Key result
ICD shocks during CRT linked to ~111% higher risk of death or HF hospitalization.
Why the study?
To assess the incidence and clinical significance of depression in CRT-D patients and evaluate the impact of shock therapy on depression development and long-term prognosis.
Does ICD shock therapy increase the risk of new-onset depression and adverse clinical outcomes in heart failure patients with CRT-D?
Cohort (n=221)
No
Does ICD shock therapy increase the risk of new-onset depression and adverse clinical outcomes in heart failure patients with CRT-D?
Effect estimate: HR 2.11 (95% CI 1.63-2.59)
Absolute Event Rate: 57.7% vs 25.4%
p-value: p=<0.001
ICD shocks in CRT-D recipients are associated with a significantly increased risk of developing new-onset depression and a higher rate of death or heart failure hospitalization.
ICD shocks associated with higher death/HF hospitalization and new depression in CRT-D patients; hypothesis-generating, needs prospective confirmation before practice change.
BACKGROUND: The aim of this study was to assess the incidence and clinical significance of depression in patients with cardiac resynchronization therapy with an implantable cardioverter-defibrillator (CRT-D). The study was also to evaluate the impact of shock therapy on depression development and long-term prognosis. METHODS: The prospective study encompassed 396 consecutive heart failure (HF) patients implanted with CRT-D. All patients completed the Beck Depression Inventory (BDI-II) and underwent a psychiatric examination at baseline. 221 patients free of depressive symptoms at baseline were included into the final analysis. The assessment of psychiatric status was routinely repeated every 6 months as well as after the shock delivery. The primary outcome was a composite endpoint of death or hospitalization for HF. RESULTS: During long-term observation (median 37.1 months) 52 (23.5%) patients suffered from an implantable cardioverter-defibrillator (ICD) shock, whereas 48 (21.8%) subjects developed depression. The incidence of new-onset depression was significantly higher in patients after shock delivery (Shock Group), CRT non-responders and subjects with atrial fibrillation. The risk for a composite endpoint was higher in the Shock Group than subjects without an ICD intervention: 57.7% vs. 25.4% and in patients with new-onset depression compared to the population free of this disorder: 62.5% vs. 24.9% (all p < 0.001). New-onset depression (HR 1.7) and an ICD shock (HR 2.1) were strong independent predictors of poor prognosis. CONCLUSIONS: Depression is a common mental disorder in CRT-D recipients, that adversely affects long-term prognosis. Subjects suffering from ICD shocks and those with HF progression are at higher risk of experiencing depressive symptoms.
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Podolecki et al. (2024) conducted a cohort in Chronic heart failure (n=221). ICD shock vs. No ICD shock was evaluated on Composite of death or hospitalization for decompensated heart failure (HR 2.11, 95% CI 1.63-2.59, p=<0.001). In heart failure patients receiving cardiac resynchronization therapy, experiencing an ICD shock significantly increased the risk of death or heart failure hospitalization compared to no shock (57.7% vs 25.4%, HR 2.11).
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