https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum Leipzig - Universität Leipzig Universitätsklinik für Herzchirurgie Leipzig, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland
Background: Heart transplantation (HTx) carries complex risks and patient outcomes are influenced by many physical but also psychological factors. This study examines how screening for psychological distress, namely depression and anxiety, could identify patients at greater risk, aiming to improve outcome prediction and allowing for more personalised care.
Methods: Between January 2013 and August 2024, in 170 patients undergoing HTx at a tertiary care center, the Hospital Anxiety and Depression Scale (HADS) was administered preoperatively. The evaluated patients were divided into four groups according to their anxiety (A) and depression (D). Scores were systematically assessed: no case (NC): ≤ 4; questionable (Q): 5-7; mild to moderate (MM): 8-10; and severe (S): ≥ 11. The mean follow-up was 1694 ± 1282 days.
Results: A total of 170 patients were analysed: median age was 57.2 (IQR 50.8-60.8); 136 (80%) were male; 64 (37.9%) patients had ischemic heart disease, 90 (53.3%) dilated cardiomyopathy and 15 (8.8%) other cardiomyopathies; 111 (65%) had prior left ventricular assist device implantation and 14 (8.4%) had prior temporary mechanical circulatory support. There were no significant differences in the groups regarding baseline characteristics.
On the preoperative HADS-A questionnaire, 56 patients scored in the NC-category, 56 in the Q-category, 27 in the MM-category and 27 in the S-category. Patients in the S-group had higher in-hospital mortality (p=0.04), however there were no differences in follow-up mortality (p=0.17). There was no significant difference in incidence of postoperative complications such as extracorporeal membrane oxygenation (ECMO), rethoracotomy due to bleeding, stroke, dialysis, wound infections, tracheotomy or intensive care unit (ICU) stay.
On the preoperative HADS-D questionnaire, 54 patients scored in the NC-category, 52 in the Q-category, 37 in the MM-category and 27 in the S-category. Recipients with higher scores were more likely to require postoperative ECMO (p=0.04) and had a trend towards more wound infections (p=0.05) and longer ICU stays (p=0.05). Differences in postoperative complications such as rethoracotomy due to bleeding, stroke, and tracheotomy did not reach statistical significance. There were also no differences in mortality.
Conclusion: Pre-existing anxiety and depression are associated with some in-hospital outcome parameters in transplant recipients. Therefore, use of screening tools may appear relevant.