Depression and Outcome among Veterans with Implantable Cardioverter Defibrillators with or without Cardiac Resynchronization Therapy Capability

The prevalence of depression in patients living with implantable cardioverter defibrillator: a systematic review and meta-analysis

Depression is a common disorder in patients with implantable cardioverter defibrillator (ICD). There are a variety of studies estimated the prevalence of depression in these patients. The present study aimed to investigate the prevalence of depression in patients with ICD.

METHODS

In the present study, we conducted a systematic review of studies published in PubMed, Scopus, Web of Science (WoS), Medline, and EMBASE without any time filtration to obtain studies investigated the prevalence of depression in patients with ICD. Search terms consisted of "Implantable Cardioverter Defibrillator(s)" in combination with "depression," "depressive," "prevalence," "implanted cardioverter," "implantable," and "implantable defibrillator."

RESULTS

We identified 15 relevant studies, comprising data from 10,182 patients with ICD from whom 2400 (23.58%) (95% CI, 15.36-31.79) had depression. The results of the subgroup analysis showed that the prevalence of depression among middle-aged patients (28.58% with confidence interval of 95%, 21.51-35.65) was higher than elderly patients (22.23% with confidence interval of 95%, 11.21-33.24) and it was not significantly correlated with the mean age of samples (P = 0.255), sample size (P = 0.686), and the publication date (P = 0.784), although there was a significant correlation between the prevalence of depression and the quality of articles so that the prevalence was decreasing with an increase in the quality (P = 0.046).

CONCLUSION

Around 1 in 4 patients with ICD (23.58%) experiences depression progression after an ICD placement. This prevalence is comparable to that in the general population, and close to that of the patients with common chronic diseases.

Multisymptom Profile Predicts Increased Risk of Poor Outcomes After Initial Placement of Implantable Cardioverter Defibrillator

CONTEXT

Patients with implantable cardioverter defibrillators (ICDs) are at risk for multiple physical and psychological symptoms. Identification of specific symptom profiles associated with poor outcomes may elucidate novel strategies to enhance symptom management.

OBJECTIVES

The objectives were to determine common symptoms after initial ICD implantation, identify classes of individuals with similar symptom profiles, describe patient characteristics associated with different symptom profiles, and determine if symptom profiles at hospital discharge predicted outcomes three and 12 months after implantation.

METHODS

This was a secondary data analysis of a randomized controlled trial that compared patient + partner versus patient-only interventions designed to help patients manage symptoms, prepare for ICD shocks, and resume daily activities. Symptoms were measured with the Patient Concerns Assessment. Latent class regression analysis was used to identify symptom classes at baseline, three-month, and 12-month follow-up. Associations between patient characteristics, class membership, and outcomes were examined using chi-square, analysis of variance, and Poisson regression.

RESULTS

The study included 301 patients (74% male, mean age 64 ± 11.9 years). Three classes were identified: Multi-Symptom (N = 119, 40%), Tired-Rundown (N = 130, 43%), and Mostly Asymptomatic (N = 52, 17%). Patients in the Multi-Symptom class were younger (59.9 years, P < 0.001) and reported more anxiety (P < 0.001) and depression (P < 0.01) than the other classes. Membership in the Multi-Symptom class predicted lower quality of life and resulted in nearly double the rate of hospitalizations after 12 months (P = 0.02, IRR 1.9).

CONCLUSION

Evaluation of symptom profiles after ICD implantation offers a promising strategy for identifying patients at risk for poor health outcomes.

Impact of Depressive Symptoms on All-Cause Mortality in Patients with Congestive Heart Failure After Cardiac Resynchronization Therapy

PURPOSE

to assess the association between depression and all-cause mortality in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT).

MATERIALS AND METHODS

We enrolled in this study 156 patients (mean age 55.3±9.6 years) with CHF and implanted devices for CRT. Mean duration of follow-up was 51.6±33.4 months. The Beck Depression Inventory (BDI) was used to evaluate depressive symptoms (DS); DS were considered absent for a score 0-9, mild to moderate - 10-18, severe - ≥19. For assessment of association of DS and mortality we used multivariate Cox proportional hazards regression model with estimation of hazard ratios (HR) with 95 % confidence intervals (95 %CI).

RESULTS

Average Beck Depression Inventory score was 12.4±8.3. In 66 patients (42.3 %) there were no DS, 57 patients (36.5 %) had mild, and 33 (21.2 %) - severe DS. These groups did not differ by main clinical-functional and laboratory indicators. Among individuals without DS prevailed men (90.9 vs. 69.7 % among those with severe DS, p=0.007). Hypercholesterolemia was more frequent in patients with DS (63.3 vs. 43.9 % in patients without DS, p=0.02). During follow-up 33 patients died (21.2 %). Adjusted HR of death from all-causes for DS score as continuous parameter was 1.05, 95 % CI 1.01-1.09, p=0.02. Patients without DS were used as reference (HR=1.0) in analysis of categorical indicator. HR was 1.08, 95 % CI 0.46-2.54, p=0.9 in patients with mild, and 2.92, 95 % CI 1.17-7.32, p=0.02 - with severe DS.

CONCLUSION

DS were associated with gender and hypercholesterolemia. Severe DS were independently associated with all-cause mortality in patients with CHF and implanted CRT devices.

Provider Response to QTc Prolongation on Standard 12-Lead EKG: Do We Notice or Do We Care?

BACKGROUND

Drugs and electrolyte imbalances are widely recognized as common triggers of a prolonged QT interval. We conducted a chart review to assess provider response to prolonged QT reported on a standard 12-lead electrocardiogram (EKG).

METHODS

We identified all Veterans Affairs Pittsburgh Healthcare System patients in a 6-month period with an EKG reporting a corrected QT (QTc) >500 ms. We excluded confounding or uninterpretable EKGs. Charts were reviewed to assess medications and electrolytes at the time of the EKG as well as the setting (inpatient vs outpatient) in which the EKG was obtained. Provider documentation of QTc and any corrective measures were sought.

RESULTS

After exclusions, 106 patients were included in this analysis (87 [82%] inpatient and 19 [18%] outpatient). Most were male (101, 95%) with a mean age of 63.5 ± 10.6 years. At the time of index EKG, most patients were receiving at least one (72, 68%), and frequently two or more (35, 33%), QTc prolonging medications. Providers documented QTc prolongation in 20 inpatients (19%). Drugs were adjusted or discontinued in only two inpatients (2%). There were 14 patients (14%) with potassium level <3.6 mmol/L and 10 of 69 (14%) patients had a magnesium level <1.7 mg/dL.

CONCLUSION

Patients with prolonged QTc on EKG were more likely to be inpatients than outpatients. Inpatients were more likely to be receiving multiple types and classes of QTc prolonging medications. In the vast majority of cases, providers did not address the prolonged QTc and only rarely initiated remedial actions.

Depression in heart failure: Intricate relationship, pathophysiology and most updated evidence of interventions from recent clinical studies

Heart failure (HF) is a burgeoning chronic health condition affecting more than 20million people worldwide. Patients with HF have a significant (17.1%) 30-day readmission rate, which invites substantial penalty in payment to hospitals from Centers for Medicare and Medicaid Services, as per the newly introduced Hospital Readmissions Reduction Program. Depression is one of the important risk factors for readmission in HF patients. It has a significant prevalence in patients with HF and contributes to the overall poor quality of life in them. Several behavioral (smoking, obesity, lack of exercise and medication noncompliance) and pathophysiological factors (hypercortisolism, elevated inflammatory biomarkers, fibrinogen, and atherosclerosis) have been found responsible for the adverse outcome in patients with HF and concomitant depression. Hippocampal volume loss noted in patients with acute HF exacerbations may contribute to the development of depressive symptoms in them. Screening for depression in HF patients continues to be challenging due to a considerable overlap in symptoms. Published trials on the use of antidepressants and cognitive behavioral therapy (CBT) have shown variable outcomes. Newer modalities like internet-based CBT have been tried in small studies, with promising results. A recent meta-analysis observed the beneficial role of aerobic exercise training in patients with HFrEF. Future long-term prospective studies may contribute to the formulation of a detailed screening and management guideline for patients with HF and depression. Our review is aimed to summarize the intricate relationship between depression and heart failure, with respect to their epidemiology, pathophysiological aspects, and optimal management approach.