symptoms, while antidepressant medication improved PHQ-9 scores.
Conclusions:
- Depressive symptoms significantly impact QoL and long-term function in HF patients with ICDs.
- Obesity and smoking exacerbate depression in this cohort, highlighting the need for lifestyle factor assessment.
- A multimodal treatment approach incorporating depression screening and management is essential for HF patients with ICDs.
Background:
Heart failure (HF) is associated with development of depressive symptoms and reduced quality of life (QoL). Patients with HF and an implantable cardioverter-defibrillator (ICD) were evaluated regarding depressive symptoms and QoL.
Methods:
The present study included 446 patients with HF and an ICD. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9), QoL was evaluated using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional ability and exercise tolerance were assessed at inclusion and after 6 months with help of the 6-min walking test (6MWT).
Results:
Patients included in the study had a mean age of 65.8 years and were predominantly male (83.6%), with mostly ischemic (n = 277; 62.1%) or dilated (n = 150; 33.6%) cardiomyopathy. One hundred ninety-three (43.2%) patients had depressive symptoms, of whom 75 patients (16.8%) were classified as moderate to severe depression according to the PHQ-9 at baseline. Depressive symptoms were associated with low QoL independent of NYHA functional class. High NYHA functional class, high PHQ-9 score, age and body mass index (BMI) were associated with a lower 6MWT at enrollment, while depressive symptoms (expressed as higher PHQ-9 score) and age were associated with a lower 6MWT after 6 months. Patients with history of smoking and a higher BMI showed higher PHQ-9 scores after 6 months. Patients under antidepressant medication showed improved PHQ-9 score after 6 months, indicating controlled/treated depression. However, patients with low QoL at inclusion remained with low QoL after 6 months.
Conclusion:
Depressive symptoms correlate with low QoL and lower long-term functional status in patients with HF and an ICD. Depressive symptoms are associated with smoking and obesity, which themselves are risk factors for a poor prognosis in HF. Only a small fraction of patients with HF and ICD showing depressive symptoms receives appropriate treatment. Assessing depressive symptoms and lifestyle factors should be part of a multimodal treatment plan in patients with HF and an ICD.
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