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

C.J. Brouwers, S.B. Christensen, N.L.M. Damen, J. Denollet, C. Torp-Pedersen, G.H. Gislason, S.S. Pedersen

Research output: Contribution to journalArticleScientificpeer-review

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.
Original languageEnglish
Pages (from-to)867–873
JournalInternational Journal of Cardiology
Volume203
DOIs
Publication statusPublished - 2016

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Brouwers, C. J., Christensen, S. B., Damen, N. L. M., Denollet, J., Torp-Pedersen, C., Gislason, G. H., & Pedersen, S. S. (2016). Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression. International Journal of Cardiology, 203, 867–873. https://doi.org/10.1016/j.ijcard.2015.11.032
Brouwers, C.J. ; Christensen, S.B. ; Damen, N.L.M. ; Denollet, J. ; Torp-Pedersen, C. ; Gislason, G.H. ; Pedersen, S.S. / Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression. In: International Journal of Cardiology. 2016 ; Vol. 203. pp. 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 = "BackgroundDepression 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.Methods121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression.ResultsIn 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.ConclusionPatients 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.",
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Brouwers, CJ, Christensen, SB, Damen, NLM, Denollet, J, Torp-Pedersen, C, Gislason, GH & Pedersen, SS 2016, 'Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression', International Journal of Cardiology, vol. 203, pp. 867–873. https://doi.org/10.1016/j.ijcard.2015.11.032

Antidepressant use and risk for mortality in 121,252 heart failure patients with or without a diagnosis of clinical depression. / Brouwers, C.J.; Christensen, S.B.; Damen, N.L.M.; Denollet, J.; Torp-Pedersen, C.; Gislason, G.H.; Pedersen, S.S.

In: International Journal of Cardiology, Vol. 203, 2016, p. 867–873.

Research output: Contribution to journalArticleScientificpeer-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, C.J.

AU - Christensen, S.B.

AU - Damen, N.L.M.

AU - Denollet, J.

AU - Torp-Pedersen, C.

AU - Gislason, G.H.

AU - Pedersen, S.S.

PY - 2016

Y1 - 2016

N2 - BackgroundDepression 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.Methods121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression.ResultsIn 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.ConclusionPatients 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 - BackgroundDepression 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.Methods121,252 HF patients surviving first hospitalization were stratified by antidepressant use and a diagnosis of clinical depression.ResultsIn 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.ConclusionPatients 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.

U2 - 10.1016/j.ijcard.2015.11.032

DO - 10.1016/j.ijcard.2015.11.032

M3 - Article

VL - 203

SP - 867

EP - 873

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -