# High social support is associated with reduced cardiac events in patients following ICD/CRT-D implantation: a one-year follow-up study in China

## TL;DR

Higher social support is linked to fewer cardiac events in patients with heart devices over one year.

## Contribution

This study shows that social support independently reduces cardiac risks after ICD/CRT-D implantation in China.

## Key findings

- High social support reduced secondary cardiac event risk by 65.6% after adjustment.
- The protective effect of social support weakened over time but remained significant.
- Anxiety and depression showed delayed, time-dependent associations with cardiac events.

## Abstract

Few studies exist on the impact of social support on cardiac events following implantation of implantable cardioverter-defibrillators (ICD) or cardiac resynchronization therapy devices with defibrillators (CRT-D). This study aims to investigate the longitudinal association between social support and adverse cardiac events among ICD/CRT-D recipients during a 1-year follow-up.

This hospital-based longitudinal study included 101 patients undergoing first ICD/CRT-D implantation. Demographic and clinical data were collected as confounders. Social support, anxiety, and depression scores were assessed at baseline and during follow-ups (1, 3, 6, 12 months). Cardiac events (primary endpoint: all-cause mortality or appropriate ICD shocks; secondary endpoint: primary endpoint events, heart failure hospitalization, or acute coronary syndrome) were documented. Kaplan-Meier analyses and Cox proportional hazards models (adjusted for age, sex, NYHA class, and ICD indication) evaluated associations, while time-dependent Cox models analyzed temporal effects.

Patients with higher baseline social support exhibited a reduced risk of the primary composite endpoint (log-rank χ² = 5.53, p = 0.019) and secondary composite endpoint (log-rank χ² = 14.64, p < 0.001). After multivariable adjustment (age, sex, NYHA class, ICD indication, anxiety/depression scores), high social support was independently linked to 65.6% lower secondary endpoint risk (adjusted HR = 0.344, 95% CI: 0.172–0.688, p = 0.003). The protective association attenuated over time (HR = 0.991 per unit time, p = 0.009) but remained statistically significant. Anxiety and depression showed no baseline association with events but demonstrated a time-dependent risk increase.

Higher social support is independently associated with a reduced risk of the secondary composite endpoint after ICD/CRT-D implantation. Sustained psychosocial interventions may be warranted to mitigate long-term risk attenuation.

The online version contains supplementary material available at 10.1186/s40359-025-03912-5.