ABSTRACT
BACKGROUND: Depression and anxiety are associated with a worse prognosis in heart failure patients. The aim of this study was to identify the prevalence of depression and anxiety in left ventricular assist device (LVAD) candidates and assess their effect on post-LVAD outcomes. METHODS: Based on the pre-LVAD psychological assessment, the total cohort of 246 patients were divided into 4 groups: 1) no depression or anxiety (NDep&Anx group, n = 138); 2) isolated depression (Dep group, n = 42); 3) isolated anxiety (Anx group, n = 32), and 4) combined depression and anxiety (Dep&Anx group, n = 34). RESULTS: The Dep&Anx group was associated with higher prevalence of female gender (p = 0.03), higher body mass index (p = 0.03), elevated E/E' (p = 0.003), and increased Model For End-Stage Liver Disease (MELD) XI score (p = 0.04) prior to LVAD as compared to the other 3 subgroups. The prevalence of other major psychiatric disorders (p = 0.03) and narcotic dependence (p = 0.004) was higher in the Dep&Anx group. Post-LVAD implantation, heart rate and filling pressures were elevated and readmission rate was higher (p = 0.001) in the Dep&Anx group. There was no difference in survival between the groups (p = 0.40, Log-Rank test). CONCLUSIONS: Pre-existing anxiety and depression was associated with worse HF pre- and post-LVAD implantation and higher readmissions rate after LVAD implantation.
ABSTRACT
The recently improved cardiac diagnostic and therapeutic means associated with improved life-expectancy of patients, highlighted the special needs of the worldwide ever-growing numbers of patients with end-stage heart failure and their families. The hospice--palliative treatment approach to end-stage heart failure patients has been well defined and recommended by the World Health Organization (W.H.O.). The principles of this approach is aimed towards achieving a maximum relief of symptoms, avoiding interference (acceleration or delay) with life expectancy; ensuring daily activity and reasonable quality of life, and providing mental and spiritual support to the patients and their close family members. Obviously, it requires a trained multidisciplinary team including a senior physician, a nurse, a psychologist and a social worker. In order to be eligible for hospice and palliative care, endstage systolic heart failure patients should meet defined criteria including: severity of illness (NYHA class IV), clinical deterioration observed within the last six months and unsuitability for advanced therapeutic options. Recently, the Israeli Ministry of Health has adapted the W.H.O. recommendations, instructing all Local health service providers to expand this service and establish it according to well-defined guidelines and standards of care. Accessibility of all end-stage heart failure patients in Israel to this service will critically contribute to their physical and mental comfort, their dignity, and to the benefit of their families.
