Associations of depressive symptoms with outcomes in patients implanted with left ventricular assist devices.
OBJECTIVE
We examined characteristics of depressive symptoms in patients who received left ventricular assist devices (LVAD) to assess their effects on negative outcomes post-implantation.


METHODS
We retrospectively identified 203 adults with pre-operative PHQ-9 scores who underwent LVAD placement as bridge to transplant (BTT) or destination therapy (DT). We analyzed effects of PHQ-9 total, somatic, and cognitive/affective scores and proportion of patients with clinical depression on all-cause mortality, rehospitalization, major bleeding, and neurologic events post-implantation, controlling for demographics and other medical comorbidities.


RESULTS
Mean total PHQ-9 scores did not differ between 81 BTT and 122 DT patients (BTT 6.4 vs. DT 7.5, p = 0.12). A higher proportion of DT patients had clinical depression (BTT 22% vs. DT 39%, p = 0.015). Somatic symptoms accounted for three-quarters of total scores in both groups. PHQ-9 domains were not associated with negative outcomes post-implantation.


CONCLUSION
Depression severity did not differ based on implant strategy, but more DT patients had clinical depression. Somatic symptoms were the biggest contributor to depressive symptoms. Pre-implantation PHQ-9 scores were not associated with outcomes, possibly because depression was mild in both groups. Additional work is needed in LVAD patients to better characterize depressive symptoms and their unique effects on clinical course and well-being.
['Suarez|Laura|L|', 'Dunlay|Shannon M|SM|', 'Schettle|Sarah D|SD|', 'Stulak|John M|JM|', 'Staab|Jeffrey P|JP|']
D000368:Aged D003863:Depression D003865:Depressive Disorder, Major D005260:Female D006333:Heart Failure D006352:Heart Ventricles D006353:Heart-Assist Devices D006801:Humans D008297:Male D000071896:Medically Unexplained Symptoms D008875:Middle Aged D009026:Mortality D017063:Outcome Assessment, Health Care D000073222:Patient Health Questionnaire D010359:Patient Readmission D012189:Retrospective Studies D012720:Severity of Illness Index
Depression Left ventricular assist device (LVAD) Somatic Cognitive/affective End-stage heart failure Patient health questionnaire (PHQ-9)