Abstract 212: Incidence of Depression and Anxiety in Patients With Durable Left Ventricular Assist Device

Abstract

Incidence of Depression and Anxiety in Patients with Durable Ventricular Assist Devices Background: There is a high incidence of depression in patients with heart failure and the presence of depression is associated with worse outcomes. There have been few reported data on depression in patients with left ventricular assist devices (LVADs). Methods: Patients with LVAD were seen by a palliative care practitioner embedded in the cardiology/CT surgery outpatient clinic at a large quaternary care hospital as part of routine post VAD management. The patients were screened for anxiety and depression as part of the palliative care clinical assessment, using previously validated PHQ-9 and GAD-7 tools. Their scores were entered into a QI database. Patients were considered to have scores concerning for depression if the total PHQ-9 score was greater than or equal to 10 (moderate depression) or if they met USPTF scoring criteria for major or other depressive disorders. Scores of greater than or equal to 10 on the GAD-7 were considered concerning for generalized anxiety disorder. Results: 129 unique post LVAD patients were seen over 40 months, over a timeframe of 3 months to 5 years post implant. Of these, 110 (85%) were screened for depression using the PHQ-9 tool, usually at the first visit, or at a second follow up visit. 20 (18%) of those surveyed had met the above criteria for at least moderate depression, and 6(5%) had scores ≥ 15 consistent with at least moderate to severe depression. 83 were surveyed for anxiety using the GAD-7, and 8 (10%) had scores ≥ 10. Four patients had significant scores for both anxiety and depression. Of those patients who screened positive for significant depression, most (13/20, 65%) had a history of depression and were on antidepressants (13/20, 65%). Conclusion: The incidence of depression and/or anxiety in patients with LVAD, although higher than that of the general population (depression reported as 5-9%), appears to be on the low end of par with that reported in heart failure (depression incidence reported as 13-48% in the outpatient HF population). In our cohort, depression or anxiety were primarily observed in patients who already had a history of such. This finding is somewhat reassuring in that VAD therapy does not appear to induce these symptoms de novo. Nonetheless, patients with such a history are likely at risk for worsening symptoms with the significant stressor of undergoing VAD implant. Given the negative impact of depression on quality of life, this population should be carefully screened and supported both pre and post VAD implant.

Spiritual Distress and Depression in Palliative Care

“…On the other hand, depression is more likely to occur if risk factors are present (Table 2). Amongst these, a history of depression is a significant risk factor [72], although de novo major depressive episodes occur in many cases [73].…”