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Does Preexisting Depression Affect Survival After Heart Transplants?
For patients undergoing heart transplants for ischemic cardiomyopathy, mortality risk was associated dramatically with a high level of presurgery depression.
Research indicates that cardiovascular outcomes after myocardial infarction and stroke are worse in patients with major depression. In a prospective German study, researchers assessed whether presurgery levels of depression and anxiety affected outcomes in 103 patients who underwent heart transplantation for either ischemic cardiomyopathy (ICM; 40 patients) or dilated cardiomyopathy (DCM; 63 patients). DCM is caused by viral, genetic, immune, toxic, or other unknown factors.
At follow-up (mean, 4.4 years after transplant), the overall survival rate was 70%: 67% among DCM patients and 75% among ICM patients, a nonsignificant difference. The 2 groups did not differ significantly in causes of death after transplantation (acute graft failure, infection, rejection, and tumor). For ICM patients, but not for DCM patients, mortality risk was associated with older donor age and older recipient age, but was associated more dramatically with a high level of presurgery depression (relative risk for ICM patients, 5.06). Presurgery anxiety level was not linked with higher mortality risk in either group.
Comment: This study is the first to link preoperative depression with post-transplant survival, and it emphasizes the importance of psychiatric screening for patients awaiting heart transplantation. The findings that presurgery depression was linked with higher mortality risk in patients with ICM -- but not DCM -- and that anxiety did not predict risk in either group raise intriguing questions about potential contributing mechanisms. Other research suggests that depressed patients' poor adherence to treatment and to recommendations for reducing cardiac risk factors might increase their mortality risk. It would be interesting to investigate why the findings between ICM and DCM patients differ, to assess the effects of post-transplant antidepressant treatment on outcomes, and to determine how inadequate treatment of depression, medication interactions, or both may affect post-transplant mortality.
— Joel Yager, MD
Published in Journal Watch Psychiatry November 6, 2002
Citation(s):
Zipfel S et al. Effect of depressive symptoms on survival after heart transplantation. Psychosom Med 2002 Sep/Oct; 64:740-7.
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