Symptomatic heart failure is the most important clinical correlate of impaired quality of life, anxiety, and depression in implantable cardioverter-defibrillator patients: a single-centre, cross-sectional study in 610 patients.
OBJECTIVE
To identify correlates of impaired quality of life (QOL), anxiety, and depression in patients with an implantable cardioverter-defibrillator (ICD).


RESULTS
Surviving patients (n = 610) who received an ICD in our institution since 1989 completed the Short Form Health Survey (SF-36) and the Hospital Anxiety and Depression Scale. Mean age was 62.4 years with 18% females. In a multivariate logistic regression analysis, symptomatic heart failure was the most important correlate of impaired QOL (SF-36) across all eight subscales [odds ratios (ORs) ranging from 5.21 to 22.53)], whereas psychotropic medication, age, comorbidity, amiodarone, and ICD shocks all correlated to a lesser extent. Symptomatic heart failure was also the most dominant correlate of anxiety [OR 5.15 (3.08-8.63), P < 0.001] and depression [OR 6.82 (3.77-12.39), P < 0.001]. Implantable cardioverter-defibrillator shocks correlated less yet significantly with anxiety [OR 2.21 (1.32-3.72) P < 0.01] and depression [OR 2.00 (1.06-3.80), P < 0.05].


CONCLUSIONS
Symptomatic heart failure was the single most important clinical correlate of impaired QOL, anxiety, and depression, with ICD shocks playing only a secondary role. This suggests that comorbidity rather than ICD therapy per se influences patients' device acceptance, supporting the increasing use of prophylactic ICD implantation.
Johansen
Jens B
JB
Department of Cardiology, Aarhus University Hospital (Skejby), Brendstrupgaardsvej 100, DK 8200 Aarhus N, Denmark. brock@dadlnet.dk
Pedersen
Susanne S
SS
Spindler
Helle
H
Andersen
Kirsten
K
Nielsen
Jens C
JC
Mortensen
Peter T
PT
D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013223:Statistics as Topic