Depressive Symptoms Not Linked to ICD Rate in Black Patients With Chronic HF

Among ambulatory Black patients with heart failure, depressive symptoms do not affect the likelihood of implantable cardioverter-defibrillator (ICD) use, according to a study in the Journal of the American Heart Association.

The results are from a secondary analysis of the VIVID (Videos to Address Racial Disparities in ICD Therapy via Innovative Designs; ClinicalTrials.gov Identifier: NCT02819973) trial that evaluated the association between depressive symptoms and patients’ decisions to have ICD implantation. The prospective study enrolled Black patients referred to electrophysiology clinics for consideration of a primary prevention ICD from 2016 to 2019. Participants in the primary study were ambulatory Black adults aged 18 years or older who had a left ventricular ejection fraction of 35% or less with New York Heart Association (NYHA) class I to III symptoms of heart failure.

A Decisional Conflict Scale was used to evaluate decisional conflict associated with patients’ decision for ICD implantation. The primary outcome was ICD implantation at 90 days, and secondary outcomes were agreement to have ICD implantation assessed at 7 days and postintervention Decisional Conflict Scale score at 7 days.

The analysis included 306 participants with a mean age of 59.7 years and 35.9% were women.

According to Patient Health Questionnaire-2 (PHQ-2) scores, 51.3% of patients reported that they did not have depressed mood or anhedonia, 2.3% had depressed mood only, 29.1% had anhedonia only, and 17.3% had both.

The patients who had depressed mood, anhedonia, or both also had reduced mean Mental Component Summary scores on the 12-Item Short-Form Health Survey (MCS-12), suggesting worse mental health and an increased likelihood of depression (45.0 vs 56.5; P <.001).

A trend was observed toward an overall decrease in decisional conflict by Decisional Conflict Scale score from baseline to week 1, although it was not statistically significant (mean difference, -6.6±11.1). Patients who had the lowest MCS-12 scores had increased decisional conflict for ICD implantation vs those with the highest MCS-12 scores (adjusted mean difference, 3.2; 95% CI, 0.5-5.9).

At 1 week, 58.8% of patients reported that they planned to have ICD implantation. At day 90, 66.0% of patients had an ICD implantation. No significant associations were observed between PHQ-2 score or MCS-12 score and ICD agreement or implantation.

Among several study limitations, the primary VIVID trial was not designed to evaluate depressive symptoms as the main exposure. Also, antidepressant drug use information was not obtained, and the population included only Black participants in electrophysiology clinics.

“The impact of mental health on shared decision-making regarding ICD implantation is understudied and remains an unexplored potential mechanism for racial and ethnic differences in device implantation,” the investigators wrote.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on The Cardiology Advisor