Effects Of Psychosocial Factors On The Prognosis Of Patients After ICD/CRT-D Implantation

Objective:To investigate the correlation between the baseline anxiety,depression,somatoform disorder,sleep disturbances and social support in patients receiving implatable cardioverter defibrillator(ICD)or cardiac resynchronous therapy with defibrillator(CRT-D)and their postoperative quality of life,as well as the occurrence of major cardiac events,including cardiac death.Methods:1.Objects:Patients who underwent ICD or CRT-D implantation for the first time in the First Affiliated Hospital of Kunming Medical University between September 2020 to October 2022 and who were able to complete the follow-up.2.Process:This study was a prospective cohort study.Patients were evaluated for anxiety,depression,somatization symptoms,sleep quality,and social support levels before operation and were divided into different groups.All these patients were followed up 1 month,3 months,6 months,and 1 year after operation,and their quality of life were assessed at each follow-up.During follow-up,the major cardiac events were inquired and recorded,including cardiac death,severe heart failure requiring hospitalization,severe ventricular arrhythmias requiring shock,and acute coronary syndrome etc.(the cutoff value was the time from the day patients receiving ICD/CRT-D implantation to the day the endpoint event occurred).Finally,the relationship between the baseline anxiety,depression,somatoform disorder,sleep disturbances,or social support,and the patient’s quality of life,were analyzed.The associations between the baseline anxiety,depression,somatoform disorder,sleep disturbances.or social support and major cardiac events were analyzed as well.3.Psychosocial factors and quality of life assessment:Anxiety,depre-ssion,somatoform disorder,sleep disturbances and social support were assessed with the Generalized Anxiety Disorder-7(GAD-7),Patient Health Questionnaire-9(PHQ-9),Patient Health Questionnaire-15(PHQ-15),Pittsburgh Sleep Quality Index(PSQI),and Social Support Rating Scale(SSRS) respectively.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)was used to assess the quality of life of patients.4.Statistical analysis:Generalized estimation equations(GEEs)were developed to analyze the relationship between patients’baseline anxiety,depression,somatoform disorder,sleep disturbances,or social support and quality of life during follow-up.The Kaplan-Meier method and Cox proportional-hazards model were used to analyze the relationship between baseline anxiety,depression,somatoform disorder,sleep disturbances,or social support and the major cardiac events after operation.Results:1.Fifty patients were enrolled in this study(39 males,11 females,mean age of 60.6±11.64 years).Among them,22 patients(44%)were in a state of anxiety,23 patients(46%)were in a state of depression,and there are 42 patients(84%)suffering somatization symptoms,and 48 patients(98%)suffering sleep disorder.Patients’social support were medium to high,which included 0 patient(0%)for low social support,17 patients(34%)for medium social support,and 33 patients(66%)for high social support.2.The GEEs showed that the score of GAD-7,PHQ-9,PHQ-15 and PSQI were positively correlated with the score of MLHFQ after operation(p<0.05),while the score of SSRS was not correlated with MLHFQ(p>0.05).After adjusting for potential confounding factors,the positive correlation between score of GAD-7,PHQ-9,PHQ-15,or PSQI and MLHFQ remained statistically significant(p<0.05).3.During the one-year follow-up period,among the 50 patients included in the study,21 cases(42%)of endpoint events occurred,with a median cutoff of 189 days.Kaplan-Meier method and Logrank test showed that the score of SSRS was related to the endpoint,and the higher the score of SSRS,i.e.the higher the level of social support,the lower the risk of endpoint events(X~2=6.90,p=0.009).Cox proportional-hazards model,which included social support and potential confounding factors showed the score of SSRS was still related to the endpoint events significantly(regression coefficient-0.79,95%confidence interval-1.49～-0.10,p=0.026).Compared with the group of low to medium social support,the risk of endpoint events occurred in the group of high social support was reduced by 55%.Conclusions:1.The score of GAD-7,PHQ-9,PHQ-15,PSQI were positively correlated with the score of MLHFQ,hinting that the high levels of anxiety,depression,somatoform disorder,and sleep disturbances at baseline predicted the poorer quality of life of patients after ICD/CRT-D implantation.2.The level of social support was negatively correlated with the incidence of major cardiac events of patients after ICD/CRT-D implantation.Higher social support can reduce the risk of cardiac events after ICD/CRT-D implantation.