LETTER TO THE EDITOR
Depression and heart failure
Laurent Fauchier, MD, PhD*
* Service de Cardiologie B, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France (Email: lfau{at}med.univ-tours.fr).
We read with great interest the recent study by Gottlieb et al. (1) and its related editorial (2) about the important problem of depression in outpatients with heart failure (HF) evaluating its prevalence and the impact of age, race, and gender. We would like to add two comments.
First, we believe that the duration of evolution of HF symptoms is a simple and important parameter that should have been taken into account. A depression is likely to occur with time when the patient realizes the true chronicle aspect of its disease, its severity, and the overall limitation in physical activity and well-being. The number of hospitalizations across the years may also play a role, and these aspects of the disease might have been included in the prediction model of Gottlieb et al. (1).
Second, the diagnosis of depression should particularly be addressed when one considers the implantation of a cardioverter-defibrillator (ICD). Although the device is usually well accepted despite fear of being shocked, patients with an ICD have high levels of anxiety and depressive symptoms (3). The ICD shocks might have the potential to cause psychological disorders. This may become a relatively frequent problem considering the preliminary results of the Sudden Cardiac Death-Heart Failure Trial (SCD-HeFT) in which treatment with an ICD compared with placebo and amiodarone was associated with a reduction in all-cause mortality in a large population of patients with heart failure of all etiologies and with a left ventricular ejection fraction <35% (4).
Thus, considering the potential association among ICD placement, electrical shock from the ICD, and depression, we should probably collect information regarding this association in the evaluation of such patients.
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References
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- Gottlieb SS, Khatta M, Friedmann E, et al. The influence of age, gender, and race on the prevalence of depression in heart failure patients J Am Coll Cardiol 2004;43:1542-1549.[Abstract/Free Full Text]
- O'Connor CM, Joynt KE. Depression: are we ignoring an important comorbidity in heart failure? J Am Coll Cardiol 2004;43:1550-1552.[Free Full Text]
- Thomas SA, Friedmann E, Kelley FJ. Living with an implantable cardioverter-defibrillator: a review of the current literature related to psychosocial factors AACN Clin Issues 2001;12:156-163.[Medline]
- Bardy GH, Lee KL, Mark DB, et al. SCD–HeFT: Sudden Cardiac Death–Heart Failure Trial. Presented at: Annual Scientific Sessions of the American College of Cardiology, New Orleans, LA, March 7–10, 2004..
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