Cardiovascular hazards of insufficient treatment of depression among patients with known cardiovascular disease: a propensity score adjusted analysis

Bangalore, Sripal; Shah, Ruchitbhai; Pappadopulos, Elizabeth; Deshpande, Chinmay; Shelbaya, Ahmed; Prieto, Rita; Stephens, Jennifer; McIntyre, Roger S.

doi:10.1093/ehjqcco/qcy023

Cited by 14 publications

(9 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Bangalore et al conducted a large retrospective cohort study ( n =1568) comparing patients receiving adequate antidepressant treatment (fluoxetine-equivalent dose of ≥20 mg/day for non-elderly or >10 mg/day for elderly, and >80% of days are covered by antidepressant use) and those receiving inadequate antidepressant treatment for 3 months. 20 The results showed that patients receiving inadequate antidepressant treatment experienced significantly higher risk of adverse cardiovascular disease events (HR: 1.20, 95% CI: 1.04–1.39; p =0.02) relative to patients who received adequate antidepressant treatment; as well as higher risks of myocardial infarction (HR: 1.37, 95% CI: 0.80–2.33; p =0.25) and congestive HF (HR: 1.14, 95% CI: 0.91–1.42; p =0.25), although neither of these increases reached statistical significance. 20 Brouwers et al assessed antidepressant use and risk for mortality in 121,252 HF patients with or without a diagnosis of clinical depression.…”

Section: Discussionmentioning

confidence: 99%

“… 20 The results showed that patients receiving inadequate antidepressant treatment experienced significantly higher risk of adverse cardiovascular disease events (HR: 1.20, 95% CI: 1.04–1.39; p =0.02) relative to patients who received adequate antidepressant treatment; as well as higher risks of myocardial infarction (HR: 1.37, 95% CI: 0.80–2.33; p =0.25) and congestive HF (HR: 1.14, 95% CI: 0.91–1.42; p =0.25), although neither of these increases reached statistical significance. 20 Brouwers et al assessed antidepressant use and risk for mortality in 121,252 HF patients with or without a diagnosis of clinical depression. The results showed that antidepressant use in patients with HF is associated with an increased risk for all-cause and cardiovascular mortality, irrespective of having clinical depression.…”

Section: Discussionmentioning

confidence: 99%

“…Seven additional studies were identified through other sources including article references leading to a total of 23 studies. The quality check method 18 , 19 led to the exclusion of 6 studies 20 – 25 due to inadequate measurement of depression. This process led to a final selection of 17 studies.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

2020

DIC

View full text Add to dashboard Cite

Objective The purpose of this paper is to review the literature on the impact of antidepressants on depressive symptom severity, quality of life (QoL), morbidity, and mortality in patients with heart failure (HF). Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies published from December 1969 to December 2019 that pertain to depression and HF were identified through the use of the PubMed and PsycINFO databases, using the keywords: ‘antidepressant*’ and ‘heart failure.’ Two authors independently conducted a focused analysis and reached a final consensus on 17 studies that met the specific selection criteria and passed the study quality checks. Results Studies varied in types of antidepressants used as well as in study designs. Ten studies were analyzed for the impact of antidepressant medications on depressive symptom severity. Five of these were randomized controlled trials (RCTs), out of which sertraline and paroxetine showed a significant reduction in depressive symptoms despite the small samples utilized. Four of the 17 studies addressed QoL as part of their outcomes showing no difference for escitalopram (RCT), significantly greater improvements for paroxetine controlled release (RCT), statistical significance for sertraline compared to control (pilot study), and showing significant improvement before and after treatment (open-label trial) for nefazodone. Thirteen of the 17 studies included measures of morbidity and mortality. Although early analyses have pointed to an association of antidepressant use and mortality particularly with fluoxetine, the reviewed studies showed no increase in mortality for antidepressants, and secondary analyses showed improved mortality in patients who achieved remission of depressive symptoms. Conclusion Out of the various antidepressants studied, which included sertraline, paroxetine, escitalopram, citalopram, bupropion, nefazodone, and nortriptyline, selective serotonin reuptake inhibitors seem to be a safe treatment option for patients with depression and HF. However, due to the variety of study designs as well as the mixed results for each antidepressant, more information for reducing depression severity, morbidity, and mortality and improving quality of life in patients with HF should be examined using robust large sample RCTs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

2020

DIC

View full text Add to dashboard Cite

show abstract

“…It is not clear how these factors interact with rtPA to affect functional ambulatory recovery in ischemic stroke patients with pre-stroke depression, and this is beyond the scope of the current study. However, ample evidence indicates that congestive heart failure may have a causal relationship with depression in stroke patients [39][40][41][42]. This is especially important since certain areas in the brain, including the medial temporal region, an area associated with the pathophysiology of depression, are particularly vulnerable to perfusion deficits which arise in the context of congestive heart failure [43,44].…”

Section: Discussionmentioning

confidence: 99%

Clinical Risk Factors that Predict Functional Recovery in Ischemic Stroke Patients with Pre-Stroke Depression

Wormack¹,

Blum²,

Bailes³

et al. 2019

Preprint

View full text Add to dashboard Cite

Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 -104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 -43.529, P=0.019), previous TIA (OR= 0.444, 95% CI, 0.517 -0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 -0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

show abstract

“…Наконец, имеются обсервационные данные, свидетельствующие о росте числа сердечно-сосудистых осложнений в отсутствие лечения или при неадекватном лечении депрессии у пациентов с ССЗ [13].…”

Section: разное §unclassified

Psychosocial Risk Factors in Patients With Most Common Cardiovascular Diseases Such as Hypertension and Coronary Artery Disease (Based on Results From the Russian Multicenter COMET Study)

et al. 2019

View full text Add to dashboard Cite

Background: Psychosocial risk factors (RFs) play a major role in the development and progression of cardiovascular diseases (CVDs).Aim. The COMET study aimed to obtain current data on psychosocial RFs in outpatients with arterial hypertension (AH) and/or coronary heart disease (CHD) seen in primary care facilities in 30 cities of Russia.Methods. In 2016-2017, a multicenter cross-sectional study was carried out involving 325 physicians from community primary care facilities who enrolled 2,775 patients with AH and/or CHD ≥ 55 years of age. However, only 73 CHD patients (2.6%) were not hypertensive, therefore, these patients were excluded from the analyses. As a result, current paper is based on the comparison of AH patients (n=1687) vs. participants with both CHD and AH (AH+CHD; n=1015). We collected patients’ socio-demographic data, clinical features, traditional and psychosocial RFs, such as anxiety and depression, stress level, type D personality, and treatment adherence.Results. The study population (women, 72%; mean age ± SD, 66.7 ± 7.9 years) had a significant prevalence of psychosocial RF. 43.8% of AH patients and 45.5 % of participants with AH+CHD rated their income as low or very low, a low educational level was reported in 21.6% and 26.0%, respectively (both p=n/s). Social isolation was uncommon, but it occurred more frequently in AH+CHD patients (8.3% vs. 5.2%, p<0.01). Nevertheless, 40.2% of AH patients and 39.4% of AH+CHD were not married, and 26.0% and 24.6% were living alone, respectively. Elevated stress level was prevalent in more than 60% of patients (67.9% in AH patients vs. 67.7% in AH+CHD patents, p=n/s), and 63.3% and 64.8% of patients, respectively, reported stressful life events in the preceding year (p=n/s). Type D personality was more common in AH+CHD patients (41.2% vs. 35.8%; p<0.01). Clinically significant anxiety symptoms were prevalent in 24.7% ofAH patients and in 27.4% ofAH+CHD patients (p=n/s), and clinically significant depressive symptoms were identified in 13.9% and 20.9%, respectively (p<0.001).Conclusion. We obtained current data on psychosocial RFs prevalence in outpatients with the most common CVDs in primary care setting. At the moment, their prevalence remains significant.

show abstract

Cardiovascular hazards of insufficient treatment of depression among patients with known cardiovascular disease: a propensity score adjusted analysis

Abstract: Inadequate MDD care was associated with a higher risk of adverse CVD events. These findings reveal a significant unmet clinical need in patients with post-MI or post-stroke MDD that may impact CVD outcomes.

Cited by 14 publications

References 28 publications

The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

The impact of antidepressants on depressive symptom severity, quality of life, morbidity, and mortality in heart failure: a systematic review

Clinical Risk Factors that Predict Functional Recovery in Ischemic Stroke Patients with Pre-Stroke Depression

Psychosocial Risk Factors in Patients With Most Common Cardiovascular Diseases Such as Hypertension and Coronary Artery Disease (Based on Results From the Russian Multicenter COMET Study)

Contact Info

Product

Resources

About