Date Published: March 11, 2019
Publisher: Public Library of Science
Author(s): Michael Weiss, Guido Michels, Frank Eberhardt, Wolfgang Fehske, Stefan Winter, Frank Baer, Yeong-Hoon Choi, Christian Albus, Daniel Steven, Stephan Baldus, Roman Pfister, Giuseppe Andò.
Psychological distress is common in patients with cardiovascular disease and negatively impacts outcome.
Psychological distress is high in acute high risk cardiac patients eligible for a WCD, and associated with low quality of life. Distress is aggravated by WCD.
Consecutive patients eligible for a WCD were included in the prospective, multicenter “Cologne Registry of External Defibrillator” registry. Quality of life (Short Form-12), depressive symptoms (Beck-Depression Inventory II) and anxiety (State Trait Anxiety Inventory) were assessed at enrollment and 6-weeks, and associations with WCD prescription were analyzed.
123 patients (mean [SD] age 59 [± 14] years, 75% male) were included, 85 (69%) of whom received a WCD. At enrollment 21% showed clinically significant depressive symptoms and 52% anxiety symptoms, respectively. At 6 weeks, depressive and anxious symptoms significantly decreased to 7% and 25%, respectively. Depressive symptoms at enrollment and changes at 6 weeks showed significant associations with health-related quality of life, whereas anxious symptoms did not. There was a trend for better improvement of depression scores in patients with WCD (mean [SD] change in score points: -4.1 [6.1] vs -1.8 [3.9]; p = 0.09), whereas change of the anxiousness score was not different (-4.6 [9.5]) vs -3.7 [9.1], p = 0.68).
In patients eligible for a WCD, depressive and anxiety symptoms were initially common and depressive symptoms showed a strong association with reduced health-related quality of life contributing to their clinical relevance. WCD recipients showed at least similar improvement of depression and anxiety at 6 weeks when compared to non recipients.
Psychological distress is associated with the development and prognosis of cardiovascular disease, and receives increasing attention in clinical care [1, 2]. About one in five patients with chronic heart failure has symptoms of depression, and presence of depression is associated with increased risk of hospitalization and mortality [3, 4]. Similar findings were reported for anxiety, with a strong mutual correlation between depression and anxiety [5, 6]. Notably, both factors substantially contribute to the severely impaired health related quality of life in patients with chronic heart failure . Patients who are at risk of or who experienced ventricular tachy-arrhythmias are also relevantly affected by psychological distress. In patients with implantable cardioverter-defibrillator (ICD)-implantation 9–18% and 16–36% showed depression and anxiety, respectively [8, 9].
123 patients were included in the registry and in this analysis. Baseline characteristics are shown in Table 1. Mean (SD) age of the patients was 59 (± 14) years and 75% were male. Six weeks’ clinical follow-up examination with complete questionnaire data was available in 97 (79%) patients, with 2 patients lost to follow-up, 6 patients deceased within first 6 weeks, 15 patients rejecting follow up examination and 3 patients with incomplete follow-up questionnaire data (Fig 1). Patients with complete paired questionnaire data (n = 97) did not differ relevantly regarding baseline characteristics compared to those alive without complete questionnaire data (n = 20) (S1 Table). In particular, there was no statistically significant difference in health-related quality of life, depression measures and anxiety rate.
In this prospective multicenter cohort of patients with acute cardiovascular disease and increased risk of sudden cardiac death eligible for WCD we found a high prevalence of psychological distress in the acute setting. Depression and anxiety were highly correlated, and depression also showed strong association with health-related quality of life. Six weeks after the index event, depressive and anxiety symptoms substantially improved, which was accompanied by improvement in quality of life. Patients subsequently prescribed a WCD had a higher prevalence of anxiety at baseline compared to patients without WCD, which was not attributable to differences in available clinical baseline characteristics. There is weak evidence that WCD is associated with reduced depressiveness during 6 weeks of follow-up compared to no WCD, whereas there was no association for anxiety.
Depressive and anxiety symptoms are common in acute cardiovascular patients at increased risk of sudden cardiac death, with prevalences comparable to heart failure patients with ICD implantation or acute myocardial infarction, but improve markedly during 6 weeks follow-up. The depressive symptoms during the acute disease manifestation as well as the short-term improvement are strongly associated with patients`health-related quality of life indicating the clinical relevance for the patient. Acknowledging the non-randomized design of this study, we found preliminary evidence that WCD may alleviate depressive symptoms more than treatment without WCD. Further large scale prospective trials with longer follow-up are needed to reevaluate these findings.