Background: To assess use of antidepressants by class in relation to cardiology practice recommendations, and the association of antidepressant use with the occurrence of major adverse cardiovascular events (MACE) including death. Methods: This is a historical cohort study of all patients who completed cardiac rehabilitation (CR) between 2002 and 2012 in a major CR center. Participants completed the Patient Health Questionnaire (PHQ-9) at the start and end of the program. A linkage system enabled ascertainment of antidepressant use and MACE through 2014. Results: There were 1,694 CR participants, 1,266 (74.7%) of whom completed the PHQ-9 after the program. Depressive symptoms decreased significantly from pre- (4.98 ± 5.20) to postprogram (3.57 ± 4.43) (p < 0.001). Overall, 433 (34.2%) participants were on antidepressants, most often selective serotonin reuptake inhibitors (SSRI; n = 299; 23.6%). The proportion of days covered was approximately 70% for all 4 major antidepressant classes; discontinuation rates ranged from 37.3% for tricyclics to 53.2% for serotonin-norepinephrine reuptake inhibitors (SNRI). Antidepressant use was significantly associated with lower depressive symptoms after CR (before, 7.33 ± 5.94 vs. after, 4.69 ± 4.87; p < 0.001). After a median follow-up of 4.7 years, 264 (20.9%) participants had a MACE. After propensity matching based on pre-CR depressive symptoms among other variables, participants taking tricyclics had significantly more MACE than those not taking tricyclics (HR = 2.46; 95% CI 1.37–4.42), as well as those taking atypicals versus not (HR = 1.59; 95% CI 1.05–2.41) and those on SSRI (HR = 1.45; 95% CI 1.07–1.97). There was no increased risk with use of SNRI (HR = 0.89; 95% CI 0.43–1.82). Conclusion: The use of antidepressants was associated with lower depression, but the use of all antidepressants except SNRI was associated with more adverse events.
The findings of this qualitative study suggest AIs from this tribal community utilize THP, but which specific THPs should be included in an ambulatory-based pain treatment program will require further research.
The original Self-Administered Alcoholism Screening Test (SAAST; Swenson and Morse, 1975) is a self-report alcoholism screening measure intended for use with adult medical patients. However, the SAAST does not indicate the recency of alcohol use-related problems, not all items use the appropriate verb tense for assessing lifetime experience of alcohol use-related problems, many of the items contain out-dated language, and the diagnostic criteria for alcohol dependence and alcohol abuse are not fully represented. The SAAST was revised to address these issues. This paper describes the rationale for revision and the process through which the SAAST was revised. Preliminary information about comparability of the original SAAST and the revised version (SAAST-R) was obtained. Data are presented from two intervention trials for smokers in which both the SAAST and SAAST-R were administered. One sample was comprised of participants in recovery from alcoholism (N = 60; 82% male) and the other sample consisted of participants not meeting criteria for alcohol abuse or dependence within the previous year (N = 98; 45% male). The results suggest that the SAAST-R is highly correlated with the original SAAST, has a similar factor structure, good internal consistency, and correctly identifies those in recovery from alcoholism. Areas for refinement in the format and items of the SAAST-R were identified and suggestions for further validation studies are presented.
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