Heart and Vessels

, Volume 29, Issue 3, pp 364–374

Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy

  • Christian Knackstedt
  • Marlies Arndt
  • Karl Mischke
  • Nikolaus Marx
  • Fred Nieman
  • Hanns Jürgen Kunert
  • Patrick Schauerte
  • Christine Norra
Original Article

DOI: 10.1007/s00380-013-0372-8

Cite this article as:
Knackstedt, C., Arndt, M., Mischke, K. et al. Heart Vessels (2014) 29: 364. doi:10.1007/s00380-013-0372-8


Congestive heart failure is frequent and leads to reduced exercise capacity, reduced quality of life (QoL), and depression in many patients. Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) offer therapeutic options and may have an impact on QoL and depression. This study was performed to evaluate physical and mental health in patients undergoing ICD or combined CRT/ICD-implantation (CRT-D). Echocardiography, spiroergometry, and psychometric questionnaires [Beck Depression Inventory, General World Health Organization Five Well-being Index (WHO-5), Brief Symptom Inventory and 36-item Short Form (SF-36)] were obtained in 39 patients (ICD: 17, CRT-D: 22) at baseline and 6-month follow-up (FU) after device implantation. CRT-D patients had a higher NYHA class and broader left bundle branch block than ICD patients at baseline. At FU, ejection fraction (EF), peak oxygen uptake, and NYHA class improved significantly in CRT-D patients but remained unchanged in ICD patients. Patients with CRT-D implantation showed higher levels of depressive symptoms, psychological distress, and impairment in QoL at baseline and FU compared to ICD patients. These impairments remained mostly unchanged in all patients after 6 months. Overall, these findings imply that there is a need for careful assessment and treatment of psychological distress and depression in ICD and CRT-D patients in the course of device implantation as psychological burden seems to persist irrespective of physical improvement.


Cardiac resynchronization therapy Depression Quality of life Psychological distress Implantable cardioverter defibrillator 



Beck Depression Inventory


Brief Symptom Inventory


Cognitive behavior therapy


Congestive heart failure


Cardiac resynchronization therapy


Cardiac resynchronization therapy with ICD properties


Ejection fraction




Implantable cardioverter defibrillator


Left bundle branch block


Left ventricular


New York Heart Association


Quality of life


Short Form 36-item


Selective serotonin re-uptake inhibitor


World Health Organization

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Christian Knackstedt
    • 1
  • Marlies Arndt
    • 2
  • Karl Mischke
    • 3
  • Nikolaus Marx
    • 3
  • Fred Nieman
    • 4
  • Hanns Jürgen Kunert
    • 5
  • Patrick Schauerte
    • 3
  • Christine Norra
    • 6
  1. 1.Department of CardiologyMaastricht University Medical CentreMaastrichtThe Netherlands
  2. 2.Department of Psychiatry and PsychotherapyRWTH Aachen UniversityAachenGermany
  3. 3.Department of CardiologyRWTH Aachen UniversityAachenGermany
  4. 4.Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CentreMaastrichtThe Netherlands
  5. 5.Medical FacultyUniversity Hospital, Georg August UniversityGöttingenGermany
  6. 6.Department of Psychiatry, Psychotherapy and Prevention MedicineRuhr University BochumBochumGermany

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