ABSTRACT
OBJECTIVE: Several studies suggest that psychological factors including anxiety are associated with negative outcomes and in particular higher mortality rates among heart failure (HF) patients. However, the impact of anxiety on mortality in patients with implanted cardiac devices has not been fully appreciated. The aim of this study was to assess the association between state (SA) and trait (TA) anxiety and all-cause mortality in patients with HF after cardiac electronic devices implantation. METHODS: The monocentric prospective study enrolled 265 patients (215 men and 50 women) aged 23 to 84 years (mean age 57.1 ± 10.0), who received cardiac resynchronization therapy or cardioverter-defibrillator implantation. Mean duration of prospective follow-up was 62.3 ± 36.6 months. State-Trait Anxiety Inventory (STAI) was used to measure anxiety symptoms. Cox proportional hazards multivariate regression model was used to calculate hazard ratio (HR) of all-cause mortality with 95% confidence interval (95% CI). RESULTS: During the prospective follow-up period, 45 (17.0%) patients died due to all causes. According to quantitative analysis, HR for death used for SA scale was 1.04 (95% CI 1.00-1.07, p = 0.07) and for the TA scale 1.02 (95% CI 0.99-1.05, p = 0.21). Analysis of categorical indicators found statistically significant higher HR of mortality in patients with severe SA (2.35, 95% CI 1.17-4.71, p = 0.02), and TA (2.02, 95% CI 1.04-3.94, p = 0.04). CONCLUSION: High levels of SA and TA was significantly and independently associated with a high risk of all-cause mortality in patients, who underwent implantation of cardiac electronic devices.
ABSTRACT
OBJECTIVE: The purpose of this study was to assess the association between depression and all-cause mortality in patients with congestive heart failure (CHF) and an implanted cardiac device. METHODS: The study enrolled 260 patients (mean age 56.8±10.0 years; 83.1% male) with CHF and an implanted cardiac device (156 patients with a resynchronization therapy cardiac device, 104 patients with an implantable cardioverter defibrillator). The mean duration of follow-up was 48.6±32.2 months. The Beck Depression Inventory was used to measure depressive symptoms. Depression was considered absent for a score between 0 and 9, mild to moderate for a score between 10 and 18, and severe if the score was 19 or greater. The Cox proportional hazards regression model was used to estimate hazard ratios (HR) with a 95% confidence interval (CI) for the impact of depression on all-cause mortality. The HR was calculated after adjustment for the following confounders: age, gender, smoking status, hypertension, diabetes mellitus, body mass index, hypercholesterolemia, left ventricular ejection fraction, number of hemodynamically significant lesions of the coronary arteries, and the type of implanted cardiac device. RESULTS: During the follow-up period, 37 patients died (14.2%). The adjusted HR of depression for all-cause mortality was 1.05, with a 95% CI of 1.01-1.09. Patients without depression were accepted as a reference group with HR=1.0 for analysis of the categorical indicator. The HR was 1.32, with a 95% CI of 0.57-3.03, in patients with mild depressive symptoms, and the HR was 3.18 with a 95% CI of 1.31-7.73 in patients with severe depressive symptoms. CONCLUSION: Increased depressive symptoms were independently associated with all-cause mortality in patients with CHF and an implanted cardiac device.
