Depression and Anxiety in Heart Transplant Recipients: Prevalence and Impact on Post-Transplant Outcomes

Abstract

Background: Depression and anxiety (DA) are common mental disorders in patients with chronic diseases, but the research regarding their prevalence in heart transplantation (HTx) is still limited. Methods: We performed an analysis of the prevalence and prognostic relevance of DA in patients who underwent HTx between 2010 and 2018 in Germany. Data were obtained from Allgemeine Ortskrankenkasse (AOK), which is the largest public health insurance provider. Results: Overall, 694 patients were identified. More than a third of them were diagnosed with DA before undergoing HTx (n = 260, 37.5%). Patients with DA more often had an ischaemic cardiomyopathy (p < 0.001) and a history of previous myocardial infarction (p = 0.001) or stroke (p = 0.002). The prevalence of hypertension (p < 0.001), diabetes (p = 0.004), dyslipidaemia (p < 0.001) and chronic kidney disease (p = 0.003) was higher amongst transplant recipients with DA. Patients with DA were more likely to suffer an ischaemic stroke (p < 0.001) or haemorrhagic stroke (p = 0.032), or develop septicaemia (p = 0.050) during hospitalisation for HTx. Our analysis found no significant differences between the groups with respect to in-hospital mortality. The female sex and mechanical circulatory support were associated with an inferior prognosis. Pretransplant non-ischaemic cardiomyopathy was related to a favourable outcome. Conclusions: DA affect up to a third of the population undergoing HTx, with a greater prevalence in patients with comorbidities. DA are associated with a higher incidence of stroke and septicaemia after HTx.

Mental Health and Substance Use Disorders in Transplant Waitlist, VAD, and Heart Transplant Patients: A TriNetX Database Analysis

“…Years after the transplant, the patient may still struggle to cope and have recurrent medical complications. Patients with depression have been found to have elevated rates of stroke and sepsis [ 3 ]. Resources are most concentrated around the pre-and postoperative period.…”

“…The global prevalence of mental health disorders has been on the rise and affects the quality of life in heart failure patients [ 1 , 2 ]. Depression and anxiety have been noted to affect more than 30% of the transplant population, which can influence outcomes in this population [ 3 ]. Patients with advanced heart failure may wait years on the cardiac transplant list before undergoing heart transplantation.…”

“…The uncertainty, fear, and medical challenges of these experiences may have a significant impact on patients’ mental health. Depression affects solid-organ recipients, and most studies suggest depression is an independent risk factor for increased morbidity and mortality after transplant [ 1 , 2 , 3 , 4 , 5 ]. Pre-transplant depression can influence outcomes such as medication compliance and hospitalizations but did not show a significant impact on post-transplant survival [ 2 , 4 ].…”

Mental Health and Substance Use Disorders in Transplant Waitlist, VAD, and Heart Transplant Patients: A TriNetX Database Analysis

“…Years after the transplant, the patient may still struggle to cope and have recurrent medical complications. Patients with depression have been found to have elevated rates of stroke and sepsis [2]. Resources are most concentrated around the pre-and postoperative period.…”

“…The uncertainty, fear, and medical challenges of these experiences may have a significant impact on patients' mental health. Depression affects up to 60% of solid-organ recipients and most studies suggest depression is an independent risk factor for increased morbidity and mortality after transplant [1][2][3]. Poor mental health has been shown to decrease treatment compliance and increase hospitalizations/ infectious complications in post-transplant patients [4,5].…”