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Multicenter Study
. 2023 Aug;16(8):e012875.
doi: 10.1161/CIRCINTERVENTIONS.123.012875. Epub 2023 Jul 28.

Association of Depression and Cognitive Dysfunction With Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement

Bassim El-Sabawi #  1 , Harrison Cloud #  1 , Jay N Patel  1 , Susan P Bell  1 , Sammy Elmariah  2 , William F Fearon  3 , Juyong B Kim  3 , Robert N Piana  1 , Samir R Kapadia  4 , Dharam J Kumbhani  5 , Linda D Gillam  6 , Brian K Whisenant  7 , Nishath Quader  8 , Alan Zajarias  8 , Frederick G Welt  9 , Anthony A Bavry  5 , Megan Coylewright  10 , Anna Vatterott  1 , Natalie Jackson  1   11 , Shi Huang  12 , Brian R Lindman  1   11
Affiliations
Multicenter Study

Association of Depression and Cognitive Dysfunction With Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement

Bassim El-Sabawi et al. Circ Cardiovasc Interv. 2023 Aug.

Abstract

Background: Depression and cognitive dysfunction (CD) are not routinely screened for in patients before transcatheter aortic valve replacement (TAVR) and their association with postprocedural outcomes is poorly understood. The objectives of this study are to determine the prevalence of depression and CD in patients with aortic stenosis undergoing TAVR and evaluate their association with mortality and quality of life.

Methods: We analyzed a prospective, multicenter TAVR registry that systematically screened patients for preexisting depression and CD with the Patient Health Questionnaire-2 and Mini-Cog, respectively. The associations with mortality were assessed with Cox proportional hazard models and quality of life (Kansas City Cardiomyopathy Questionnaire and EuroQol visual analogue scale) were evaluated using multivariable ordinal regression models.

Results: A total of 884 patients were included; median follow-up was 2.88 years (interquartile range=1.2-3.7). At baseline, depression was observed in 19.6% and CD in 31.8%. In separate models, after adjustment, depression (HR, 1.45 [95% CI, 1.13-1.86]; P<0.01) and CD (HR, 1.27 [95% CI, 1.02-1.59]; P=0.04) were each associated with increased mortality. Combining depression and CD into a single model, mortality was greatest among those with both depression and CD (n=62; HR, 2.06 [CI, 1.44-2.96]; P<0.01). After adjustment, depression was associated with 6.6 (0.3-13.6) points lower on the Kansas City Cardiomyopathy Questionnaire 1-year post-TAVR and 6.7 (0.5-12.7) points lower on the EuroQol visual analogue scale. CD was only associated with lower EuroQol visual analogue scale.

Conclusions: Depression and CD are common in patients that undergo TAVR and are associated with increased mortality and worse quality of life. Depression may be a modifiable therapeutic target to improve outcomes after TAVR.

Keywords: aortic valve stenosis; depression; mortality; quality of life; transcatheter aortic valve replacement.

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Conflict of interest statement

Disclosures Dr Fearon receives institutional research support from Edwards, Abbott, Boston Scientific, and Medtronic. Dr Elmariah has received research grants from Edwards Lifesciences, Medtronic, and Abbott and consulting fees from Edwards Lifesciences. Dr Gillam is an advisor to Bracco Diagnostics, Philips and Edwards Lifesciences and directs an imaging core laboratory with contracts with Edwards Lifesciences, Medtronic, and Abbott (no direct compensation). Dr Whisenant is a consultant at Edwards Lifescience and Medtronic. Dr Zajarias is a consultant at Edwards Lifescience. Dr Welt formerly sat on the Medtronic Advisory Board. Dr Coylewright received research funding from Edwards LifeSciences and received consulting fees and serves on an executive steering committee for Medtronic. Dr Piana serves on the data safety monitoring boards for Abbott Medical and Baim Cardiovascular Research Institute and Dr Lindman has received research grants from Edwards Lifesciences and Roche Diagnostics. The other authors report no conflicts.

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