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) and could be shown to be attenuated after successful transcatheter aortic valve implantation (TAVI) already at the 6 weeks’ follow-up. This effect remained stable at least for one year after TAVI. The current study was aimed to test, in which way dynamics of depression assessment before and after TAVI affect long-term outcome of patients.
Methods:
A total of 499 patients that underwent TAVI at the University Hospital Jena and were prospectively included in the real-world registry Jenaer Aortenklappenregister. Dynamics of depression were assessed using the Hospital Anxiety and Depression Scale (HADS-D) before and 6 weeks after TAVI. Complete survival data were available at 30 days, 1, 2 and 3 years after TAVI. Depression dynamics before versus after TAVI were defined by exceeding the pathologic HADS-D cut-off value of 8 points for depression resulting in the following 4 subgroups: non-depressive > non-depressive (group 1); non-depressive > depressive (group 2); depressive > depressive (group 3) and depressive > non-depressive (group 4). Kaplan Meier survival analysis was performed for comparison between these groups.
Results:
The mean age of the patients was 79 ± 7 years, 50% were female and the mean STS score was 4.6 ± 3.6%. Mortality rates were 2.8% after 30 days, 16.3% after 1, 25% after 2 and 34.5% after 3 years. Analysis of depression dynamics as defined above revealed the following frequencies per group: group 1 – 62.4%; group 2 – 14.4%; group 3 – 13.5%; group 4 – 9.7%. Patients being depressive before TAVI (26.1%) showed an improvement in 41.9% of cases, while patients being non-depressive before TAVI (73.9%) showed a worsening in only 18.8% of cases. The 3-year mortality rates were 22.7% in the non-depressive > non-depressive, 39.1% in the non-depressive > depressive, 25.6% in the depressive > depressive and 19.4% in the depressive > non-depressive group (p=0.021 between group 1 and 2; p=n.s. for all other group comparisons).
Conclusions:
When comparing depression dynamics in elderly AS patients before and after TAVI, the lowest mortality rates were observable in patients showing an improvement of depression. In contrast, in patients showing worsening of depression, mortality rates were much higher. This finding was most evident in patients that develop new depression after TAVI. Our data underline a certain role of mental co-morbidities in the complex clinical management of this special patient collective.