title: Anxiety predicts mortality in ICD patients: results from the cross-sectional national CopenHeartICD survey with register follow-up.
abstract: BACKGROUND
  Although highly effective in preventing arrhythmic death, patients receiving an implantable cardioverter defibrillator (ICD) may still experience psychological difficulties such as anxiety, depression, and reduced quality of life. The objectives of this study were to describe patient-reported outcomes among ICD patients: (1) compared to a matched healthy population, (2) compared by ICD indication, (3) factors predicting patient-reported outcomes, and (4) if patient-reported outcomes predicted mortality.
  
  
  METHODS
  The study was a mailed survey to an unselected group of patients 18+ years old receiving ICD between January 1, 2011 and June 30, 2011 (n = 499). The following instruments were used: SF-36, Hospital Anxiety and Depression Scale, HeartQoL, EQ-5D, and the Multidimensional Fatigue Inventory.
  
  
  RESULTS
  The response rate was 72%. Mean age was 65.5 years and 82% patients were males. Fifty-three percent of patients had primary prevention indication ICD. Compared to an age- and gender-matched population without disease, the ICD population had worse mental health (55.0 vs 51.7 points) and physical health (52.6 vs 41.9 points). Patients with primary prevention indication had lower levels of perceived health, quality of life, and fatigue; for example, physical health 39.8 versus 44.3 points, compared to secondary prevention indication. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality, anxiety being the strongest with an adjusted odds ratio of 4.17 (1.49; 11.66).
  
  
  CONCLUSIONS
  Patients with primary prevention ICD had lower levels of perceived health, quality of life, and more fatigue. Anxiety, poor perceived health, fatigue, and low quality of life were all predictors of mortality.
authors.affiliation: Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Selina
authors.initials: S
authors.lastname: Kikkenborg Berg
authors.forename: Lau
authors.initials: L
authors.lastname: Caspar Thygesen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hastrup Svendsen
authors.forename: Anne
authors.initials: A
authors.lastname: Vinggaard Christensen
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
mesh_terms: D001007:Anxiety / Q000150:complications*; D003430:Cross-Sectional Studies; D017147:Defibrillators, Implantable / Q000523:psychology*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D011795:Surveys and Questionnaires
keywords: ICD; anxiety; depression; mortality; quality of life