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

Abstract

Objective: Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified, and whether they were differentially associated with mortality. Methods: Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventoryversion 1A (BDI-1A)), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni-and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables. Results: Clinically significant depression was a significant predictor of mortality (hazard ratio (HR): 2.088; 95% confidence interval (95% CI): 1.366-3.192; p=.001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (HR: 1.982; 95% CI: 1.220-3.217; p=.006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, while neither of the two subscales was an independent predictor of mortality in the multivariate analysis. Psychosom Med Depression and mortality after HTx 24.01.19 2 Conclusions: Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.

The impact of depression on heart transplant outcomes: A retrospective single‐center cohort study

“…Our observation that heart transplant recipients with depression within the first year had decreased survival up to 5 years post‐transplant is congruent with other studies 9,13 . After adjustment, this relationship was no longer significant suggesting an associative rather than causative relationship.…”

“…The relationship between depression and post‐transplant clinical characteristics and outcomes is not well understood. Depression either pre‐ or post‐heart transplantation may be associated with a greater degree of medication nonadherence and post‐transplant hospitalization and in some studies, increased mortality 5‐9 …”

Depression and heart failure: the lonely comorbidity

“…26 Some evidence also suggests that depression is associated with poor outcomes after heart transplantation. 27 Besides, different case-control studies showed that HF is associated with an increased risk of suicide, especially during the first 6 months and up to 2 years after HF diagnosis. 28 This suicide risk is influenced by depressive symptoms.…”

Symptoms of anxiety after heart transplantation and their association with mortality: A secondary analysis

“…Details on recruitment procedures as well as a variety of results of cross-sectional and longitudinal studies of this cohort have been published earlier. 3,[16][17][18] All patients received immunosuppressive therapy according to local protocol.…”

“…2,3 Both biological and behavioral mechanisms have been discussed as underlying factors for this association. 3 In contrast, data on the association of anxious symptomatology with survival after HTx are still sparse and contradictory, 4-10 with only three studies specifically examining the association of posttransplant anxious symptomatology with survival after HTx. 4,8,9 The authors of a meta-analysis published in 2015, deemed it premature to draw strong conclusions…”