2017


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2017/№2

Prognostic role of depression in patients with congestive heart failure with implanted cardiac devices

Fisher Y. A., Pushkarev G. S., Soldatova A. M., Enina T. N, Sapozhnikova А. D., Kuznetsov V. A.
"Tyumen Cardiology Science Center", Branch of the Federal State Budgetary Science Institution "Tomsk National Research Medical Center of the Russian Academy of Sciences", Melnikayte 111, Tyumen 625026

Keywords: depression, chronic heart failure, psychosocial risk factors, cardiac resynchronization therapy

DOI: 10.18087/rhj.2017.2.2307

Aim. To evaluate the effect of depression on risk of all-cause death in patients with chronic heart failure (CHF) who had undergone a surgery for implantation of cardiological electronic devices. Materials and methods. The study included 149 patients who had undergone implantation of a biventricular cardiac pacemaker for resynchronization therapy and 104 patients who had undergone implantation of a cardioverter defibrillator. In total, 253 patients (210 males and 43 females) aged 23 to 84 (mean age, 56.8±10.1) were evaluated. Mean duration of follow-up was 49.5±31.7 months. Depression symptoms were determined using the Beck Depression Inventory. A score of 19 or higher was defined as pronounced depressive symptoms and from 10 to 18 – as mild depressive symptoms. If the score was 9 or less the patient was characterized as having no depressive symptoms. A multivariate regression model of Cox proportional hazards was used for evaluation of the hazard ratio (HR) for all-cause death. HR was calculated with an account of age, gender, smoking, presence of arterial hypertension, diabetes mellitus, body mass index, presence of hypercholesterolemia, left ventricular ejection fraction, number of hemodynamically significantly stenotic coronary arteries, and presence of an implantable cardiac pacemaker. The analysis included both quantitative and categorical parameters. Results. Mean Beck’s scale score was 12.8±8.1. 99 (39.1%) patients had no symptoms of depression; 96 (37.9%) patients had mild depression; and 58 (22.9%) patients had pronounced symptoms of depression. 37 patients (11.4%) died of all causes during the period of prospective observation. The analysis showed that HR for the depression score was 1.04 (95% CI, 1.01–1.08). For the analysis of categorical depression indexes, the group of patients with no signs of depression was taken as a reference group with HR 1.0. The HR was 1.07 (95% CI, 0.46–2.50) for patients with mild depression and 2.72 (95%CI, 1.14–6.47) for patients with pronounced depressive symptoms. Conclusion. Depression exerted a significant and independent effect on the risk of all-cause death in patients with CHF who had undergone a surgery for implantation of an electronic cardiological device.
  1. Оганов Р. Г., Шальнова С. А., Калинина А. М. Профилактика сердечно-сосудистых заболеваний. -Москва: ГЭОТАР-Медиа; 2009. 216 с [Oganov R . G., Shal`nova S. A., Kalinina A. M. Profilaktika serdechno-sosudisty`x zabolevanij. -Moskva: GE`OTAR-Media; 2009. 216 s].
  2. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81. DOI:10.1093/eurheartj/ehw106.
  3. Lichtman JH, Bigger JT, Blumenthal JA, Frasure-Smith N, Kaufmann PG, Lespérance F et al. Depression and coronary heart disease: recommendations for screening, referral, and treatment: a science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation. 2008;118(17):1768–75. DOI:10.1161/CIRCULATIONAHA.108.190769.
  4. Pedersen SS, Denollet J, Daemen J, van de Sande M, de Jaegere PT, Serruys PW et al. Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents. J Psychosom Res. 2007;62(4):455–61. DOI:10.1016/j.jpsychores.2006.12.018.
  5. Dzau V, Braunwald E. Resolved and unresolved issues in the prevention and treatment of coronary artery disease: a workshop consensus statement. Am Heart J. 1991;121(4 Pt 1):1244–63.
  6. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in Heart Failure. Journal of the American College of Cardiology. 2006;48(8):1527–37. DOI:10.1016/j.jacc.2006.06.055.
  7. Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015;36(41):2793–867. DOI:10.1093/eurheartj/ehv316.
  8. Shalaby AA, Brumberg GE, Pointer L, Bekelman DB, Rumsfeld JS, Yang Y et al. Depression and outcome among veterans with implantable cardioverter defibrillators with or without cardiac resynchronization therapy capability. Pacing Clin Electrophysiol. 2014;37(8):994–1001. DOI:10.1111/pace.12361.
  9. Тарабрина Н.В. Практикум по психологии посттравматического стресса. –СПб: Питер; 2001. 272с [Tarabrina N.V. Praktikum po psixologii posttravmaticheskogo stressa. –SPb: Piter; 2001. 272s].
  10. Медик В.А., Токмачев М.С. Математическая статистика в медицине. –Москва: Финансы и статистика; 2007. 800с [Medik V.A., Tokmachev M.S. Matematicheskaya statistika v mediczine. –Moskva: Finansy` i statistika; 2007. 800s].
  11. Sokoreli I, de Vries JJG, Riistama JM, Pauws SC, Steyerberg EW, Tesanovic A et al. Depression as an independent prognostic factor for all-cause mortality after a hospital admission for worsening heart failure. Int J Cardiol. 2016;220:202–7. DOI:10.1016/j.ijcard.2016.06.068.
  12. Watkins LL, Koch GG, Sherwood A, Blumenthal JA, Davidson JRT, O’Connor C et al. Association of anxiety and depression with all-cause mortality in individuals with coronary heart disease. J Am Heart Assoc. 2013;2(2):e000068. DOI:10.1161/JAHA.112.000068.
  13. Konrad M, Jacob L, Rapp MA, Kostev K. Depression risk in patients with coronary heart disease in Germany. World J Cardiol. 2016;8(9):547–52. DOI:10.4330/wjc.v8.i9.547.
  14. Осипова О.А., Власенко М.А., Годлевская О.М., Суязова С.Б. Цитокины в развитии и прогрессировании хронической сердечной недостаточности. Вестник новых медицинских технологий. 2012;19(2):322–7 [Osipova O.A., Vlasenko M.A., Godlevskaya O.M., Suyazova S.B. Czitokiny` v razvitii i progressirovanii xronicheskoj serdechnoj nedostatochnosti. Vestnik novy`x mediczinskix texnologij. 2012;19(2):322–7].
  15. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009;71(2):171–86. DOI:10.1097/PSY.0b013e3181907c1b.
  16. Окороков А.Н. Диагностика болезней внутренних органов. Диагностика болезней сердца и сосудов. –Москва: Медицинская литература; 2009. 432 с [Okorokov A.N. Diagnostika boleznej vnutrennix organov. Diagnostika boleznej serdcza i sosudov. –Moskva: Mediczinskaya literatura; 2009. 432 s].
Fisher Y. A., Pushkarev G. S., Soldatova A. M., Enina T. N, Sapozhnikova А. D., Kuznetsov V. A. Prognostic role of depression in patients with congestive heart failure with implanted cardiac devices. Russian Heart Journal. 2017;16 (2):98–102

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