Abstract 20400: Selective Serotonin Reuptake Inhibitor Use Improves Mortality in Congestive Heart Failure Patients: A Retrospective Analysis
Background: It has been shown that clinical depression is very common in patients with Congestive Heart Failure (CHF). Many recent studies have indicated the depletion of serotonin as a possible mechanism in causing CHF and the role of serotonin receptor modulation for treatment of CHF. The use of Selective Serotonin Reuptake Inhibitors (SSRIs) may lead to elevation of serum serotonin levels and hence improvement in cardiac function and "depression symptoms". However, there is no objective data on CHF endpoints following SSRI treatment in terms of any positive outcome on mortality or hospital readmission rates. Based on the accumulating evidence, we hypothesized that SSRIs may improve the outcomes of Congestive Heart Failure.
Methods: Mortality and readmissions data was analyzed retrospectively for CHF patients treated at Montefiore Medical Center in the years 1999 to 2009. We included all patients with a clinical diagnosis of CHF whether or not left ventricular ejection fraction was decreased or preserved. Both cohorts of patients were on Beta Blockers, Angiotensin Converting Enzyme Inhibitors, or Angiotensin Receptor Blockers. Analysis was based on whether or not they were on one of the following SSRIs: Sertraline, Fluoxetine, Paroxetine, Citalopram, Escitalopram, Fluvoxamine.
Results: There were 3512 patients who met our criteria, of which 377 were on a SSRI and 3135 were not on a SSRI. We found that the CHF patients on a SSRI had lower mortality rates than those who were not on a SSRI (6.32% vs 11.56%, p=0.01) after a 1 year period. However, there was no significant difference in terms of hospital readmission rates (p=0.57). Baseline characteristics were similar in both groups. In subgroup analysis, there was a statistically significant reduction in mortality in both CHF patients with decreased or preserved EF.
Conclusion: Serotonergic mechanisms may be implicated in CHF and according to our study, the use of a SSRI may improve the outcomes in patients with CHF. Depression is common in CHF patients; therefore SSRIs might have positive effects on cardiac function and depressive symptoms. However, this study has a small cohort of patients who were on a SSRI. Larger retrospective and possibly a prospective study may be needed to validate these findings.
- © 2010 by American Heart Association, Inc.