Physical activity and depression predict event-free survival in heart transplant candidates

Objective: This study prospectively evaluated the relationship of physical activity (PA), depression and anxiety to event-free survival during waiting-time for heart transplantation in ambulatory patients enrolled in the “Waiting for a New Heart Study”. Methods: Data from 227 ambulatory patients newly listed for heart transplantation was analyzed. Everyday PA (number of activities, caloric expenditure), depression, and anxiety at time of listing were assessed via questionnaires. Events were defined as death, high-urgency transplantation, delisting due to clinical deterioration, and mechanical circulatory support device implantation (MCSD). Associations of PA scores, depression and anxiety with event-free survival were analyzed using Cox proportional hazards models. Covariates included age, sex, BMI, and objective indicators of disease severity. Results: After a median follow-up of 478 days (6-1849 days), 132 events occurred (46 deaths, 20 MCSDs, 54 high-urgency transplantations, 12 delistings). A higher number of activities was significantly associated with a reduced hazard ratio (HR) to experience an event (HR=.88, 95% CI .81-.96), while depression increased this risk (HR=1.64, 95% CI 1.16-2.32). Both effects remained significant in multivariate analyses (HR=.91, 95% CI .83-.99; HR=1.60, 95% CI 1.12-2.29, p-values<.02). No significant interactions between PA scores and emotions were observed and anxiety was unrelated to survival. Conclusion: Both everyday physical activity and the absence of depression prolonged event-free survival in ambulatory heart transplant candidates. These findings were independent of objective measures of disease severity. Patients waiting for cardiac transplantation may benefit from interventions focused on increasing their everyday physical activity and reducing depressive symptoms.