title: Depression as a predictor for appropriate shocks among patients with implantable cardioverter-defibrillators: results from the Triggers of Ventricular Arrhythmias (TOVA) study.
abstract: OBJECTIVE
  We sought to examine the relationship between symptoms of depression and shock-treated ventricular arrhythmias among implantable cardioverter-defibrillator (ICD) patients.
  
  
  BACKGROUND
  Depression predicts mortality in patients with coronary artery disease (CAD), but whether this is via an increased risk of fatal ventricular arrhythmias is unclear.
  
  
  METHODS
  We prospectively analyzed data on symptoms of depression and risk of ventricular arrhythmia (ventricular tachycardia/ventricular fibrillation [VT/VF]) resulting in ICD discharge in the Triggers of Ventricular Arrhythmias (TOVA) study. Symptoms were assessed by the Center for Epidemiologic Studies-Depression (CES-D) scale. Scores of 16 to 26 and > or =27 represented mild and moderate/severe depression, respectively. The Cox and Anderson-Gill proportional hazards models were used to test for associations among all patients and patients with CAD.
  
  
  RESULTS
  Among 645 patients with baseline assessments, 90 (14%) were mildly depressed and 25 (3.9%) were moderately to severely depressed. Moderate/severe depression was associated with time to first shock for VT/VF (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1 to 9.9) and all shocks for VT/VF including recurrent episodes (HR 3.2, 95% CI 1.2 to 8.6). Among the 476 CAD patients, the association with time to first shock (HR 6.4, 95% CI 1.9 to 21.1) and all shocks (HR 8.3, 95% CI 2.9 to 23.3) remained. The risk of shock for VT/VF was associated with depression severity in the total population (p for trend = 0.02) and among patients with CAD (p < 0.01), even after controlling for multiple confounders.
  
  
  CONCLUSIONS
  More severe symptoms of depression predict shocks for VT/VF among ICD patients. The elevated risk of VT/VF among patients with CAD and depression suggests that arrhythmia may contribute significantly to total mortality in this subgroup.
authors.affiliation: Cardiovascular Division, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. wwhang@partners.org
authors.forename: William
authors.initials: W
authors.lastname: Whang
authors.forename: Christine M
authors.initials: CM
authors.lastname: Albert
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Sears
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
authors.forename: Jamie B
authors.initials: JB
authors.lastname: Conti
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Wang
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: James E
authors.initials: JE
authors.lastname: Muller
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D015331:Cohort Studies; D017147:Defibrillators, Implantable; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000473:pathology / Q000523:psychology* / Q000628:therapy*