title: Effect of depression on mortality in implantable cardioverter defibrillator recipients--findings from the prospective LICAD study.
abstract: BACKGROUND
  Depression predicts mortality in patients with coronary artery disease and heart failure. However, its effect on patient outcome in the presence of an implantable cardioverter defibrillator (ICD) has not been investigated.
  
  
  METHODS
  A total of 236 ICD patients (76 females, 58.6 ± 14.0 years) were screened for depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). The outcome measure was all-cause mortality and the prognostic effect of depression was evaluated with Cox proportional hazards regression analysis.
  
  
  RESULTS
  Fifty (21%) patients reported depressive symptoms (HADS score ≥ 8). Renal failure (odds ratio [OR]= 4.0, 95% confidence intervals [CI]= 1.47-10.87, P = 0.007), prior angina (OR = 2.1, 95% CI = 1.07-4.12, P = 0.03), but not the experience of ICD shocks were associated with baseline depressive symptoms. In a mean follow-up period of 6.1 ± 2.5 years, 74 patients (31%) died. Mortality significantly increased from 45.1 deaths per 1,000 person-years among patients without depression to 80.3 deaths per 1,000 person-years in patients with depressive symptoms (P = 0.039). In the univariate model, depression (HADS score ≥8) was a significant predictor of mortality (OR = 1.81, 95% CI = 1.1-3.0, P = 0.02). However, in the multivariate model, depression lost its prognostic significance.
  
  
  CONCLUSIONS
  In our prospective patient cohort, one-fifth of ICD recipients reported depressive symptoms. Depression increased the absolute mortality risk but was not an independent predictor of mortality.
authors: Deutsches Herzzentrum München und 1. Medizinische Klinik des Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors: Stylianos
authors: S
authors: Tzeis
authors: Christof
authors: C
authors: Kolb
authors: Jens
authors: J
authors: Baumert
authors: Tilko
authors: T
authors: Reents
authors: Bernhard
authors: B
authors: Zrenner
authors: Isabel
authors: I
authors: Deisenhofer
authors: Joram
authors: J
authors: Ronel
authors: George
authors: G
authors: Andrikopoulos
authors: Karl-Heinz
authors: KH
authors: Ladwig
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000401:mortality; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality*; D017147:Defibrillators, Implantable / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000401:mortality; D016896:Treatment Outcome