A comparison of symptoms of anxiety and depression in patients with a primary and secondary prophylactic indication for an implantable cardioverter defibrillator. [Data from the ACQUIRE-ICD RCT

Abstract

Abstract Introduction Indication for the implantable cardioverter defibrillator (ICD) is either primary or secondary prophylactic. Symptoms of anxiety and depression are known to be evident in patients with an ICD. However, research has not shown agreement in whether there is a difference in the degree of symptoms in these two indication groups. Purpose We investigated the association between anxiety and depression and indication for ICD from implantation and up to 24 months of follow-up. Methods Data was derived from a national randomized controlled trial the "Web-based healthcare innovation to advance the quality of life and care of patients with an implantable cardioverter defibrillator [ACQUIRE-ICD]" to perform a secondary analysis. A total of 478 patients with a first-time ICD were included and completed the Generalized Anxiety Disorder Assessment (GAD-7) and the Patient Health Questionnaire (PHQ-9) after ICD implantation and at 6, 12 and 24 months. Mixed effects regression models and estimated marginal means were used to analyze longitudinal data. Results Anxiety mean scores did not differ statistically between patients with a primary prophylactic ICD as compared to patients with a secondary prophylactic ICD. Most patients showed limited symptoms of anxiety. However, 9% reported values above the cut-off for clinical relevant anxiety. Depression mean scores were significantly higher at 24 months in patients with primary prophylactic ICD as compared to patients with a secondary prophylactic ICD (mean 4.15 vs. 3.05; p=0.014) but not statistically significant at other time points. Most patients showed limited levels of depression. However, 13.2% reported values above the cut-off for clinical relevant depression. Both anxiety and depression scores decreased over time from baseline in both groups. Conclusion Patients with a primary prophylactic ICD did not differ in symptoms of anxiety and had mostly the same level of depression as compared to patients with a secondary prophylactic ICD. However, at 24 months patients with a primary prophylactic ICD reported more symptoms of depression as compared to patients with a secondary prophylactic ICD.Table 1