title: Comorbidity burden is associated with poor psychological well-being and physical health status in patients with an implantable cardioverter-defibrillator.
abstract: OBJECTIVE
  Comorbidity burden has been linked to survival in patients with an implantable cardioverter-defibrillator (ICD), but no study has examined the influence on psychological well-being and health status. We examined the relationship between comorbidity burden and anxiety, depression, and health status in patients with an ICD during the first 12 months post-implantation using a prospective study design.
  
  
  RESULTS
  Consecutively, implanted ICD patients (N = 401; 78% men) completed the Hospital Anxiety and Depression Scale and the Short Form Health Survey 36 (SF-36) at baseline, 3, 6, and 12 months post-implantation. Data were analysed using general linear mixed modelling repeated measures multivariable analysis of variance. The mean Charlson comorbidity index score was 3.5 (± 2.4). In adjusted analyses, comorbidity burden was significantly associated with depression (P = 0.003) and the physical health status domains of the SF-36 (Physical Functioning: P < 0.001; Role Limitations-Physical: P = 0.023; Bodily Pain: P = 0.004; and General Health: P = 0.025) but not with anxiety (P = 0.62) and the mental health status domains of the SF-36 (all P's > 0.05). Chronic heart failure, chronic obstructive pulmonary disease, cerebrovascular disease, and renal failure were the comorbidities with the most impact on depression and physical health status.
  
  
  CONCLUSIONS
  Comorbidity burden was a significant predictor of poorer psychological well-being and physical health status in ICD patients during the first 12 months post-implantation. In the care and management of ICD patients, it is important to recognize the impact of comorbidity burden on patients' mood and health status, and that adjunctive intervention may be warranted to enhance well-being.
authors.affiliation: CoRPS - Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
authors.forename: Madelein T
authors.initials: MT
authors.lastname: Hoogwegt
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
authors.forename: Luc
authors.initials: L
authors.lastname: Jordaens
authors.forename: Susanne S
authors.initials: SS
authors.lastname: Pedersen
authors.forename: Dominic A M J
authors.initials: DA
authors.lastname: Theuns
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anxiety; Comorbidities; Depression; Health status; Implantable cardioverter-defibrillator