Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression

Corline Brouwers, Stefan B. Christensen, Nikki L. Damen, Johan Denollet, Christian Torp-Pedersen, Gunnar H. Gislason, Susanne S. Pedersen*

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftInternational Journal of Cardiology
Vol/bind203
Sider (fra-til)867-873
ISSN0167-5273
DOI
StatusUdgivet - 15. jan. 2016

Fingeraftryk

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Prescriptions
Comorbidity

Citer dette

Brouwers, Corline ; Christensen, Stefan B. ; Damen, Nikki L. ; Denollet, Johan ; Torp-Pedersen, Christian ; Gislason, Gunnar H. ; Pedersen, Susanne S. / Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression. I: International Journal of Cardiology. 2016 ; Bind 203. s. 867-873.
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title = "Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression",
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.",
keywords = "Antidepressant, Clinical depression, Heart failure, Mortality",
author = "Corline Brouwers and Christensen, {Stefan B.} and Damen, {Nikki L.} and Johan Denollet and Christian Torp-Pedersen and Gislason, {Gunnar H.} and Pedersen, {Susanne S.}",
year = "2016",
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Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression. / Brouwers, Corline; Christensen, Stefan B.; Damen, Nikki L.; Denollet, Johan; Torp-Pedersen, Christian; Gislason, Gunnar H.; Pedersen, Susanne S.

I: International Journal of Cardiology, Bind 203, 15.01.2016, s. 867-873.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression

AU - Brouwers, Corline

AU - Christensen, Stefan B.

AU - Damen, Nikki L.

AU - Denollet, Johan

AU - Torp-Pedersen, Christian

AU - Gislason, Gunnar H.

AU - Pedersen, Susanne S.

PY - 2016/1/15

Y1 - 2016/1/15

N2 - 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.

AB - 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.

KW - Antidepressant

KW - Clinical depression

KW - Heart failure

KW - Mortality

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U2 - 10.1016/j.ijcard.2015.11.032

DO - 10.1016/j.ijcard.2015.11.032

M3 - Journal article

C2 - 26599753

VL - 203

SP - 867

EP - 873

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -