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From the Department of Internal Medicine II (General Internal and Psychosomatic Medicine) (S.Z., A.S., B.W., B.L., J.J., G.B., W.H.), the Department of Internal Medicine III (Cardiology, Angiology, Pulmonology) (M.H.), and the Department of Heart Surgery (F.-U.S.), University of Heidelberg, Medical Hospital, Heidelberg, Germany.
Address reprint requests to: Stephan Zipfel, Department of General Internal and Psychosomatic Medicine, University of Heidelberg, Medical Hospital, Bergheimer Straße 58, D-69115 Heidelberg, Germany. Email: stefan_zipfel{at}med.uni-heidelberg.de
OBJECTIVE: This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated.
METHOD: An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome.
RESULTS: Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables.
CONCLUSIONS: Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.
Key Words: heart transplantation, • depression, • anxiety, • survival prediction, • cardiomyopathy.
Abbreviations: HTx = heart transplantation;; ICMP = ischemic cardiomyopathy;; DCMP = dilated cardiomyopathy;; NYHA functional class = New York Heart Association functional class;; DS = Depression Scale;; STAI = State and Trait Anxiety Inventory;; GBB = Giessen Complaints List;; RR = risk ratio;; LDL = low-density lipoprotein.
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