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Association of Depression and Cognitive Dysfunction With Patient-Centered Outcomes After Transcatheter Aortic Valve

Bassim El-Sabawi1, Harrison Cloud1, Jay N Patel1

  • 1Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.).

Circulation. Cardiovascular Interventions
|July 28, 2023
PubMed

Insights

Depression and cognitive dysfunction are common in patients undergoing transcatheter aortic valve replacement (TAVR). These conditions increase mortality risk and worsen quality of life, suggesting depression may be a target for improved TAVR outcomes.

Area of Science:

  • Cardiology
  • Psychiatry
  • Geriatrics

Background:

  • Depression and cognitive dysfunction (CD) are not routinely assessed before transcatheter aortic valve replacement (TAVR).
  • The impact of these conditions on post-TAVR outcomes is not well understood.

Purpose of the Study:

  • To determine the prevalence of depression and CD in patients undergoing TAVR.
  • To evaluate the association of depression and CD with mortality and quality of life after TAVR.

Main Methods:

  • Analysis of a prospective, multicenter TAVR registry.
  • Systematic screening for depression (Patient Health Questionnaire-2) and CD (Mini-Cog) at baseline.
  • Cox proportional hazard models for mortality and multivariable ordinal regression for quality of life (Kansas City Cardiomyopathy Questionnaire, EuroQol visual analogue scale).

Main Results:

  • 19.6% of 884 patients had depression, and 31.8% had CD at baseline.
  • Both depression (HR, 1.45) and CD (HR, 1.27) were independently associated with increased mortality.
  • Patients with both depression and CD had the highest mortality risk (HR, 2.06).
  • Depression was linked to significantly lower quality of life scores post-TAVR.

Conclusions:

  • Depression and CD are prevalent in TAVR patients and linked to worse outcomes.
  • Targeting depression could be a modifiable strategy to enhance post-TAVR results.
Abstract

Keywords:
aortic valve stenosisdepressionmortalityquality of lifetranscatheter aortic valve replacement

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