The impact of shock therapy on depression development and remote prognosis in cardiac resynchronization therapy
Tomasz Podolecki1,2, Robert Pudlo3, Michał Mazurek4
1Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland. tomekpod@interia.pl.
Insights
Depression is common in cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D) patients, especially after ICD shock. New-onset depression and ICD shocks independently predict poor prognosis in heart failure patients.
Area of Science:
- Cardiology
- Psychiatry
- Medical Devices
Background:
- Assessing depression incidence and clinical significance in CRT-D patients.
- Evaluating the impact of shock therapy on depression and long-term prognosis.
Purpose of the Study:
- To determine the incidence of depression in CRT-D patients.
- To evaluate the effect of ICD shock therapy on depression development.
- To assess the impact of depression and shock therapy on long-term prognosis in heart failure patients.
Main Methods:
- Prospective study of 396 heart failure patients implanted with CRT-D.
- Beck Depression Inventory (BDI-II) and psychiatric examination at baseline and every 6 months.
- Analysis of 221 patients without baseline depression, monitoring for new-onset depression and composite endpoint (death/hospitalization for HF).
Main Results:
- 23.5% experienced ICD shock, 21.8% developed new-onset depression.
- Higher depression incidence observed after shock delivery, in CRT non-responders, and with atrial fibrillation.
- New-onset depression (HR 1.7) and ICD shock (HR 2.1) were independent predictors of poor prognosis.
Conclusions:
- Depression is a prevalent mental disorder in CRT-D recipients, negatively impacting long-term outcomes.
- Patients experiencing ICD shocks and those with heart failure progression are at increased risk for depressive symptoms.
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.
