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Mood Disorders and Outcome in Patients Receiving Cardiac Resynchronization Therapy
Author(s) -
SHALABY ALAA,
BRUMBERG GENEVIEVE,
ELSAED AIMAN,
SABA SAMIR
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2011.03304.x
Subject(s) - medicine , ejection fraction , cardiac resynchronization therapy , cardiology , heart failure , cardiomyopathy , univariate analysis , depression (economics) , qrs complex , veterans affairs , multivariate analysis , economics , macroeconomics
Background:Mood disorders (MD) have been demonstrated to influence outcome in cardiac disease in general and specifically in chronic heart failure (HF). Little is known about their possible effect on response to cardiac resynchronization therapy (CRT).Objective:To evaluate the influence of MD on CRT response.Methods:We conducted a retrospective chart review of all cardiac CRT‐D (CRT defibrillator) recipients (N = 153) at the Veterans Affairs Pittsburgh Healthcare System from beginning of 2004 through end of 2006. All‐cause death and HF‐related hospitalizations (HFH), individually and combined, were sought through 2009.Results:During a mean follow‐up time of 31.4 ± 14.7 months, there were 48 (31.4%) deaths and 55 (35.9%) HFHs in HF patients having New York Heart Association class of 2.9 ± 0.3, left ventricular ejection fraction (LVEF) of 25.8 ± 9.1%, left ventricular end‐diastolic diameter (LVEDD) of 61.6 ± 11.6 mm, and QRS of 152 ± 30.5 ms. A total of 65 (42.5%) patients had MD (depression, anxiety, or posttraumatic stress disorder). Compared to others, patients in the MD group were at a significantly higher risk of HFH alone (47.7% vs 27.3%, P = 0.009) or when combined with death (58.5% vs 39.8%, P = 0.022) but not death alone (35.4% vs 28.4%, P = 0.36). The significant predictive effect of MD on HFH alone and when combined with death shown in univariate analysis was not attenuated after adjustment for age, ejection fraction, etiology of cardiomyopathy, cumulative number of any shocks, smoking, and evidence of postimplantation echocardiographic improvement.Conclusions:MD in patients with advanced but stable HF receiving CRT‐D therapy was a predictor of HFH alone or when combined with death but not mortality alone. (PACE 2011;1–9)