Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

Abstract

Background: We evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients.

Methods and results: Between 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow-up of 70 months (<1-93 months post-HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020-0.039). Actuarial 1-year/5-year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).

Conclusions: Low depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.

Keywords: depression; heart failure; psychology and behavior; social isolation, social contacts; survival analysis; transplantation.

Figure 1

Flow chart illustrating participants and their outcomes during the course of the prospective Waiting for a New Heart Study. HTx indicates heart transplantation.

Figure 2

Kaplan–Meier survival plot comparing 4 groups with either low or high scores in depressive symptoms (HADS‐D <9 vs HADS‐D ≥9) and in social isolation (median split of social isolation, median=−6.5). Patients with low depression and low social isolation constitute the reference group against which each other group is compared applying the log rank test. (Overall log rank test χ²(3)=7.3, P=0.066.) HADS‐D indicates Hospital Anxiety and Depression Scale‐D.