Transplant Research and Risk Management (Mar 2017)
Association of depression and anxiety before heart transplant with mortality after transplant: a single-center experience
Abstract
Flavio Epstein,1 Melissa M Parker,2 Anna Lucero,3 Rakesh Chaudhary,4 Eyun Song,3 Dana Weisshaar1 1Heart Transplant Department, Kaiser Permanente Santa Clara Medical Center, Santa Clara, 2Kaiser Permanente Division of Research, Oakland, 3Department of Graduate Medical Education, 4Department of Internal Medicine, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA Objective: The purpose of this study was to evaluate the effects of depression and anxiety before heart transplant on all-cause mortality after heart transplant in a Northern California cohort.Methods: A total of 130 adult patients with heart transplants enrolled at Kaiser Permanente between June 2005 and December 2013 were included in a retrospective chart review. Preoperative depression and anxiety, evidenced by diagnoses, and other risk factors for all-cause mortality were investigated. Statistical methods included Kaplan–Meier survival analysis and Cox proportional hazard regression models.Results: After risk adjustment, patients with preoperative depression and anxiety diagnoses had higher risk of all-cause mortality at 2 years (hazard ratio [HR] =4.2, 95% confidence interval [CI]: 1.1, 15.0, p=0.03) and 3 years (HR=3.7, 95% CI: 1.2, 11.9, p=0.04) following heart transplant than those without depression or anxiety. This finding did not reach statistical significance at 5 years post-heart transplant (HR=2.0, 95% CI: 0.8, 5.3, p=0.14).Conclusion: The findings suggest an association between preoperative depression and anxiety with mortality in heart transplant patients 2 and 3 years post-transplant. Keywords: pre-operative depression, anxiety, survival after heart transplant
