TY - JOUR

T1 - Prognosis in heart failure and the value of {beta}-blockers are altered by the use of antidepressants and depend on the type of antidepressants used

AU - Fosbøl, Emil Loldrup

AU - Gislason, Gunnar H

AU - Poulsen, Henrik Enghusen

AU - Hansen, Morten Lock

AU - Folke, Fredrik

AU - Schramm, Tina Ken

AU - Olesen, Jonas Bjerring

AU - Bretler, Ditte-Marie

AU - Abildstrøm, Steen Z

AU - Sørensen, Rikke

AU - Hvelplund, Anders

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Fosbøl, Emil Loldrup

AU - Gislason, Gunnar H

AU - Poulsen, Henrik Enghusen

AU - Hansen, Morten Lock

AU - Folke, Fredrik

AU - Schramm, Tina Ken

AU - Olesen, Jonas Bjerring

AU - Bretler, Ditte-Marie

AU - Abildstrøm, Steen Z

AU - Sørensen, Rikke

AU - Hvelplund, Anders

AU - Køber, Lars

AU - Torp-Pedersen, Christian

N1 - Keywords: Adrenergic beta-Antagonists; Aged; Aged, 80 and over; Antidepressive Agents, Tricyclic; Cohort Studies; Denmark; Depression; Drug Interactions; Female; Heart Failure; Hospitalization; Humans; Kaplan-Meiers Estimate; Male; Medication Adherence; Middle Aged; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Serotonin Uptake Inhibitors; Time Factors; Treatment Outcome

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Depression worsens the prognosis in patients with cardiac disease, and treatment with antidepressants may improve survival. Guidelines recommend use of selective serotonin reuptake inhibitors (SSRIs), but knowledge of the prognostic effect of different classes of antidepressants is sparse. METHODS AND RESULTS: We studied 99 335 patients surviving first hospitalization for heart failure (HF) from 1997 to 2005. Use of HF medication and antidepressants (divided into tricyclic antidepressants [TCA] and SSRI) was determined by prescription claims. Risk of overall and cardiovascular death associated with antidepressants, HF medication, and coadministration of these 2 drug classes was estimated by Cox proportional hazard analyses. Propensity adjusted models were performed as sensitivity analysis. During the study period, there were 53 988 deaths, of which 83.0% were due to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of beta-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and beta-blockers was associated with a higher risk of overall and cardiovascular death compared with coadministration of beta-blockers and TCA (P for interaction <0.01). CONCLUSIONS: Use of antidepressants in patients with HF was associated with worse prognosis. Coadministration of SSRIs and beta-blockers was associated with increased risk of overall death and cardiovascular death compared with coadministration of TCAs and beta-blockers. To further clarify this, clinical trials testing the optimal antidepressant strategy in patients with HF are warranted.

AB - BACKGROUND: Depression worsens the prognosis in patients with cardiac disease, and treatment with antidepressants may improve survival. Guidelines recommend use of selective serotonin reuptake inhibitors (SSRIs), but knowledge of the prognostic effect of different classes of antidepressants is sparse. METHODS AND RESULTS: We studied 99 335 patients surviving first hospitalization for heart failure (HF) from 1997 to 2005. Use of HF medication and antidepressants (divided into tricyclic antidepressants [TCA] and SSRI) was determined by prescription claims. Risk of overall and cardiovascular death associated with antidepressants, HF medication, and coadministration of these 2 drug classes was estimated by Cox proportional hazard analyses. Propensity adjusted models were performed as sensitivity analysis. During the study period, there were 53 988 deaths, of which 83.0% were due to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of beta-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and beta-blockers was associated with a higher risk of overall and cardiovascular death compared with coadministration of beta-blockers and TCA (P for interaction <0.01). CONCLUSIONS: Use of antidepressants in patients with HF was associated with worse prognosis. Coadministration of SSRIs and beta-blockers was associated with increased risk of overall death and cardiovascular death compared with coadministration of TCAs and beta-blockers. To further clarify this, clinical trials testing the optimal antidepressant strategy in patients with HF are warranted.

U2 - 10.1161/CIRCHEARTFAILURE.109.851246

DO - 10.1161/CIRCHEARTFAILURE.109.851246

M3 - Journal article

C2 - 19919983

VL - 2

SP - 582

EP - 590

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3289

IS - 6

ER -