Changes in quality of life, depression, general anxiety, and heart-focused anxiety after defibrillator implantation.

AIMS: The Anxiety-CHF (Anxiety in patients with Chronic Heart Failure) study investigated heart-focused anxiety (HFA, with the dimensions fear, attention, and avoidance of physical activity), general anxiety, depression, and quality of life (QoL) in patients with heart failure. Psychological measures were assessed before and up to 2 years after the implantation of an implantable cardioverter defibrillator (ICD) with or without cardiac resynchronization therapy defibrillator (CRT-D). METHODS AND RESULTS: One hundred thirty-two patients were enrolled in this monocentric prospective study (44/88 CRT-D/ICD, mean age 61 ± 14 years, mean left ventricular ejection fraction 31 ± 9%, and 29% women). Psychological assessment was performed before device implantation as well as after 5, 12, and 24 months. After device implantation, mean total HFA, HFA-fear, HFA-attention, general anxiety, and QoL improved significantly. Depression and HFA-related avoidance of physical activity did not change. CRT-D patients compared with ICD recipients and women compared with men reported worse QoL at baseline. Younger patients (

Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study.

AIMS: We analysed heart-focused anxiety (HFA) and its predictors in patients with heart failure before implantation of an implantable cardioverter defibrillator (ICD). Herein, we report the baseline data of the Anxiety-CHF Study which investigates HFA before and after ICD implantation. METHODS AND RESULTS: HFA, general anxiety and depression, perceived quality of life (QoL) and type D personality were measured with validated psychological instruments. Clinical parameters such as severity of heart failure measured by NYHA class and left ventricular ejection fraction (EF) were determined. One hundred and ten patients were interrogated before ICD implantation (70 % male, mean age = 60.5 ± 14.9 years, mean EF = 31 % ± 9 %, 91 % NYHA II-III, 92 % primary prevention). HFA was present in 53 patients (48.6 %); 37 participants (33.9 %) showed increased levels of general anxiety and 33 patients (30.3 %) showed increased levels of depression with clinical significant levels in 16 subjects (14.7 %) for general anxiety and 13 subjects (11.9 %) for depression. Poor QoL was reported in 30 patients (27.5 %). HFA was correlated with QoL, general anxiety, depression, type D personality, myocardial infarction (MI), and systolic blood pressure. QoL, general anxiety and former MI were significant predictors of HFA (R (2) = 0.453). CONCLUSION: Heart-focused anxiety is highly prevalent in heart failure patients prior to ICD implantation. Measures of disease severity such as EF or NYHA class do not predict HFA, neither does Type D personality. HFA is predicted by a history of MI and psychological parameters such as general anxiety and impaired QoL. CLINICALTRIALS. GOV IDENTIFIER: NCT02226770.

[Psychocardiology: how heart and mind interact]. / Psychokardiologie: Wie Herz und Psyche zusammenhängen.

Patients with heart disease often suffer from psychological comorbidities in addition to various physical impairments. These mental disorders reduce the quality of life and have a negative effect on the development and course of heart diseases. Particularly the occurrence of depression, anxiety and post-traumatic stress disorder (PTSD) may lead to an increase in hospitalization-, morbidity-, and mortality rates. Early diagnosis of psychological disorders in patients with cardiovascular disease and consecutive treatment is therefore desirable. In this context, psychocardiology addresses the interaction of cardiac disease and psychological alterations as well as the influencing psychosocial factors.

Anxiety, depression, quality of life and stress in patients with resistant hypertension before and after catheter-based renal sympathetic denervation.

AIMS: This study analysed quality of life (QoL), anxiety and depression, headache and stress tolerance in patients with resistant hypertension before and after renal denervation (RDN). METHODS AND RESULTS: RDN was performed in 119 patients (age 62 ± 11 years, 55% male) with resistant hypertension (office blood pressure [BP] 165/91 ± 22/15 mmHg), treated with 5.7 ± 0.2 antihypertensive drugs. At baseline, at three and at six months after RDN, psychological status, intensity of headache and stress tolerance were documented. Stress was induced by a multitasking situation (Wiener Determination Task [DT]). Depression and anxiety (hospital anxiety and depression scale) and QoL (short form-12 health survey) were investigated. Intensity of headache was measured by visual analogous scale. Systolic and diastolic BP decreased by -20 ± 2.4 and -10 ± 1.4 mmHg, respectively, six months after RDN (p<0.0001). Patients showed more correct reactions (p<0.0001), fewer errors (p<0.05) and reacted faster (p<0.001) in the DT. Patients reported an improvement in QoL (p<0.05). Furthermore, anxiety (p<0.0001) and depression (p<0.0001) scores decreased. Intensity of headache decreased after RDN (p<0.01). CONCLUSIONS: RDN is associated with reduced anxiety and depression, intensity of headache and with improved QoL and stress tolerance in patients with resistant hypertension.

Orthostatic function after renal sympathetic denervation in patients with resistant hypertension.

INTRODUCTION: Catheter-based renal denervation (RDN) reduces local and whole-body sympathetic activity and blood pressure (BP) in patients with resistant hypertension. However, safety concerns exist concerning the development of orthostatic dysfunction after RDN. METHODS AND RESULTS: In 36 patients (65 ± 7.6 years, 75% male) with resistant hypertension (office BP 162 ± 24/91 ± 14 mm Hg) treated with 4.8 ± 1.7 antihypertensive drugs, tilt table testing (TTT) was performed before and three months after RDN. Response to RDN was defined as a reduction in office systolic BP (SBP) ≥ 10 mm Hg three months after RDN. Responders (n=26; 72.2%) and non-responders (n=10; 27.8%) were evaluated separately. After RDN, office SBP and diastolic BP (DBP) were reduced by 29 ± 6.2/14 ± 3.6 mm Hg (p<0.0001; p=0.0002) only in responders. During TTT, SBP and DBP in supine position were only reduced in responders. Resting heart rate (HR) decreased in responders but not in non-responders by 5.9 ± 1.7beats/min (p=0.0016). Mean and minimal SBP were not altered during passive tilting. In the responder group, ∆SBP was reduced in the initial phase of tilting. The adaptive increase of HR was preserved in both groups after RDN, while only in responders mean and minimal HR were reduced after passive tilting. Following drug provocation, mean and minimal SBP during all phases of passive tilting remained unchanged. ∆SBP, ∆HR and total number of (pre-)syncopes were neither influenced by RDN nor differing between responders and non-responders. CONCLUSIONS: In patients with resistant hypertension, RDN reduced office BP, supine BP and HR during TTT without causing orthostatic dysfunction or (pre-)syncopes three months after treatment.