title: Depression and outcome among veterans with implantable cardioverter defibrillators with or without cardiac resynchronization therapy capability.
abstract: BACKGROUND
  The impact of depression on outcome in implantable cardioverter defibrillator (ICD) recipients has not been fully appreciated. We assessed the prevalence of depression and its association with heart failure (HF) outcome among veterans with ICDs.
  
  
  RESULTS
  Patients enrolled between January 2005 and January 2010 in the Outcomes among Veterans with Implantable Defibrillators Registry were studied. We examined the cross-sectional association of depression with severity of HF functional class as well as the association of depression with the composite outcome of mortality or HF hospitalization over a mean follow-up time of 2.7 years. There were 3,862 patients enrolled. Patients with depression (1,162, 43%) were younger (63.1 ± 9.4 years vs 66.6 ± 9.9 years, P < 0.001), more likely to have a history of tobacco or alcohol abuse (P < 0.0001) or atrial fibrillation (P = 0.05) while having a higher ejection fraction (28.3% vs 27.4%, P = 0.03). Depression was associated with advanced HF class at time of implant; odds ratio (OR; vs class I) for class III: 1.65 (confidence interval [CI] 1.17-2.33), class IV: 1.73 (95% CI 1.08-2.76). Death or HF hospitalization was more likely to occur in patients with depression (35.2% vs 32.0%, HR: 1.15 [95% CI 0.99-1.33]). The predictive value of depression was stronger after multivariable adjustment; HR: 1.25 (95% CI 1.05-1.49).
  
  
  CONCLUSIONS
  Depression was prevalent among veterans with ICDs. Depression was associated with severity of HF. The predictive value of associated depression was significant after multivariable adjustment.
authors: University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
authors: Alaa A
authors: AA
authors: Shalaby
authors: Genevieve E
authors: GE
authors: Brumberg
authors: Lauren
authors: L
authors: Pointer
authors: David B
authors: DB
authors: Bekelman
authors: John S
authors: JS
authors: Rumsfeld
authors: Yanfei
authors: Y
authors: Yang
authors: Cara N
authors: CN
authors: Pellegrini
authors: Paul A
authors: PA
authors: Heidenreich
authors: Edmund
authors: E
authors: Keung
authors: Barry M
authors: BM
authors: Massie
authors: Paul D
authors: PD
authors: Varosy
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016896:Treatment Outcome; D058014:Veterans Health
keywords: depression; heart failure; implantable cardiac defibrillator; mortality