Depression and severe heart failure: benefits of cardiac resynchronization therapy.
BACKGROUND
The relationship between depression and heart failure is neither coincidental nor trivial, since depression is a powerful predictor of re-hospitalization and mortality. We prospectively studied the prevalence and impact of depression on the clinical outcomes of patients attending for cardiac resynchronization therapy (CRT). We specifically examined whether patients with depression have a different rate of response to CRT and whether CRT has an effect on depressive symptoms.


METHODS
Sixty-eight recipients of CRT systems were included. The depressive status was evaluated before implant and after 6 months by a structured diagnostic interview measuring Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria of major depression and by a self-report questionnaire (Center for Epidemiological Studies Depression Scale, CES-D). The CRT response was assessed at 6 months by a clinical composite score.


RESULTS
At inclusion, DSM-IV criteria of major depression were identified in 41% of the population, while using the self-report questionnaire 65% were observed to have mild to major depressive symptoms (CES-D ≥ 16). Only 4 patients were taking antidepressants. At 6 months, 75% were considered responders to CRT. Response to CRT did not differ between those with and without depression at baseline. The rate of patients with depression at 6 months was significantly lower in responders to CRT compared with nonresponders.


CONCLUSIONS
We found a high prevalence of depressive symptoms in patients receiving CRT systems. Patients with depression should not be excluded from CRT, because they demonstrate a similar rate of response than the persons without depression and the responders are less likely to be depressed at 6 months.
Hôpital Cardiologique Haut-Lévèque, CHU Bordeaux, France. sylvain.ploux@free.fr
Sylvain
S
Ploux
Helene
H
Verdoux
Zachary
Z
Whinnett
Philippe
P
Ritter
Pierre
P
Dos Santos
François
F
Picard
Jacques
J
Clementy
Michel
M
Haïssaguerre
Pierre
P
Bordachar
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D016009:Chi-Square Distribution; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents