Abstract 2558: Depression, Antidepressants, and Prognosis of Patients with Heart Failure
Objective: Recent studies suggested that use of antidepressants may be associated with increased mortality in patients with cardiac disease. Whether the association was due to antidepressants or to depression has not been evaluated. We therefore conducted a study to examine the association of long-term mortality with antidepressants usage and depression in patients with heart failure (HF).
Methods: Depression, assessed via the Beck Depression Inventory (BDI) scale, and use of antidepressant were prospectively collected from patients with HF who were hospitalized on the cardiology service in a tertiary hospital between March 1997 and June 2003 and who provided consent to participate the study. The participants were followed for vital status at 6 months, and annually thereafter.
Results: One thousand and six HF patients were enrolled with 61.6 % with ischemic disease). Of them, 30% were depressed (defined by BDI score ≥ 10), and 16.1% were taking one or more antidepressants during the index admission. Of the patients who were taking antidepressants, 20 (1.99%) were taking tricyclic antidepressants (TCA) with/ without selective serotonin reuptake inhibitors (SSRI), 129 (12.8%) taking SSRI only, and 13 (1.3%) taking other antidepressants with/without SSRI. The vital status was obtained from all participants and the average days of follow-up were 972±731 (Median = 801 days). During this period, 42.7% of the participants died. Overall antidepressant usage was associated with increased mortality (hazard ratio, 1.32; 95% confidence interval, 1.03–1.69, p=0.029). However, the association was no longer exist after controlling for the presence of depression (hazard ratio, 1.20; 95% confidence interval, 0.84 –1.71; hazard ratio for depression, 1.4; 95% confidence interval, 1.1–1.74). Usage of SSRI only was not associated with increased mortality among patients with HF (hazard ratio, 1.32; 95 percent confidence interval, 0.99 –1.74).
Conclusions: This study suggests that depression, but not antidepressant use, is associated with increased mortality of HF patients.