Mental Disorders Following Implantable Cardioverter-Defibrillator Therapy: Incidence and Prognostic Implications in a Nationwide Cohort Study

Juwon Kim ¹, Hyewon Kim ², Hyunsoo Kim ³, Ju Youn Kim ¹, Kyoung-Min Park ¹, Young Keun On ¹, Danbee Kang ⁴, Seung-Jung Park ⁵

• PMID: 41134242
• DOI: 10.1016/j.jacep.2025.09.006

Abstract

Background: The incidence and prognostic implications of mental disorders after implantable cardioverter-defibrillator (ICD) therapy remain underexplored.

Objectives: This study sought to investigate the incidence of newly diagnosed mental disorders after ICD implantation compared with the incidence in matched non-ICD control subjects and to evaluate the impact of these disorders on prognosis.

Methods: Using the Korean National Health Insurance Service database, 6,356 patients with an ICD and 17,664 propensity score-matched control subjects were selected between 2010 and 2020. In the ICD group, long-term prognosis was compared between patients with and without mental disorders newly diagnosed postimplantation.

Results: The 10-year cumulative incidence of newly diagnosed mental disorders was 37.3% in ICD patients, significantly higher than in the matched control subjects (34.5%; HR: 1.21; 95% CI: 1.14-1.29). The most frequent mental disorders were depressive disorder (18.4%), insomnia (16.8%), and anxiety disorder (5.8%). Among ICD patients, newly diagnosed mental disorders adversely affected long-term prognosis, with significantly higher all-cause mortality (HR: 2.00; 95% CI: 1.76-2.28), cardiac mortality (HR: 1.83; 95% CI: 1.53-2.18), severe heart failure events (HR: 2.12; 95% CI: 1.54-2.93), and any-cause readmissions (HR: 1.65; 95% CI: 1.50-1.82) compared with those without mental disorders. In particular, schizophrenia spectrum disorders and mental disorders diagnosed early (within 2.8 years' postimplantation) were strongly associated with worse clinical outcomes. The adverse effect of mental disorders on mortality was more pronounced in patients with atrial fibrillation than in those without atrial fibrillation (P_interaction = 0.04).

Conclusions: Evidence-based ICD implantation, proactive screening, and timely management of mental disorders may mitigate adverse outcomes associated with ICD therapy and mental disorders.

Keywords: implantable cardioverter-defibrillator; mental disorder; mortality; population-based study.