Anxiety and depression in patients with an implantable cardioverter defibrillator does personality and icd expectations play a role?

Abstract

Abstract Background The implantable cardioverter defibrillator (ICD) is the treatment of choice for the prevention of sudden cardiac death. Given that 22.6% of patients with an ICD develop anxiety and 15.4% depression (1), it is paramount to identify factors contributing to their distress. Anxiety may lead to depression if untreated and both have been associated with risk of morbidity and mortality. Purpose To examine if Type D personality and expectations to ICD therapy are associated with anxiety and depression in ICD patients at 12 months follow-up. Methods Patients with a first-time ICD or cardiac resynchronization therapy device (CRT-D) participating in the national Danish ACQUIRE-ICD trial completed the Type D Scale (2), the EXPECT-ICD Scale containing both negative and positive expectations at baseline, the Generalized Anxiety Disorder scale (GAD-7), and the Patient Health Questionnaire (PHQ-9) to determine anxiety and depression, respectively, both at baseline and 12 months follow-up. Results Of the 478 patients participating in the study, the mean age was 60.2 ± 11.2, 397 (83.1%) were male and 81 (16.9%) women. Of all patients, 255 (53.3%) had a primary prevention indication for the ICD and 223 (46.7%) a secondary prevention indication, while 441 (92.3%) were in NYHA Class I-II and 37 (7.7%) in NYHA class III-IV at the time of implant. With respect to personality, 73 patients (15.3%) had a Type D personality. Mean scores on Positive expectations towards ICD implantation were 12.8 ± 3.18, and mean scores on negative expectations were 5.37 ± 3.30. In the multivariate, adjusted analysis for depression, Type D personality was independently associated with 12 months depression scores, over and above the impact of baseline depressive symptoms (B = 2.43, 95% CI [1.42, 3.43], p < .001). ICD expectations were not significantly associated with 12 months depression scores. In the multivariate, adjusted analysis for anxiety, Type D personality was independently associated with 12 months anxiety scores, over and above the impact of baseline anxiety symptoms (B = 1.90, 95% CI [1.07, 2.73], p <.001). ICD expectations were not significantly associated with 12 months depression scores. Conclusion In a large Danish national cohort of ICD patients, depressive symptoms at baseline and Type D personality were associated with increased depressive symptoms at 12 months follow-up. Neither positive nor negative ICD expectations were associated with depressive symptoms at 12 months follow-up, adjusting for other variables. Similar results were found for anxiety symptoms. Anxiety symptoms at baseline and Type D personality were associated with increased anxiety at 12 months follow-up, adjusting for all other variables, including ICD expectations. It may be worthwhile to screen cardiac patients for this personality type in clinical practice.