Anxiety and depression in relation to levels of N-terminal B-type natriuretic peptides in patients treated with implantable cardioverter defibrillators

Background: Implantable cardioverter defibrillator (ICD) is an effective preventive treatment for ventricular arrhythmias and is recommended in the guidelines for patients at high risk. Higher prevalence of anxiety and depression has been reported in patients treated with ICD, particular after receiving ICD shock. Nterminal pro-B type natriuretic peptide (NT-proBNP) is a widely used diagnostic and prognostic biomarker in heart failure, and NT-proBNP robustly reflects the severity of the disease. The association between the prevalence of anxiety and depression in participants with ICD, when accounting for concentrations of NTproBNP as a surrogate for disease severity, is not known. Objective: The main purpose of the current study is to assess the relation between mental distress and disease severity, as indicated by NT-proBNP concentrations, in patients treated with ICD at risk of ventricular arrhythmias. Method: This is a cross-sectional substudy, where 178 (75%) of the participants from the SMASH-1 study at Akershus University Hospital were included. Blood samples were drawn from the participants, and concentrations of NT-proBNP were analyzed by a commercial immunossay. Each participant completed a questionnaire that consisted of Hospital Anxiety and Depression Scale (HADS) and Florida Shock Anxiety Scale (FSAS), in order assess the prevalence of anxiety and depression. Results: The mean age was 66.9 years±9.9, and 89% of the participants were men. 18 (10.1%) participants were classified with depression (HADS-D sumscore ≥8), 23 (12.9%) participants with anxiety (HADS-A sumscore ≥8) and 69 (38.8%) participants had shock related anxiety (FSAS sumscore ≥12). Dyspnea (OR 10.8 [95% CI 2.3-50.5] p=0.002) and palpitations (OR 4.5 [95% CI 1.2-16.9] p=0.02) were independently associated with depression while female gender was associated with shock related anxiety (OR 3.8 [95% CI=1.1-13.3] p=0.03). Consentrations of NT-proBNP were not associated with depression, anxiety or shock-related anxiety. Previous shock was not related with the patient related outcomes in the study population. Conclusion: Dyspnea and palpitations were associated with depression, and female gender was seen as determinant for development of shock related anxiety. Concentrations of NT-proBNP were not associated with mental distress. In addition, no significant association between previous shock and depression, anxiety or shock related anxiety was seen