Corline Brouwers1, Stefan B Christensen2, Nikki L Damen1, Johan Denollet1, Christian Torp-Pedersen2, Gunnar H Gislason3, Susanne S Pedersen4. 1. CoRPS - Center of Research on Psychology in Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. 2. Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. 3. Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark. 4. Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: sspedersen@health.sdu.dk.
Abstract
BACKGROUND: Depression is a risk factor for mortality in patients with heart failure (HF), however, treating depression with antidepressant therapy does not seem to improve survival. We examined the prevalence of antidepressant use in HF patients, the correlates of antidepressant use subsequent to hospital discharge and the relation between antidepressant use, clinical depression and mortality in patients with HF. METHODS: 121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression. RESULTS: In total, 15.6% (19,348) received antidepressants at baseline, of which 86.7% (16,780) had no diagnosis of clinical depression. Female gender, older age, higher socio-economic status, more comorbidities, increased use of statins, spironolactone and aspirin, lower use of beta-blockers and ACE-inhibitors, greater HF severity and a diagnosis of clinical depression were independently associated with antidepressant use. Patients using no antidepressants with clinical depression and patients using antidepressants, with or without clinical depression, had a significantly higher risk for all-cause mortality (HR, 1.25; 95% CI, 1.15-1.36; HR, 1.24; 95% CI, 1.22-1.27; HR, 1.21; 95% CI, 1.16-1.27, respectively) and CV-mortality (HR: 1.17; 95% CI, 1.14-1.20, P<.001; HR: 1.20; 95% CI, 1.08-1.34, P<.001; HR: 1.21; 95% CI, 1.12-1.29, P<.001, respectively) as compared to patients not using antidepressants without depression in adjusted analysis. CONCLUSION: Patients with HF taking antidepressants had an increased risk for all-cause and CV-mortality, irrespectively of having clinical depression. These results highlight the importance of further examining the antidepressant prescription pattern in patients with HF, as this may be crucial in understanding the antidepressant effects on cardiac function and mortality.
BACKGROUND:Depression is a risk factor for mortality in patients with heart failure (HF), however, treating depression with antidepressant therapy does not seem to improve survival. We examined the prevalence of antidepressant use in HF patients, the correlates of antidepressant use subsequent to hospital discharge and the relation between antidepressant use, clinical depression and mortality in patients with HF. METHODS: 121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression. RESULTS: In total, 15.6% (19,348) received antidepressants at baseline, of which 86.7% (16,780) had no diagnosis of clinical depression. Female gender, older age, higher socio-economic status, more comorbidities, increased use of statins, spironolactone and aspirin, lower use of beta-blockers and ACE-inhibitors, greater HF severity and a diagnosis of clinical depression were independently associated with antidepressant use. Patients using no antidepressants with clinical depression and patients using antidepressants, with or without clinical depression, had a significantly higher risk for all-cause mortality (HR, 1.25; 95% CI, 1.15-1.36; HR, 1.24; 95% CI, 1.22-1.27; HR, 1.21; 95% CI, 1.16-1.27, respectively) and CV-mortality (HR: 1.17; 95% CI, 1.14-1.20, P<.001; HR: 1.20; 95% CI, 1.08-1.34, P<.001; HR: 1.21; 95% CI, 1.12-1.29, P<.001, respectively) as compared to patients not using antidepressants without depression in adjusted analysis. CONCLUSION:Patients with HF taking antidepressants had an increased risk for all-cause and CV-mortality, irrespectively of having clinical depression. These results highlight the importance of further examining the antidepressant prescription pattern in patients with HF, as this may be crucial in understanding the antidepressant effects on cardiac function and mortality.
Authors: Ida Kim Wium-Andersen; Marie Kim Wium-Andersen; Martin Balslev Jørgensen; Merete Osler Journal: J Psychiatry Neurosci Date: 2017-09 Impact factor: 6.186
Authors: Meredith L Wallace; Daniel J Buysse; Susan Redline; Katie L Stone; Kristine Ensrud; Yue Leng; Sonia Ancoli-Israel; Martica H Hall Journal: J Gerontol A Biol Sci Med Sci Date: 2019-11-13 Impact factor: 6.053
Authors: Kenneth E Freedland; Brian C Steinmeyer; Robert M Carney; Judith A Skala; Michael W Rich Journal: Gen Hosp Psychiatry Date: 2020-04-25 Impact factor: 3.238
Authors: Debra K Moser; Cynthia Arslanian-Engoren; Martha J Biddle; Misook Lee Chung; Rebecca L Dekker; Muna H Hammash; Gia Mudd-Martin; Abdullah S Alhurani; Terry A Lennie Journal: Curr Cardiol Rep Date: 2016-12 Impact factor: 2.931