P953Gender differences in comorbidity and impact on patient distress and quality of life during the first 12 months after ICD implantation (Data from the DEFIB-WOMEN study)

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Funding Acknowledgements: The DEFIB-WOMEN study was supported with grant no. 09-10-R75-A2713-22565. Pregraduat research was supported with grant no. 16-R107-A6711-22021 Introduction: The implantable cardioverter defibrillator (ICD) is the first choice therapy for the prevention of sudden cardiac death in patients at risk of life threatening arrhythmias. Although the medical benefits of ICD therapy are unequivocal, patients are faced with device- and arrhythmia-related challenges and other comorbidities. Comorbidities may cause psychological distress and reduce quality of life. Little is known about the impact of comorbidities across genders in ICD patients and whether comorbidities have a different impact on women versus men. Purpose: To evaluate (i) the prevalence of comorbidities in women compared to men, and (ii) the influence of comorbidities on distress (i.e. anxiety and depression) and quality of life in women compared to men at 12 months post ICD implantation. Methods: Consecutive patients with a first-time defibrillator (VVI, DDD or CRT-D) included in the national, multicentre prospective observational study (DEFIB-WOMEN) between 2010 and 2013 completed the Hospital Anxiety and Depression Scale (HADS) and the Short Form Health Survey 36 (SF-36) at baseline and 12 months follow-up. A cut-off ≥8 on HADS-A and HADS-D was used to indicate probable clinical levels of anxiety and depression, while the lowest tertile on the SF-36 Physical Component Summary (PCS) and Mental Component Summary (PCS) reflected poor quality of life. Information on comorbidity (Charlson Comorbidity Index (CCI): 0 = none; ≥ 1 = comorbidity) and baseline data was captured from the Danish National Patient Register and the Danish Pacemaker and ICD Register. Logistic regression was used to assess the impact of comorbidities on anxiety, depression, and quality of life. Results: Of 1790 patients (61.5% response rate) implanted with a defibrillator, eligible for study inclusion and willing to participate, 1149 patients (64.2%) completed HADS and the SF-36 both at baseline and 12 months follow-up. The prevalence of comorbidity at implant was significantly higher in men than in women (58.6% vs 46.0%, p=0.001). The impact of comorbidities in women versus men on anxiety (p=0.77) and depression (p=0.71) at 12 months was similar, as indicated by the non-significant interaction effects, including also the main effects for gender, prevalence of comorbidity and baseline anxiety and depression, respectively, in the analysis. The impact of comorbidities in women versus men on MCS (p=0.70) and PCS (p=0.98) were also similar, as indicated by the non-significant interaction effects including also the main effects for gender, prevalence of comorbidity and baseline MSC and PSC, respectively. Conclusion: Men had more often comorbidities at the time of ICD implant compared to women. There were no differences between women and men with respect to the impact of comorbidity on anxiety, depression, and quality of life.

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