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. 2022 Jun 17:13:827967.
doi: 10.3389/fpsyt.2022.827967. eCollection 2022.

Depressive Symptoms and Quality of Life in Patients With Heart Failure and an Implantable Cardioverter-Defibrillator

Christos Zormpas  1 , Kai G Kahl  2 , Stephan Hohmann  1 , Hanno Oswald  3 , Christopher Stiel  4 , Christian Veltmann  1 , Johann Bauersachs  1 , David Duncker  1
Affiliations

Depressive Symptoms and Quality of Life in Patients With Heart Failure and an Implantable Cardioverter-Defibrillator

Christos Zormpas et al. Front Psychiatry. .

Abstract

Background: Heart failure (HF) is associated with development of depressive symptoms and reduced quality of life (QoL). Patients with HF and an implantable cardioverter-defibrillator (ICD) were evaluated regarding depressive symptoms and QoL.

Methods: The present study included 446 patients with HF and an ICD. Depressive symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9), QoL was evaluated using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Functional ability and exercise tolerance were assessed at inclusion and after 6 months with help of the 6-min walking test (6MWT).

Results: Patients included in the study had a mean age of 65.8 years and were predominantly male (83.6%), with mostly ischemic (n = 277; 62.1%) or dilated (n = 150; 33.6%) cardiomyopathy. One hundred ninety-three (43.2%) patients had depressive symptoms, of whom 75 patients (16.8%) were classified as moderate to severe depression according to the PHQ-9 at baseline. Depressive symptoms were associated with low QoL independent of NYHA functional class. High NYHA functional class, high PHQ-9 score, age and body mass index (BMI) were associated with a lower 6MWT at enrollment, while depressive symptoms (expressed as higher PHQ-9 score) and age were associated with a lower 6MWT after 6 months. Patients with history of smoking and a higher BMI showed higher PHQ-9 scores after 6 months. Patients under antidepressant medication showed improved PHQ-9 score after 6 months, indicating controlled/treated depression. However, patients with low QoL at inclusion remained with low QoL after 6 months.

Conclusion: Depressive symptoms correlate with low QoL and lower long-term functional status in patients with HF and an ICD. Depressive symptoms are associated with smoking and obesity, which themselves are risk factors for a poor prognosis in HF. Only a small fraction of patients with HF and ICD showing depressive symptoms receives appropriate treatment. Assessing depressive symptoms and lifestyle factors should be part of a multimodal treatment plan in patients with HF and an ICD.

Keywords: PHQ-9; depression; heart failure; implantable cardioverter-defibrillator; quality of life.

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Conflict of interest statement

CZ received travel grants and a fellowship grant from Biotronik and Medtronic. SH received a fellowship grant from Boston Scientific. CV received lecture honorary, travel grants advisory board fees from Bayer, Biotronik, BMS, Boston Scientific, CVRx, Daiichi Sankyo, Medtronic, Abbott, and Zoll. DD received lecture honorary, travel grants and/or a fellowship grant from Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Medtronic, Microport, Pfizer, and Zoll. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Summary figure. Overview of the methodology and main results of the present study.
Figure 2
Figure 2
Quality of life (mean value of the Minnesota Living with Heart Failure points) according to the grade of depressive symptoms at time of inclusion and after 6 months. *p < 0.001.
See this image and copyright information in PMC

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