Characteristics of Depression Remission and Its Relation With Cardiovascular Outcome Among Patients With Chronic Heart Failure (from the SADHART-CHF Study)

Abstract

Depression is prevalent among heart failure (HF) patients, and is associated with a significant increase in hospitalizations and death. Primary results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic HF) trial revealed that sertraline and placebo had comparable effects on depression and cardiovascular outcomes. In this study, we explore whether remission from depression is associated with better survival and to characterize participants who remitted during the trial. Based on the depression response during the 12-week treatment phase, SADHART-CHF participants were divided into 2 groups: 1) remission, defined as participants whose last measured Hamilton Depression Rating Scale (HDRS) score was <8; 2) non-remission, defined as participants whose last measured HDRS score was ≥8. Patients who dropped out prior to having any repeat HDRS were not included. Baseline characteristics and survival differences up to 5 years were evaluated between the remission and the non-remission groups Of the 469 SADHART-CHF participants, 208 (44.3%) achieved remission, 194 (41.4%) remained depressed, and 67 (14.3%) dropped out or died without any repeat HDRS assessment. Patients in the remission group had significantly lower cardiovascular events than those in the non-remission group (1.34±1.86 vs. 1.93±2.71; P adjusted =.01). Male patients were more likely to remit than female patients (56.5 vs. 44.8%, p=0.02). The remission group had milder depressive symptoms at baseline compared to the non-remission group (HDRS: 17.0±5.4 vs. 19.6±5.5; Beck Depression Inventory scale: 17.9±6.5 vs. 20.3±7.2; ps<0.001). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of HF patients.

2013 ACCF/AHA Guideline for the Management of Heart Failure

“…[841][842][843] Although it might be assumed that depression occurs only among hospitalized patients, 844 a multicenter study demonstrated that even at least 3 months after a hospitalization, 63% of patients with HF reported symptoms of depression. 845 Potential pathophysiologic mechanisms proposed to explain the high prevalence of depression in HF include autonomic nervous system dysfunction, inflammation, cardiac arrhythmias, and altered platelet function, but the mechanism remains unclear.…”

“…846 Although remission from depression may improve cardiovascular outcomes, the most effective intervention strategy is not yet known. 842 …”

Chronic fluoxetine reduces autonomic control of cardiac rhythms in rats with congestive heart failure

“…In contrast, studies (24, 28) examining the effect of SSRIs when variability was assessed over 24 h showed contradictory results with evidence of an increase, decrease, or no change in HRV. While SSRIs have been shown to improve mood and perceived quality of life after myocardial infarction, the effect of SSRIs on cardiovascular outcomes remains controversial (19,48). SSRI treatment has been shown to reduce cardiovascular-related morbidity and mortality in depressed patients after myocardial infarction (45).…”

Atualização da Diretriz Brasileira de Insuficiência Cardíaca Crônica - 2012

“…Resultados do estudo SADHART-CHF mostraram que o uso de sertralina em pacientes com IC é seguro; entretanto, em comparação a placebo, seu uso não determinou melhora de sintomas depressivos ou do estado cardíaco 230 . Pacientes no estudo SADHART-CHF com remissão da depressão apresentaram menos eventos cardiovasculares 231 . O uso de citalopram em idosos com IC também não melhorou depressão 232 .…”