09 - Cognitive/affective and Somatic Aspects of Depression Prior to Lvad Implantation and Associations With Mortality
Year: 2019
Type: other
Abstract: Background: Left ventricular assist devices (LVAD) are increasingly utilized as a bridge to transplant (BTT) or destination therapy (DT) for patients with advanced heart failure. There is limited evidence regarding the effect of depressive symptoms on BTT and DT patients. We hypothesized that DT recipients would have more severe depressive symptoms pre-implantation than BTT recipients because of greater medical comorbidity and other factors precluding transplantation. We also hypothesized that somatic symptoms would contribute more to depressive burden than cognitive/affective symptoms and would be more strongly associated with all-cause mortality post LVAD implantation.Methods: In this retrospective study, we used pre-operative PHQ-9 scores to evaluate somatic and cognitive/affective symptoms of depression in 203 adult patients who underwent LVAD placement from 2007-2017. We compared demographic variables, mean PHQ-9 scores (total, somatic symptoms, and cognitive/affective symptoms), and proportions of patients with total PHQ-9 scores u226510 in BTT and DT groups. We also analyzed the effect of PHQ-9 total, somatic, and cognitive/affective scores on all-cause mortality using a Cox Proportional Hazards Model, adjusted for demographic and clinical variables.Results: We included 81 BTT and 122 DT patients. Total PHQ-9 scores did not differ between groups (BTT 6.4 vs. DT 7.5, p=0.12), but there was a trend toward more patients in the DT group with PHQ-9 scores u226510 (BTT 26% vs. DT 39%, p=0.063). Somatic symptoms accounted for three-quarters of total PHQ-9 scores in both groups (BTT 76% vs. DT 74%). In Cox Proportional Hazards Models, PHQ-9 total (adjusted HR 1.02, 95% CI 0.98-1.06, p=0.316), somatic symptoms (adjusted HR 1.03, 95% CI 0.97-1.09, p=0.341) and cognitive/affective symptoms (adjusted HR 1.04, 95% CI 0.95-1.15, p=0.381) were not associated with all-cause mortality.Discussion: In keeping with our hypotheses, somatic symptoms were the biggest contributor to total PHQ-9 scores. In contrast, the mean severity of depressive symptoms and the proportion of patients with clinically significant depressive symptoms did not differ between BTT and DT patients. Pre-implantation depressive symptoms were not associated with post-implantation mortality. Mean depressive symptoms were mild in both groups, with a preponderance of somatic symptoms, which may have been due to medical morbidity. Core cognitive/affective symptoms were low in our patients, so it is not surprising that PHQ-9 scores were not associated with mortality. Nonetheless, depression has been linked to other negative outcomes in patients with end-stage heart failure. Additional work is needed to identify depression better in patients being considered for LVAD and to measure its unique effects on their clinical course and well-being.Conclusion: In patients who underwent LVAD implantation, pre-operative mean PHQ-9 scores were mild, did not differ between those receiving DT vs. BTT, and were not associated with mortality. Somatic symptoms were the biggest contributor to total PHQ-9 scores.
Institution: Mayo Clinic
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W4213140363