Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study

Camilla H B Jespersen; Johanna Krøll; Priya Bhardwaj; Bo Gregers Winkel; Peter Karl Jacobsen; Christian Jøns; Jens Haarbo; Jens Kristensen; Jens Brock Johansen; Berit T Philbert; Sam Riahi; Christian Torp-Pedersen; Lars Køber; Jacob Tfelt-Hansen; Peter E Weeke

doi:10.1093/europace/euad112

Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study

Camilla H B Jespersen^*, Johanna Krøll, Priya Bhardwaj, Bo Gregers Winkel, Peter Karl Jacobsen, Christian Jøns, Jens Haarbo, Jens Kristensen, Jens Brock Johansen, Berit T Philbert, Sam Riahi, Christian Torp-Pedersen, Lars Køber, Jacob Tfelt-Hansen, Peter E Weeke

^*Corresponding author for this work

14 Citations (Scopus)

Abstract

AIMS: Reduced psychological health is associated with adverse patient outcomes and higher mortality. We aimed to examine if a Brugada syndrome (BrS) diagnosis and symptomatic disease presentation were associated with an increased risk of new-onset depression or anxiety and all-cause mortality.

METHODS AND RESULTS: All Danish patients diagnosed with BrS (2006-2018) with no history of psychiatric disease and available for ≥6 months follow-up were identified using nationwide registries and followed for up to 5 years after diagnosis. The development of clinical depression or anxiety was evaluated using the prescription of medication and diagnosis codes. Factors associated with developing new-onset depression or anxiety were determined using a multivariate Cox proportional hazards regression model. Disease manifestation was categorized as symptomatic (aborted cardiac arrest, ventricular tachycardia, or syncope) or asymptomatic/unspecified at diagnosis. A total of 223 patients with BrS and no history of psychiatric disease were identified (72.6% male, median age at diagnosis 46 years, 45.3% symptomatic). Of these, 15.7% (35/223) developed new-onset depression or anxiety after BrS diagnosis (median follow-up 5.0 years). A greater proportion of symptomatic patients developed new-onset depression or anxiety compared with asymptomatic patients [21/101 (20.8%) and 14/122 (11.5%), respectively, P = 0.08]. Symptomatic disease presentation (HR 3.43, 1.46-8.05) and older age (lower vs. upper tertile: HR 4.41, 1.42-13.63) were significantly associated with new-onset depression or anxiety. All-cause mortality in this group of patients treated according to guidelines was low (n = 4, 1.8%); however, 3/4 developed depression or anxiety before death.

CONCLUSION: Approximately, one-sixth of patients with BrS developed new-onset depression or anxiety following a diagnosis of BrS. Symptomatic BrS disease manifestation was significantly associated with new-onset depression or anxiety.

Original language	English
Article number	euad112
Journal	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
Volume	25
Issue number	5
ISSN	1099-5129
DOIs	https://doi.org/10.1093/europace/euad112
Publication status	Published - 19 May 2023

Keywords

Anxiety/diagnosis
Brugada Syndrome/diagnosis
Death, Sudden, Cardiac/etiology
Denmark/epidemiology
Depression/diagnosis
Electrocardiography/methods
Female
Humans
Male
Middle Aged
Risk Assessment/methods

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Jespersen, C. H. B., Krøll, J., Bhardwaj, P., Winkel, B. G., Jacobsen, P. K., Jøns, C., Haarbo, J., Kristensen, J., Johansen, J. B., Philbert, B. T., Riahi, S., Torp-Pedersen, C., Køber, L., Tfelt-Hansen, J., & Weeke, P. E. (2023). Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 25(5), Article euad112. https://doi.org/10.1093/europace/euad112

Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study. / Jespersen, Camilla H B ; Krøll, Johanna ; Bhardwaj, Priya et al.
In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, Vol. 25, No. 5, euad112, 19.05.2023.

Research output: Contribution to journal › Journal article › Research › peer-review

Jespersen, CHB , Krøll, J , Bhardwaj, P , Winkel, BG , Jacobsen, PK, Jøns, C, Haarbo, J, Kristensen, J, Johansen, JB, Philbert, BT, Riahi, S, Torp-Pedersen, C , Køber, L , Tfelt-Hansen, J & Weeke, PE 2023, 'Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study', Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, vol. 25, no. 5, euad112. https://doi.org/10.1093/europace/euad112

Jespersen CHB , Krøll J , Bhardwaj P , Winkel BG , Jacobsen PK, Jøns C et al. Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2023 May 19;25(5):euad112. Epub 2023 May 2. doi: 10.1093/europace/euad112

Jespersen, Camilla H B ; Krøll, Johanna ; Bhardwaj, Priya et al. / Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety : a Danish nationwide study. In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2023 ; Vol. 25, No. 5.

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title = "Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study",

abstract = "AIMS: Reduced psychological health is associated with adverse patient outcomes and higher mortality. We aimed to examine if a Brugada syndrome (BrS) diagnosis and symptomatic disease presentation were associated with an increased risk of new-onset depression or anxiety and all-cause mortality.METHODS AND RESULTS: All Danish patients diagnosed with BrS (2006-2018) with no history of psychiatric disease and available for ≥6 months follow-up were identified using nationwide registries and followed for up to 5 years after diagnosis. The development of clinical depression or anxiety was evaluated using the prescription of medication and diagnosis codes. Factors associated with developing new-onset depression or anxiety were determined using a multivariate Cox proportional hazards regression model. Disease manifestation was categorized as symptomatic (aborted cardiac arrest, ventricular tachycardia, or syncope) or asymptomatic/unspecified at diagnosis. A total of 223 patients with BrS and no history of psychiatric disease were identified (72.6\% male, median age at diagnosis 46 years, 45.3\% symptomatic). Of these, 15.7\% (35/223) developed new-onset depression or anxiety after BrS diagnosis (median follow-up 5.0 years). A greater proportion of symptomatic patients developed new-onset depression or anxiety compared with asymptomatic patients [21/101 (20.8\%) and 14/122 (11.5\%), respectively, P = 0.08]. Symptomatic disease presentation (HR 3.43, 1.46-8.05) and older age (lower vs. upper tertile: HR 4.41, 1.42-13.63) were significantly associated with new-onset depression or anxiety. All-cause mortality in this group of patients treated according to guidelines was low (n = 4, 1.8\%); however, 3/4 developed depression or anxiety before death.CONCLUSION: Approximately, one-sixth of patients with BrS developed new-onset depression or anxiety following a diagnosis of BrS. Symptomatic BrS disease manifestation was significantly associated with new-onset depression or anxiety.",

keywords = "Anxiety/diagnosis, Brugada Syndrome/diagnosis, Death, Sudden, Cardiac/etiology, Denmark/epidemiology, Depression/diagnosis, Electrocardiography/methods, Female, Humans, Male, Middle Aged, Risk Assessment/methods",

author = "Jespersen, \{Camilla H B\} and Johanna Kr{\o}ll and Priya Bhardwaj and Winkel, \{Bo Gregers\} and Jacobsen, \{Peter Karl\} and Christian J{\o}ns and Jens Haarbo and Jens Kristensen and Johansen, \{Jens Brock\} and Philbert, \{Berit T\} and Sam Riahi and Christian Torp-Pedersen and Lars K{\o}ber and Jacob Tfelt-Hansen and Weeke, \{Peter E\}",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2023",

month = may,

day = "19",

doi = "10.1093/europace/euad112",

language = "English",

volume = "25",

journal = "Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology",

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publisher = "Oxford University Press",

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TY - JOUR

T1 - Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety

T2 - a Danish nationwide study

AU - Jespersen, Camilla H B

AU - Krøll, Johanna

AU - Bhardwaj, Priya

AU - Winkel, Bo Gregers

AU - Jacobsen, Peter Karl

AU - Jøns, Christian

AU - Haarbo, Jens

AU - Kristensen, Jens

AU - Johansen, Jens Brock

AU - Philbert, Berit T

AU - Riahi, Sam

AU - Torp-Pedersen, Christian

AU - Køber, Lars

AU - Tfelt-Hansen, Jacob

AU - Weeke, Peter E

N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2023/5/19

Y1 - 2023/5/19

N2 - AIMS: Reduced psychological health is associated with adverse patient outcomes and higher mortality. We aimed to examine if a Brugada syndrome (BrS) diagnosis and symptomatic disease presentation were associated with an increased risk of new-onset depression or anxiety and all-cause mortality.METHODS AND RESULTS: All Danish patients diagnosed with BrS (2006-2018) with no history of psychiatric disease and available for ≥6 months follow-up were identified using nationwide registries and followed for up to 5 years after diagnosis. The development of clinical depression or anxiety was evaluated using the prescription of medication and diagnosis codes. Factors associated with developing new-onset depression or anxiety were determined using a multivariate Cox proportional hazards regression model. Disease manifestation was categorized as symptomatic (aborted cardiac arrest, ventricular tachycardia, or syncope) or asymptomatic/unspecified at diagnosis. A total of 223 patients with BrS and no history of psychiatric disease were identified (72.6% male, median age at diagnosis 46 years, 45.3% symptomatic). Of these, 15.7% (35/223) developed new-onset depression or anxiety after BrS diagnosis (median follow-up 5.0 years). A greater proportion of symptomatic patients developed new-onset depression or anxiety compared with asymptomatic patients [21/101 (20.8%) and 14/122 (11.5%), respectively, P = 0.08]. Symptomatic disease presentation (HR 3.43, 1.46-8.05) and older age (lower vs. upper tertile: HR 4.41, 1.42-13.63) were significantly associated with new-onset depression or anxiety. All-cause mortality in this group of patients treated according to guidelines was low (n = 4, 1.8%); however, 3/4 developed depression or anxiety before death.CONCLUSION: Approximately, one-sixth of patients with BrS developed new-onset depression or anxiety following a diagnosis of BrS. Symptomatic BrS disease manifestation was significantly associated with new-onset depression or anxiety.

AB - AIMS: Reduced psychological health is associated with adverse patient outcomes and higher mortality. We aimed to examine if a Brugada syndrome (BrS) diagnosis and symptomatic disease presentation were associated with an increased risk of new-onset depression or anxiety and all-cause mortality.METHODS AND RESULTS: All Danish patients diagnosed with BrS (2006-2018) with no history of psychiatric disease and available for ≥6 months follow-up were identified using nationwide registries and followed for up to 5 years after diagnosis. The development of clinical depression or anxiety was evaluated using the prescription of medication and diagnosis codes. Factors associated with developing new-onset depression or anxiety were determined using a multivariate Cox proportional hazards regression model. Disease manifestation was categorized as symptomatic (aborted cardiac arrest, ventricular tachycardia, or syncope) or asymptomatic/unspecified at diagnosis. A total of 223 patients with BrS and no history of psychiatric disease were identified (72.6% male, median age at diagnosis 46 years, 45.3% symptomatic). Of these, 15.7% (35/223) developed new-onset depression or anxiety after BrS diagnosis (median follow-up 5.0 years). A greater proportion of symptomatic patients developed new-onset depression or anxiety compared with asymptomatic patients [21/101 (20.8%) and 14/122 (11.5%), respectively, P = 0.08]. Symptomatic disease presentation (HR 3.43, 1.46-8.05) and older age (lower vs. upper tertile: HR 4.41, 1.42-13.63) were significantly associated with new-onset depression or anxiety. All-cause mortality in this group of patients treated according to guidelines was low (n = 4, 1.8%); however, 3/4 developed depression or anxiety before death.CONCLUSION: Approximately, one-sixth of patients with BrS developed new-onset depression or anxiety following a diagnosis of BrS. Symptomatic BrS disease manifestation was significantly associated with new-onset depression or anxiety.

KW - Anxiety/diagnosis

KW - Brugada Syndrome/diagnosis

KW - Death, Sudden, Cardiac/etiology

KW - Denmark/epidemiology

KW - Depression/diagnosis

KW - Electrocardiography/methods

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Risk Assessment/methods

UR - https://www.scopus.com/pages/publications/85166313833

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DO - 10.1093/europace/euad112

M3 - Journal article

C2 - 37129985

SN - 1099-5129

VL - 25

JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

IS - 5

M1 - euad112

ER -

Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study

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