Comparison of the levels of depression and anxiety in elderly aortic stenosis patients treated with surgical or transcatheter aortic valve replacement

Mental health and transcatheter aortic valve replacement: A scoping systematic review

OBJECTIVE

To systematically review the literature on mental health symptoms before and after transcatheter aortic valve replacement (TAVR) and describe reported clinical associations with these symptoms.

METHODS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines, we reviewed studies involving pre- or post-TAVR mental health assessments or psychiatric diagnoses.

RESULTS

Eighteen studies were included. Before TAVR, clinically significant depression and anxiety prevalence is 15-30% and 25-30%, respectively, with only a third of these meeting diagnostic thresholds. These symptoms generally improve over the year post-TAVR. Depression is associated with functional impairment, multimorbidity, and lower physical activity; few associations have been described in relation to anxiety. Inconsistent evidence finds depression associated with post-TAVR mortality. One notable study found persistent depression independently predictive of 12-month mortality, and another found depression and cognition to have additive value in predicting mortality risk.

CONCLUSIONS

Mental health symptoms occur in a significant proportion of the TAVR population. Although symptoms tend to improve, the associations with depression, particularly persistent depression, call for further investigation to examine their associated outcomes. Research is also needed to understand the relationships between mental health conditions and cognition in TAVR-related outcomes.

Anxiety and depression in patients aged 80 years and older following aortic valve therapy. A six-month follow-up study

BACKGROUND

Little is known about mental health following advanced cardiac procedures in the oldest patients.

AIMS

To study changes in anxiety and depression from baseline to one- and six-month follow-up in older patients following transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).

METHODS

Prospective cohort study of patients ≥ 80 years undergoing elective TAVI or SAVR in a tertiary university hospital. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale. Differences between TAVI/SAVR were analyzed using Welch's t test or chi-squared. Changes over time and group differences were established with longitudinal models using generalized least squares.

RESULTS

In 143 patients (83.5 ± 2.7 years), 46% (n = 65) received TAVI. Anxiety was identified in 11% of TAVI patients at baseline. One- and six-months later, percentages were 8% and 9%. In SAVR patients, 18% had baseline scores indicating anxiety. One and six-months later, percentages were 11% and 9%. Depression was identified in 15% of TAVI patients. One- and six-months later, percentages were 11% and 17%. At baseline, 11% of SAVR patients had scores indicating depression. One- and six-months after SAVR, percentages were 15% and 12%. Longitudinal analyses showed reductions (P < 0.001) in anxiety from baseline to one-month, and stable scores between one- and six-months for both treatment groups. There was no change over time for depression among treatment groups (P = 0.21).

DISCUSSION AND CONCLUSIONS

SAVR or TAVI in patients ≥ 80 years was associated with anxiety reduction between baseline and follow-up. For depression, there was no evidence of change over time in either treatment group.

Study on anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy

BACKGROUND

Patients with malignant tumors are more likely to have psychological problems due to their worries about their life expectancy. To understand the psychological status of elderly patients with malignant liver tumor undergoing hepatectomy better, the study was designed to investigate the current situation of anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy and to analyze its related factors.

METHODS

A total of 126 elderly patients with malignant liver tumor undergoing hepatectomy were selected as the research objects. The anxiety and depression of all subjects were evaluated by HADS (Hosptial Anxiety and Depression Scale). The correlation factors affecting the psychological state of elderly patients with malignant liver tumor undergoing hepatectomy were analyzed by linear regression method.

RESULTS

The HADS-A score of elderly patients with malignant liver tumor undergoing hepatectomy was 8.79 ± 2.56, among which 37 patients were asymptomatic, 60 patients with suspicious symptoms, and 29 patients with definite symptoms. The HADS-D score was 8.40 ± 2.97, among which 61 patients were asymptomatic, 39 patients with suspicious symptoms, and 26 patients with definite symptoms. Multivariate analysis using linear regression method showed that FRAIL score, residence, and complication were significantly associated with anxiety and depression of elderly patients with malignant liver tumor undergoing hepatectomy.

CONCLUSIONS

Anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy were obvious. FRAIL score, regional differences, and the complication were the risk factors for anxiety and depression in elderly patients with malignant liver tumor undergoing hepatectomy. Improving frailty, reducing regional differences, and preventing complications is beneficial to alleviate the adverse mood of elderly patients with malignant liver tumor undergoing hepatectomy.

Quality of Life and Depressive Symptoms in Transcatheter Aortic Valve Implementation Patients-A Cross-Sectional Study

Quality of life is an important factor influencing mood. In any group of elderly people undergoing valve implementation or surgical aortic valve replacement, one in three will have depressive symptoms. The aims of this study were as follows: 1. to evaluate the impact of health-related quality of life on depressive symptoms in elderly patients undergoing TAVI, and 2. to analyze beliefs about TAVI. Methods: A total of 131 elderly people (mean age: 82.1 ± 6.1 years) scheduled to receive TAVI completed the Geriatric Depression Scale, EQ-5D-3L, and Mini Mental State Examination. A total of 43 patients completed the questionnaires after the treatment. The narrative interview analyses were performed based on 20 randomly selected patients after TAVI. Results: The mean level of general depression before TAVI was 4.19 ± 2.83, and after it was 3.12 ± 2.52 (p = 0.02), and the frequency decreased from 20% to 3%. An increase in the level of activity and number of interests and a decrease in life satisfaction were identified. The higher the general quality of life was, the lower the levels of depressiveness before and after TAVI were (r = 0.26 vs. r = 0.48; p < 0.05). Conclusions: Patients differed in their depressive symptoms, as well as their intensity and frequency, before and after TAVI. These results underscore the importance of screening for depression at baseline and reassessing changes in depressiveness during follow-up.