Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

Abstract

BackgroundWe evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients.Methods and ResultsBetween 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow‐up of 70 months (<1–93 months post‐HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020–0.039). Actuarial 1‐year/5‐year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).ConclusionsLow depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.

The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up

“…In the present study, we aimed to extend existing knowledge about the prognostic impact of depression Our results also suggest that a dose-response relationship between self-reported depressive symptoms after HTx and mortality might exist. Earlier reports on HTx samples were inconclusive in this regard (6,24). However, existence of a dose-response relationship would be in accordance with data on patients with CAD (25,26).…”

“…Although data on the association of depression with increased mortality after HTx seem robust in the medium term (i.e., median observation time of 5.4 years across studies in a meta-analysis (4)) (4)(5)(6), knowledge is limited about depression's long-term effects on mortality (7).…”

Renal Function in Patients with or without a Left Ventricular Assist Device Implant During Listing for a Heart Transplant

“…Third, GFR values were only estimated by the simplified MDRD formula, and creatinine concentrations may have been influenced by factors that are unrelated to kidney function such as changes in muscle mass. Fourth, there was a predominance of male patients in our study groups, but this is a general phenomenon in patients awaiting heart transplantation [ 38 ] and thus unrelated to our investigation. Fifth, censoring of patients that received transplants and deceased patients may have biased outcome results.…”

The Effect of Psychotherapy on Anxiety, Depression, and Quality of Life of Patients with Heart Failure: A Randomized Clinical Trial

“…A survey 24 showed that depressive symptoms and social isolation influenced the prognosis and survival (75% in up to 1 year) of patients waitlisted for heart transplant, and individuals without this condition had a survival of up to 8 years after transplant. The authors concluded on the importance of well-defined screening and intervention in patients at risk.…”