Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study

Selina Kikkenborg Berg*, Trine Bernholdt Rasmussen, Rikke Elmose Mols, Charlotte Brun Thorup, Britt Borregaard, Anne Vinggaard Christensen, Pernille Fevejle Cromhout, Ola Ekholm, Knud Juel, Lars Thrysoee

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown. Aim: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission. Methods: A national cross-sectional survey at hospital discharge (n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge. Results: Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06–3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13–1.98) and 1.47 (1.07–2.03), respectively). Conclusion: Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.

Original languageEnglish
JournalEuropean journal of cardiovascular nursing
Volume18
Issue number2
Pages (from-to)96-105
ISSN1474-5151
DOIs
Publication statusPublished - Feb 2019

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Patient Readmission
Implantable Defibrillators
Mental Health
Cardiac Resynchronization Therapy
Patient Discharge
Depression
Quality of Life
Ventricular Fibrillation
Primary Prevention
Cross-Sectional Studies

Keywords

  • Implantable defibrillators
  • mortality
  • patient readmission
  • patient reported outcome measures

Cite this

Berg, Selina Kikkenborg ; Rasmussen, Trine Bernholdt ; Mols, Rikke Elmose ; Thorup, Charlotte Brun ; Borregaard, Britt ; Christensen, Anne Vinggaard ; Cromhout, Pernille Fevejle ; Ekholm, Ola ; Juel, Knud ; Thrysoee, Lars. / Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators : findings from the national DenHeart study. In: European journal of cardiovascular nursing . 2019 ; Vol. 18, No. 2. pp. 96-105.
@article{5f763e48e808405cb72cd1e659ddea31,
title = "Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators: findings from the national DenHeart study",
abstract = "Background: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown. Aim: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission. Methods: A national cross-sectional survey at hospital discharge (n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge. Results: Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06–3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13–1.98) and 1.47 (1.07–2.03), respectively). Conclusion: Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.",
keywords = "Implantable defibrillators, mortality, patient readmission, patient reported outcome measures",
author = "Berg, {Selina Kikkenborg} and Rasmussen, {Trine Bernholdt} and Mols, {Rikke Elmose} and Thorup, {Charlotte Brun} and Britt Borregaard and Christensen, {Anne Vinggaard} and Cromhout, {Pernille Fevejle} and Ola Ekholm and Knud Juel and Lars Thrysoee",
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Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators : findings from the national DenHeart study. / Berg, Selina Kikkenborg; Rasmussen, Trine Bernholdt; Mols, Rikke Elmose; Thorup, Charlotte Brun; Borregaard, Britt; Christensen, Anne Vinggaard; Cromhout, Pernille Fevejle; Ekholm, Ola; Juel, Knud; Thrysoee, Lars.

In: European journal of cardiovascular nursing , Vol. 18, No. 2, 02.2019, p. 96-105.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Both mental and physical health predicts one year mortality and readmissions in patients with implantable cardioverter defibrillators

T2 - findings from the national DenHeart study

AU - Berg, Selina Kikkenborg

AU - Rasmussen, Trine Bernholdt

AU - Mols, Rikke Elmose

AU - Thorup, Charlotte Brun

AU - Borregaard, Britt

AU - Christensen, Anne Vinggaard

AU - Cromhout, Pernille Fevejle

AU - Ekholm, Ola

AU - Juel, Knud

AU - Thrysoee, Lars

PY - 2019/2

Y1 - 2019/2

N2 - Background: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown. Aim: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission. Methods: A national cross-sectional survey at hospital discharge (n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge. Results: Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06–3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13–1.98) and 1.47 (1.07–2.03), respectively). Conclusion: Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.

AB - Background: Although highly effective in preventing arrhythmic death, there is a high prevalence of anxiety, depression and reduced quality of life among patients who have received an implantable cardioverter defibrillator (ICD). Whether mortality, ICD shock and readmission are predicted by patient-reported outcomes is unknown. Aim: The aim of this study was to describe patient-reported outcomes among patients with ICDs compared by: ICD indication and generator type (ICD or cardiac resynchronisation therapy ICD), and to determine whether patient-reported outcomes at discharge predict mortality, ICD therapy and readmission. Methods: A national cross-sectional survey at hospital discharge (n=998) with register follow-up. Patient-reported outcomes included the Hospital Anxiety and Depression Scale, Short Form-12, HeartQoL, EQ-5D and Edmonton Symptom Assessment Scale. Register data: ICD therapy, readmissions and mortality within one year following discharge. Results: Patients with primary prevention ICDs had significantly worse patient-reported outcomes at discharge than patients with secondary prevention ICDs. Likewise, patients with cardiac resynchronisation therapy ICDs had significantly worse patient-reported outcomes at discharge than patients without cardiac resynchronisation therapy. One-year mortality was predicted by patient-reported outcomes, with the highest hazard ratio (HR) being anxiety (HR 2.02; 1.06–3.86), but was not predicted by indication or cardiac resynchronisation therapy. ICD therapy and ventricular tachycardia/ventricular fibrillation were not predicted by patient-reported outcomes, indication or cardiac resynchronisation therapy. Overall, patient-reported outcomes predicted readmissions, e.g. symptoms of anxiety and depression predicted all readmissions within 3 months (HR 1.50; 1.13–1.98) and 1.47 (1.07–2.03), respectively). Conclusion: Patients with primary indication ICDs and cardiac resynchronisation therapy ICDs report worse patient-reported outcomes than patients with secondary indication and no cardiac resynchronisation therapy. Patient-reported outcomes such as mental health, quality of life and symptom burden predict one-year mortality and acute and planned hospital readmissions.

KW - Implantable defibrillators

KW - mortality

KW - patient readmission

KW - patient reported outcome measures

U2 - 10.1177/1474515118794598

DO - 10.1177/1474515118794598

M3 - Journal article

C2 - 30114937

AN - SCOPUS:85052556443

VL - 18

SP - 96

EP - 105

JO - European Journal of Cardiovascular Nursing

JF - European Journal of Cardiovascular Nursing

SN - 1474-5151

IS - 2

ER -