TAVR survival less likely when patients are depressed
Long-term survival after transcatheter aortic valve replacement (TAVR) is much less likely when patients report feeling depressed prior to treatment, according to a new analysis published in JACC: Advances.[1]
“Depression represents a common comorbidity in elderly patients with symptomatic aortic stenosis (AS) eligible for both surgical aortic valve replacement and TAVR after a heart team discussion,” wrote corresponding author Marcus Franz, MD, PhD, with the department of internal medicine at University Hospital Jena in Germany, and colleagues. “The impact of preexisting depression on outcome after AS treatment is still a matter of debate. Thus, it remains unclear whether depression represents a phenomenon occurring secondary to somatic disease burden or represents an independent determinant of individual prognosis.”
Franz et al. tracked registry data from 499 patients who underwent transfemoral TAVR at a single facility from 2016 to 2020. The median patient age was 80 years old, 50% of patients were women and the median Society of Thoracic Surgeons (STS) risk score was 3.5%. All patients were evaluated using the Hospital Anxiety and Depression Scale (HADS-D) before undergoing treatment. Depression was defined as a HADS-D score ≥ 8 points, and no depression was defined as a HADS-D score < 8 points.
Overall, 26.1% of patients presented with a HADS-D score that suggested they were depressed. There were no significant differences between patients with and without depression in terms of baseline characteristics or major complications.
Mortality was seen in 2.8% of patients after 30 days, 16.3% after one year, 25.2% after two years and 32.3 after three years. At that three-year mark, the mortality rates were much higher for patients with depression (34%) than those without depression (22.2%). A Kaplan-Meier survival analysis confirmed this trend.
In addition, researchers noted, a multivariable logistic regression analysis confirmed HADS-D score was an independent predictor of three-year mortality, along with STS risk score and six-minute walk distance.
“The detailed assessment of depression as an important comorbidity in elderly patients with AS is recommended to improve prediction of individual prognosis and select patients that potentially benefit from supportive psychological interventions,” the authors wrote.
The group also noted that there were certain limitations to its research. This was a single-center study, for example, and patients were not evaluated again after TAVR to undergo an additional evaluation or signs of depression.
Click here to read the full study in JACC: Advances, an American College of Cardiology journal.
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