Background:

Both, depression and anxiety, represent relevant and underestimated mental disorders in elderly patient suffering from cardiovascular diseases. For patients with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), little is known about the prognostic impact of pre-existing mental disorders in this special patient cohort. Thus, the current study was aimed to investigate their association to long-term survival in a large collective of the aortic valve registry of the University Hospital Jena.

Methods:

All patients that underwent TAVI at the University Hospital Jena, agreed to participate in the local aortic valve registry (Jenaer Aortenklappenregister, JAKR) were included in this analysis. A total of 499 patients provided the Hospital Anxiety and Depression Scale (HADS-D) prior to TAVI. Information on 2-year survival were available for all of these patients. By using a cut-off value of ≥ 8 points defining at least subclinical anxiety or depression, patients were divided into a depressive and an anxious group. Long-time survival rates were calculated by using the Kaplan Meier method and the log-rank rest. In depressive patients, assessment of intra-individual dynamics of HADS-D depression values at short-term follow-up was performed in comparison to baseline and patients showing improvement were defined as responders and corresponding 2-year survival rates were compared to non-responders. 

Results: Patients included represented a typical TAVI cohort (mean age 79 ± 7 years, 50% were female and the mean STS score was 4.6 ± 3.6%). The 2-year mortality rate was 23.2%. Prior to TAVI, 29.5% of patients (n=147) were classified as anxious and 26.1% as depressive (n=130) according to HADS as defined above. Kaplan Meier analysis with respect to 2-year survival did not show differences between the anxious (78.3%) compared to the non-anxious (76.2%) group (p=0.608). In contrast, depressive patients showed a significantly decreased 2-year survival (79.2%) compared to non-depressive subjects (70.1%, p=0.034). For 87 out of 130 depressive patients, follow-up data including HADS-D were available and 75% (n=65) were identified as responders (improvement of depression in HADS-D) with a long-term survival rate of 90.8% (n=59) compared to non-responders (25%, n=22) with a survival rate of 81.8% (n=18, p=n.s.). Within the responder group, patients reaching HADS-D values for depression < 8 at follow-up and can thus be considered as non-depressive (n=48), had the highest survival rate of 91.3%. In contrast, those patients showing worse values within the depressive range (n=15) had the lowest survival rate of 80.0% (p=n.s.).

Conclusions: The results of the current analysis show for the first time an association of pre-existing depression but not anxiety to reduced long-term survival in a large cohort of typical elderly AS patients undergoing TAVI. The results underline the need for mental disorder screening in these patients and the further evaluation, if targeted psychological interventions might be beneficial for outcome and prognosis in addition to the treatment of the underlying cardiac disease.