https://doi.org/10.1007/s00392-025-02625-4
1Medizinische Hochschule Hannover Kardiologie und Angiologie, EMAH-Zentrum Hannover, Deutschland; 2Medizinische Hochschule Hannover Kardiologie und Angiologie Hannover, Deutschland; 3Medizinische Hochschule Hannover Klinik für Psychiatrie Hannover, Deutschland
Objective: In ACHD depression is regarded as a potential prognostic marker of cardiovascular outcome. To date, prospective studies in unselected patient populations using the diagnostic gold standard of depression, the structured clinical interview, are lacking. We aimed to evaluate the prospective significance of various measures of depression and quality of life (QoL) on unexpected cardiac events (UCE) and heart failure/death (HF/D)
Methods: This prospective cross-sectional observational study included 215 participants (mean age 35.5±11.5 years, mean follow up 55.6±13.5 months, male 57.8%). Cox regression analysis identified significant univariate predictors (p<0.07) of UCE and HF/D. These were calculated in different multivariate models, each with one single psychological variable. External and self-rating-scales (Hospital-Anxiety-and-Depression-Sub-Scale (HADS-D); Beck-Depression-Inventory-II (BDI-II), Montgomery–Åsberg-Depression-Rating-Scale (MDRS) were optimally fitted according to adverse events.
Results: UCE occurred in 26.5%, HF/D in 6.6%. External and self-assessment scales had low cut-off points in both HF/D (HADS-D:>5.5; (BDI-II)>8.5; MDRS:>8.5; QoL<56.25) and UCE (HADS-D: >5.5; BDI-II>12.5; MDRS:>8.5; QoL<68.7). In multivariate analysis, all calculated parameters predicted HF/D (HADS-D [95%CI, 3.2-39.1]); (BDI [95%CI, 1.62-18.4]), (MDRS [95%CI, 1.36-17.2]), (QoL [95%CI, 1.81-20.75]). HADS-D and MDRS predicted UCE. The negative predictive value (NPV) was particularly high in HF/D (95.6-98.2) and lower in UCE (77.7-94.6). Multivariate analysis using clinical diagnosis identified only lacking/mild depression as low-risk of HF/D (sensitivity 28.6%/ specificity 87.7%; NPV 94.5; [95% CI, 1.02-3.43]).
Conclusion: Symptoms of depression and reduced Qol as detected by external and self-assessment scales are more suitable for cardiovascular risk stratification than clinical diagnosis. Particularly HADS-D appears promising to detect patients at low risk.