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Depression and Outcome among Veterans with Implantable Cardioverter Defibrillators with or without Cardiac Resynchronization Therapy Capability
Author(s) -
SHALABY ALAA A.,
BRUMBERG GENEVIEVE E.,
POINTER LAUREN,
BEKELMAN DAVID B.,
RUMSFELD JOHN S.,
YANG YANFEI,
PELLEGRINI CARA N.,
HEIDENREICH PAUL A.,
KEUNG EDMUND,
MASSIE BARRY M.,
VAROSY PAUL D.
Publication year - 2014
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/pace.12361
Subject(s) - medicine , depression (economics) , cardiac resynchronization therapy , implantable cardioverter defibrillator , atrial fibrillation , odds ratio , heart failure , confidence interval , ejection fraction , cardiology , economics , macroeconomics
Background The impact of depression on outcome in implantable cardioverter defibrillator (ICD) recipients has not been fully appreciated. We assessed the prevalence of depression and its association with heart failure (HF) outcome among veterans with ICDs. Methods and Results Patients enrolled between January 2005 and January 2010 in the Outcomes among Veterans with Implantable Defibrillators Registry were studied. We examined the cross‐sectional association of depression with severity of HF functional class as well as the association of depression with the composite outcome of mortality or HF hospitalization over a mean follow‐up time of 2.7 years. There were 3,862 patients enrolled. Patients with depression (1,162, 43%) were younger (63.1 ± 9.4 years vs 66.6 ± 9.9 years, P < 0.001), more likely to have a history of tobacco or alcohol abuse (P < 0.0001) or atrial fibrillation (P = 0.05) while having a higher ejection fraction (28.3% vs 27.4%, P = 0.03). Depression was associated with advanced HF class at time of implant; odds ratio (OR; vs class I) for class III: 1.65 (confidence interval [CI] 1.17–2.33), class IV: 1.73 (95% CI 1.08–2.76). Death or HF hospitalization was more likely to occur in patients with depression (35.2% vs 32.0%, HR: 1.15 [95% CI 0.99–1.33]). The predictive value of depression was stronger after multivariable adjustment; HR: 1.25 (95% CI 1.05–1.49). Conclusion Depression was prevalent among veterans with ICDs. Depression was associated with severity of HF. The predictive value of associated depression was significant after multivariable adjustment.