Abstract 1126: Antidepressants Do Not Improve Event-free Survival in Patients With Heart Failure When Depressive Symptoms Remain
Background: Depressive symptoms increase the risk of hospitalization and death in patients with heart failure (HF). Pharmacological treatment may reduce depressive symptoms, but it is not known whether antidepressants improve patient outcomes.
Purpose: To examine whether use of antidepressants alters the association between depressive symptoms and poor outcomes.
Methods: HF patients were followed for up to 1 year to collect data on death and hospitalizations after their depressive symptoms and antidepressant use were assessed using the Patient Health Questionnaire-9 (PHQ-9) and medical record review at the entry to the study. Patients were grouped by presence (PHQ-9 score > 9) or absence of depressive symptoms and use of antidepressants (yes, no) and their outcomes compared using Kaplan-Meier with log rank test and Cox proportional hazards models.
Results: Of the 230 patients (age 62±12 years, 68% male), 23% had depressive symptoms and 24% were taking antidepressants. Of those with depressive symptoms, only 39% were on antidepressants. Depressive symptoms, not antidepressant therapy, predicted event-free survival (p=.004). Even with stratification by antidepressant use, patients with depressive symptoms experienced shorter event-free survival than those without depressive symptoms (p=.003). Depressed patients on antidepressants were at 3.1 times higher risk for death and hospitalization than non-depressed patients on antidepressant (95% CI=1.7–7.2, p=.008).
Conclusion: Antidepressant use did not improve outcomes when patients still reported depressive symptoms. Ongoing assessment of patients on antidepressants is needed to assure adequate treatment.