title: Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy.
abstract: Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.
authors.affiliation: Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands, c.knackstedt@mumc.nl.
authors.forename: Christian
authors.initials: C
authors.lastname: Knackstedt
authors.forename: Marlies
authors.initials: M
authors.lastname: Arndt
authors.forename: Karl
authors.initials: K
authors.lastname: Mischke
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Fred
authors.initials: F
authors.lastname: Nieman
authors.forename: Hanns Jürgen
authors.initials: HJ
authors.lastname: Kunert
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
authors.forename: Christine
authors.initials: C
authors.lastname: Norra
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000523:psychology; D017281:Cost of Illness; D017147:Defibrillators, Implantable; D003863:Depression / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D004452:Echocardiography; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011237:Predictive Value of Tests; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013147:Spirometry; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome