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Symptoms of Anxiety and Depression in Patients Who Underwent Transcatheter Aortic Valve Implantation: The SAD-TAVI Study.

Author information

Affiliations

  • 1. Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
      Authors
    • Butala AD 1
    • Sehgal K 1
    • Gardner E 1
    • Noaman S 1
    • Guiney L 1
    • Johnston R 1
    (6 authors)
  • 2. Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Victoria, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
      Authors
    • Stub D 2
    (1 author)
  • 3. Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
      Authors
    • Palmer S 3
    (1 author)
  • 4. Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Victoria, Australia.
      Authors
    • Htun NM 4
    (1 author)
  • 5. Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Victoria, Australia.
      Authors
    • Walton AS 5
    (1 author)
    • Show all (6)

The American Journal of Cardiology, 23 Oct 2024, :S0002-9149(24)00735-5
https://doi.org/10.1016/j.amjcard.2024.10.007 PMID: 39454701 

Abstract 

Symptoms of anxiety and/or depression (SAD) commonly co-exist in severe aortic stenosis. In patients who underwent transcatheter aortic valve implantation (TAVI), these symptoms are associated with increased morbidity and mortality. Despite this, mental health remains under-researched in the TAVI literature. Drawing from the largest registry in Australia, we aimed to characterize the prevalence of SAD in TAVI patients. We also aimed to identify patient phenotypes at the highest risk of these symptoms, examine how they evolve after TAVI, and establish factors predictive of improvement and regression in mental health. A total of 1,279 patients who underwent TAVI between 2018 and 2023 included in a multi-center Australian registry were analyzed. The median age was 82 years (interquartile range 77 to 87), 41% were females, and the median Society of Thoracic Surgeons score was 3.9 (2.3 to 5.9). In addition, 353 patients (28%) reported moderate or worse SAD at baseline. Of this group, 260 (74%) had complete resolution in symptoms within 30 days. Body mass index <25 kg/m2 (adjusted odds ratio [aOR] 3.4, p <0.001), vascular site complications (aOR 3.4, p = 0.029), and nonhome discharge (aOR 2.4, p = 0.036) independently predicted the persistence of SAD. Only 72 patients (8%) developed new-onset SAD at 30 days after TAVI. Nonhome discharge (aOR 2.12, p = 0.025) and a composite cardiovascular end point, including stroke, acute myocardial infarction, and heart failure readmission (aOR 2.55, p = 0.028), were independent predictors of new-onset SAD. In conclusion, SAD are common but under-recognized in aortic stenosis. TAVI is highly effective at improving these symptoms, and regular screening for mental health should be considered in the management of all TAVI patients.

Full text links 

Read article at publisher's site: https://doi.org/10.1016/j.amjcard.2024.10.007

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Funding 

Funders who supported this work.

National Health and Medical Research Council

    National Heart Foundation of Australia