Effect of depressive symptoms on survival after heart transplantation.
OBJECTIVE
This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated.


METHODS
An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome.


RESULTS
Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables.


CONCLUSIONS
Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.
Zipfel
Stephan
S
Department of Internal Medicine II, General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, Heidelberg, Germany. stephan_zipfel@med.uni-heidelberg.de
Schneider
Antonius
A
Wild
Beate
B
Löwe
Bernd
B
Jünger
Jana
J
Haass
Markus
M
Sack
Falk-Udo
FU
Bergmann
Günther
G
Herzog
Wolfgang
W
D001007:Anxiety / Q000175:diagnosis / Q000209:etiology; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery; D003863:Depression / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D015996:Survival Rate