Raised risk of depression among patients with a cardiac device

People who have a device fitted to help prevent sudden death face increased risk of anxiety or depression, researchers warn today, calling for psychological support for these patients.

The research, by a team at the University of South Australia, Adelaide, Australia, found almost one-third of people with an implantable cardioverter defibrillator (ICD) develop anxiety while one in five will develop depression.

Writing in EP Europace, the researchers say their findings demonstrate the need for patients’ moods to be monitored.

Study author Professor Hannah Keage said: “Implantable cardioverter defibrillators (ICDs) are effective at extending patients’ lives but we need to make sure that’s a good quality life.

“Rates of mood disorders in people with an ICD are much higher than in the general population, suggesting that psychological assessment and therapy should be integrated into the routine care of these patients.”

An ICD is recommended for people at high risk of a life-threatening heart rhythm and those who have had a cardiac arrest.

It is known that anxiety and depression are associated with a higher likelihood of premature death in patients with an ICD, and this study compiled the best available evidence to determine levels of depression, anxiety and post-traumatic stress disorder (PTSD) in patients with an ICD.

The analysis included 109 studies covering 39,954 ICD patients and the team ascertained the prevalence of anxiety, depression and PTSD – taken from the time of ICD insertion to more than one year of follow-up – was 23%, 15% and 12%, respectively.

This compares with the rates in the general population, which are estimated at 13%, 7% and 1-2% respectively.

When they analysed further detail for anxiety and depression, they found in the first five months, 32% and 23% had anxiety and depression, respectively. At six to 12 months after insertion, rates of anxiety and depression dropped to 29% and 21%, respectively. Twelve months and beyond after implantation, rates were 22% and 15%, respectively.

Professor Keage said: “Rates of all three mood disorders were notably high compared to what we would expect in people without an ICD, particularly for PTSD.

“Around 30% of ICD patients will experience a shock in the first two years and for some patients this is a constant fear that affects decisions about driving, swimming, and so on.

“The decline in mood disorders over time could be due to a number of factors, including patients getting psychological help or adapting to their new life. We can’t discount the possibility that healthier people tend to stay in studies longer while those in ill-health are more likely to drop out. The sex differences were expected as rates of anxiety are generally higher in women compared to men.”

The analysis also examined mood disorders in non-ICD participants of the 109 studies. They found about 23% of ICD patients’ partners had anxiety following the implantation and 14% had depression – which was similar to the rates in patients themselves. Patients with cardiac disease but no ICD also had similar rates of mood disorders as those with an ICD.

Professor Keage added: “Partners are clearly worried about their loved one undergoing surgery and then potentially having a shock. Involving ICD patient partners in psychological therapies is more effective in improving patients’ physical and psychological health than attending alone.

“The findings in cardiac patients make a lot of sense, as heart health and mood disorders go hand in hand. Psychological ill-health can also lead to heart problems through chronic stress and unhealthy lifestyles.

“Psychologists have had little involvement in the care of cardiac patients but this needs to change. I would encourage patients and partners to seek help if their mood is low or they are overly worried, as there are evidence-based therapies for anxiety, depression and PTSD.”

Ghezzi ES, Sharman RLS, Selvanayagam JB, et al. Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: A systematic review and meta-analysis of 39,954 patients. Europace 20 June 2023; doi:10.1093/europace/euad130.


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