CoRPS Center of Research on Psychology in Somatic diseases Depression is associated with a 2-fold independent risk of mortality in implantable cardioverter.

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Presentation transcript:

CoRPS Center of Research on Psychology in Somatic diseases Depression is associated with a 2-fold independent risk of mortality in implantable cardioverter defibrillator patients Susanne S. Pedersen 1,2,3, Professor of Cardiac Psychology 1 Medical Psychology, Tilburg University, The Netherlands 2 Thoraxcenter, Erasmus Medical Center, The Netherlands 3 Department of Cardiology, Odense University Hospital, Denmark

CoRPS Disclosures Cameron Health Medtronic Sanofi-Aventis St. Jude Medical Moderate speaker or consultancy fees, or independent research grants:

CoRPS Prevalence of distress in ICD patients Psychological morbidity: Anxiety/depression ≈ 25% Posttraumatic stress ≈ 12% Chronic anxiety ≈ 50% Versteeg et al. Int J Cardiol 2011;146:438-9; Pedersen et al. Int J Cardiol 2011;147:420-3; von Känel et al. J Affect Disord 2011;131: Subset of patients (1 in 4) Depression: 11% to 28% Anxiety: 11% to 26%

CoRPS Should we take distress in ICD patients seriously? Braunschweig, Boriani,... Pedersen et al. Europace 2010;12: Stressed out - ME???!!!

CoRPS Down in the dumps Feeling blue Angry Worried Bad mood Unhappy Type D ? Type D personality - burden of increased negative emotions and inhibition No!! I do not want to share my emotions with others… No!! I do not want to share my emotions with others…

CoRPS Type D personality: An important risk marker for poor prognosis Denollet et al. Circ Cardiovasc Qual Outcomes 2010;3: Mean OR across 9 studies: 3.7 [95% CI ]

CoRPS Pedersen, Jordaens, Theuns et al. Europace 2010;12: Type D personality, pre-implantation ICD concerns and mortality HR: 2.38 [95% CI: ]; p = % 4.5% HR: 2.74 [95% CI: ]; p = % 4.9% (N = 371)

CoRPS Posttraumatic stress symptoms and mortality Ladwig et al. Arch Gen Psychiatry 2008;65: HR: 3.45 [95% CI: ]; p = 0.02 (N = 211)

CoRPS What about depression?

CoRPS Study objectives To examine: (i)the influence of depression on mortality (ii)whether specific depressive symptoms drive the relationship between depression and mortality

CoRPS Methods: Participants Consecutive patients (N = 430; 79% men; mean age = 58 ± 12) with a first-time ICD or CRT-D Implanted between August 2003 to March 2010 in the Erasmus Medical Center, Rotterdam Participating in Mood and personality as precipitants of arrhythmia in patients with an Implantable cardioverter Defibrillator: A prospective Study (MIDAS)

CoRPS Methods: Design and measures Prospective follow-up study – 2 ½ years (range 47 days to 3 years) Demographic and clinical characteristics (incl. device therapy) obtained from medical chart abstraction and purpose-designed questions Patients completed: o 7-item depression scale at baseline – Hospital Anxiety and Depression Scale (HADS) Statistical analysis: Univariable and multivariable Cox’s proportional hazard regression analysis

CoRPS Results: Mortality stratified by depression (cut-off ≥8) 11% died (47/430) during the follow-up period HR: 2.31 [95% CI: ]; p = % 18.5% * HR: 2.16 [95% CI: ]; p = 0.01 * Adjusted for gender, age, indication for ICD implantation, symptomatic heart failure, beta-blocker therapy, appropriate shocks HR: 1.12 [95% CI: ]; p < Percentage

CoRPS Results: Mortality stratified by specific depressive symptoms HADS-D (item)HR[95% CI]p “Do not enjoy the things I used to” (#2)1.57[ ]0.004 “Cannot laugh and see funny side” (#4)1.44[ ]0.06 “Do not feel cheerful” (#6)1.33[ ]0.09 “Feel as if I am slowed down” (#8)1.33[ ]0.08 “Lost interest in my appearance” (#10)1.85[ ]< “Hardly ever look forward with enjoyment to things” (#12) 1.70[ ]< “Cannot enjoy a good book radio or TV program” (#14) 1.30[ ]0.07

CoRPS Take home message Depression was associated with a 2-fold risk for mortality – independent of demographic and clinical risk factors including shocks Cardio-toxic symptoms of depression – tapping into feelings of anhedonia (i.e., lack of positive affect) but also depression Depression in ICD patients should be taken seriously – hampers patient survival despite state- of-the-art treatment

CoRPS Acknowledgements Funding VENI grant ( ) from the Netherlands Organization for Scientific Research (NWO) VIDI grant ( ) from the Netherlands Organization for Health Research and Development (ZonMw) FUNDING Center of Research on Psychology in Somatic diseases, Tilburg University, The Netherlands Research team Co-authors Dominic Theuns (PhD), Erasmus MC Luc Jordaens (MD, PhD), Erasmus MC Ruud AM Erdman (PhD), Erasmus MC