Patients with depression are less likely to take their heart medications

These results highlight the importance of considering the psychological status of people receiving an ICD.


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For those who have experienced a sudden cardiac arrest or are at high risk of developing a life-threatening arrhythmia, an ICD implantation is advised. According to estimates, one out of every five individuals with an ICD suffers from depression or anxiety. Both mental health conditions have been connected to an increased chance of passing away in those with ICDs.

Most ICD patients are given medication to treat their heart problems. It is essential to identify individuals more prone to quit taking their medicine so that support measures can be started because failing to take cardiac drugs raises the risk of complications and death.

New research presented today at ACNAP 2023, a scientific congress of the European Society of Cardiology (ESC), suggests that patients who feel low when having a cardiac device implanted are likelier to stop taking their heart medications than those without depression.

This study examined the relationship between anxiety and depression at the time of ICD implantation and medication adherence a year later. The research was a secondary examination of the ACQUIRE-ICD randomized controlled trial of an e-health intervention, which included participants from all six Danish implantation centers.

433 (91%) of the 478 trial participants who had an ICD or an ICD with cardiac resynchronization treatment (CRT-D) installed already used at least one heart medication. These included statins, diuretics, ACE inhibitors, and beta-blockers. In the current analysis, 322 of the 433 patients (or 74% of the total) who underwent medication adherence assessments at baseline (implant) and one year later were included.

The Morisky Medication Adherence Scale (MMAS), which has scores ranging from 0 to 8.6, was used to assess medication adherence by self-report. Scores from 6, 6 to, 8, and 8 were used to characterize poor, medium, and high adherence, respectively. The Patient Health Questionnaire 9 (PHQ-9; scores 0-27) and the Generalised Anxiety Disorder (GAD-7; scores 0-21) scales were used to assess depression and anxiety at baseline, with higher scores suggesting more symptoms. Both were utilized as continuous assessments, and patients were not divided into groups based on whether they were depressed or anxious.

After accounting for the baseline MMAS score, sex, trial intervention group, the severity of heart failure, and implantation facility, the researchers examined the relationship between mental health scores and medication adherence. At 12 months, medication adherence was adversely correlated with depression levels at baseline (p=0.02). Anxiety was not significantly associated with the connection.

Mr. Ole Skov, a psychologist and Ph.D. student in cardiac psychology at the University of Southern Denmark, Odense, Denmark, said, “Patients with higher levels of depressive symptoms at the time of ICD implantation were less likely to be taking their heart medications one year later. The effect of depression was statistically significant but small, which is not surprising given the complexity and multitude of factors involved in medication adherence.”

“These results highlight the importance of considering the psychological status of people receiving an ICD. Those with symptoms of depression at the time of implantation could be at risk of discontinuing their heart medications, even if they are taking them initially, and may need extra support.”


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