1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH Rotenburg an der Fulda, Deutschland; 3Universitätsklinikum Jena Klinik für Herz- und Thoraxchirurgie Jena, Deutschland
Background and aims:
Depression represents a common comorbidity in elderly patients with aortic stenosis (AS). Its impact on outcome and survival has been a matter of debate since depression development is multifactorial and therefore causalities are difficult to attribute in these complex patients. Thus, the current study was aimed to test, whether preexisting depression independently predicts patients’ long-term mortality.
Methods:
In this prospective, real-world registry study, a total of 499 patients that underwent transfemoral transcatheter aortic valve implantation (TAVI) at the University Hospital Jena and agreed to participate in the Jenaer Aortenklappenregister were included. Before TAVI, depression was assessed using the Hospital Anxiety and Depression Scale (HADS-D) in all patients. Patients’ outcome and survival data were recorded continuously and the predictive value of preexisting depression for 3-year mortality was tested using binary logistic regression analysis including age, sex, STS score (STS), six-minutes’ walk distance (SMWD), EQ-5D-5L parameters (mobility, self-care, usual activities and visual analogue scale; VAS), Rockwood clinical frailty scale (CFS) and HADS-D depression. Moreover, Kaplan Meier survival analysis was performed.
Results:
In all 499 patients (mean age 79 ± 7 years, 50% female, mean STS score 4.6 ± 3.6%) included in this analysis, TAVI was performed successfully. Mortality rates were 2.8% after 30 days, 16.3% after 1 year, 25% after 2 years and 34.5% after 3 years. The percentage of patients showing a HADS-D value for depression of ≥ 8 points defined as pathologic, was 26.1%. When comparing survivor with non-survivors after 3 years, depression was more frequent in non-survivors (23.2% versus 31.6%, p=0.042).
Multivariate analysis including the above-mentioned co-variates revealed STS (Wald: 6.009, p=0.014, OR: 1.107, 95% CI: 1.021 - 1.201), SMWD (Wald: 5.363, p=0.021, OR: 0.997, 95% CI: 0.995 - 1.0) and HADS-D depression (Wald: 6.870, p=0.009, OR: 1.129, 95% CI: 1.031 – 1.235) as independent predictors of 3-year mortality. Kaplan Meier survival analysis demonstrated a significantly increased mortality in depressive (41.9% after 3 years) compared to non-depressive (32% after 3 years) patients (log rank test: p=0.028).
Conclusions: To our best knowledge, this is the first study identifying depression in AS patients at baseline (before TAVI) as an independent predictor of long-term mortality. Thus, the detailed assessment of mental disorders as important co-morbidities in these typical elderly patient cohort is recommended to first), improve prediction of individual prognosis and second), select patients that potentially benefit from supportive psychological therapies.