Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

TY - JOUR

T1 - Role of Depression and Social Isolation at Time of Waitlisting for Survival 8 Years After Heart Transplantation

AU - Spaderna, Heike

AU - Zittermann, Armin

AU - Reichenspurner, Hermann

AU - Ziegler, Corinna

AU - Smits, Jacqueline

AU - Weidner, Gerdi

N1 - © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

PY - 2017/11/29

Y1 - 2017/11/29

N2 - BACKGROUND: We evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients.METHODS AND RESULTS: Between 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow-up of 70 months (<1-93 months post-HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020-0.039). Actuarial 1-year/5-year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).CONCLUSIONS: Low depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.

AB - BACKGROUND: We evaluated depression and social isolation assessed at time of waitlisting as predictors of survival in heart transplant (HTx) recipients.METHODS AND RESULTS: Between 2005 and 2006, 318 adult HTx candidates were enrolled in the Waiting for a New Heart Study, and 164 received transplantation. Patients were followed until February 2013. Psychosocial characteristics were assessed by questionnaires. Eurotransplant provided medical data at waitlisting, transplantation dates, and donor characteristics; hospitals reported medical data at HTx and date of death after HTx. During a median follow-up of 70 months (<1-93 months post-HTx), 56 (38%) of 148 transplanted patients with complete data died. Depression scores were unrelated to social isolation, and neither correlated with disease severity. Higher depression scores increased the risk of dying (hazard ratio=1.07, 95% confidence interval, 1.01, 1.15, P=0.032), which was moderated by social isolation scores (significant interaction term; hazard ratio = 0.985, 95% confidence interval, 0.973, 0.998; P=0.022). These findings were maintained in multivariate models controlling for covariates (P values 0.020-0.039). Actuarial 1-year/5-year survival was best for patients with low depression who were not socially isolated at waitlisting (86% after 1 year, 79% after 5 years). Survival of those who were either depressed, or socially isolated or both, was lower, especially 5 years posttransplant (56%, 60%, and 62%, respectively).CONCLUSIONS: Low depression in conjunction with social integration at time of waitlisting is related to enhanced chances for survival after HTx. Both factors should be considered for inclusion in standardized assessments and interventions for HTx candidates.

KW - Australia/epidemiology

KW - Depression/epidemiology

KW - Female

KW - Follow-Up Studies

KW - Germany/epidemiology

KW - Heart Failure/mortality

KW - Heart Transplantation/mortality

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Period

KW - Prognosis

KW - Retrospective Studies

KW - Risk Factors

KW - Social Isolation/psychology

KW - Time Factors

KW - Waiting Lists/mortality

U2 - 10.1161/JAHA.117.007016

DO - 10.1161/JAHA.117.007016

M3 - SCORING: Journal article

C2 - 29187384

VL - 6

JO - J AM HEART ASSOC

JF - J AM HEART ASSOC

SN - 2047-9980

IS - 12

ER -