Depression and anxiety in Greek heart failure patients who received a cardiac resynchronization therapy device and did not receive shock therapy during a 12-month follow-up
Authors: Korantzopoulos P , Florou E , Sfairopoulos D , Plakoutsi S , Zekios K , Bechlioulis A 
Published: May 2024

Abstract

Background/Introduction
Cardiac resynchronization therapy (CRT) represents an effective therapy in selected heart failure with reduced ejection fraction (HFrEF) patients. There are racial, social, geographical, and ethnic differences in the perception of cardiac device therapies as well as in the associated depression and anxiety status. Regarding psychological status indexes in CRT patients, heterogenous results have been reported while data on their variation over time are limited. No relative data regarding Greek patients have been published in the literature.

Purpose
We aimed to study psychological status and quality of life validated parameters at baseline as well as their variation at 6 and 12 months after implantation of a CRT device in Greek adult patients with HFrEF.

Methods
We recruited consecutive HFrEF adult patients who were implanted a CRT device (defibrillator or pacemaker). From the present analysis we excluded patients who suffered defibrillator shocks, those with neuropsychiatric disorders, and those with severe chronic medical illnesses or disabilities. Baseline demographic, clinical, laboratory, electrocardiographic, and echocardiographic parameters were carefully recorded. The following scores were assessed at baseline as well as 6 and 12 months after implantation: Minnesota Living with Heart Failure (MLHF), GAD-7 Anxiety, and PHQ-9 Depression. The variation of these scores over time was examined using the non-parametric Friedman’s test. Potential correlations of the baseline scores with other parameters were examined using the Spearman rank test. Comparison of these scores between different groups of patients was examined using the Mann-Whitney U test.

Results
The initial study population consisted of 105 patients, but after excluding 8 patients who experienced defibrillator shocks, we finally analyzed 97 patients (median age: 72 [64-76.5] years, 76% men). Six patients died during the 12-month follow-up.
At baseline the MLHF score was 37 [20 - 56], at 6 months it was 1 [0 – 8], and at 12 months 0.5 [0-10]. The PHQ-9 score for depression at baseline was 9 [3.75 – 14.25], at 6 months it was 0.5 [0 – 2], and at 12 months it was 0.25 [0 – 1.5]; p &lt;0.01. The GAD-7 anxiety score at baseline was 8 [2 – 16], at 6 months it was 0.5 [0 – 2], and at 12 months it was 0.5 [0 – 2.5]; p &lt;0.01.
At baseline 29% of patients had PHQ-9 score &lt;5, namely minimal depression; and 35% had GAD-7 score &lt;5, namely minimal anxiety. The baseline PHQ-9 and GAD-7 scores did not correlate to any other parameter while there were no differences between different patient groups. Baseline PHQ-9 and GAD-7 scores demonstrated strong correlation with the baseline MLHF score (p &lt;0.01).

Conclusions
In Greek patients with HFrEF who were implanted a CRT device, depression was present in 71% and anxiety in 65% of them. The indexes of quality of life, anxiety, and depression were markedly reduced during the 12-month follow-up.