Europace Advance Access published online on March 31, 2008
Europace, doi:10.1093/europace/eun073
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Symptomatic heart failure is the most important clinical correlate of impaired quality of life, anxiety, and depression in implantable cardioverter-defibrillator patients: a single-centre, cross-sectional study in 610 patients
1 Department of Cardiology, Aarhus University Hospital (Skejby), Brendstrupgaardsvej 100, DK 8200 Aarhus N, Denmark; 2 CoRPS—Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; 3 Department of Psychology, Aarhus University, Jens Chr. Skous Vej 4, DK 8000 Århus C, Denmark
Aims: To identify correlates of impaired quality of life (QOL), anxiety, and depression in patients with an implantable cardioverter-defibrillator (ICD).
Methods and results: Surviving patients (n = 610) who received an ICD in our institution since 1989 completed the Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale. Mean age was 62.4 years with 18% females. In a multivariate logistic regression analysis, symptomatic heart failure was the most important correlate of impaired QOL (SF-36) across all eight subscales [odds ratios (ORs) ranging from 5.21 to 22.53)], whereas psychotropic medication, age, comorbidity, amiodarone, and ICD shocks all correlated to a lesser extent. Symptomatic heart failure was also the most dominant correlate of anxiety [OR 5.15 (3.08–8.63), P < 0.001] and depression [OR 6.82 (3.77–12.39), P < 0.001]. Implantable cardioverter-defibrillator shocks correlated less yet significantly with anxiety [OR 2.21 (1.32–3.72) P < 0.01] and depression [OR 2.00 (1.06–3.80), P < 0.05].
Conclusion: Symptomatic heart failure was the single most important clinical correlate of impaired QOL, anxiety, and depression, with ICD shocks playing only a secondary role. This suggests that comorbidity rather than ICD therapy per se influences patients' device acceptance, supporting the increasing use of prophylactic ICD implantation.
Key Words: Implantable cardioverter-defibrillator, ICD, Quality of life, Anxiety, Depression, ICD shocks
* Corresponding author. Tel: +45 89496136; fax: +45 89496002.E-mail address: brock{at}dadlnet.dk
Manuscript submitted 9 January 2008. Accepted after revision 4 March 2008.