Archives of Internal Medicine
Depression is an independent predictor of poor outcomes in patients with heart failure (HF), regardless of HF severity, investigators report in the (2007;167:367-373). While depression is a well-known risk factor for HF, this is one of the first studies to look at the effect of depression on patients already diagnosed with HF.
Included were 204 outpatients (mean age, 56.8 years; 32% women) with relatively stable HF who had a ventricular ejection fraction ≤40%. At baseline, about half (n = 94) had clinically significant depression, based on a Beck Depression Inventory score ≥10. Of these, 21% were taking an antidepressant medication.
At 3 years’ follow-up, those with clinically significant depressive symptoms had a hazard ratio of 1.56 for death or cardiovascular-related hospitalization, after adjusting for known risk factors, such as HF disease severity, ejection fraction, HF etiology, age, and medications.
The most surprising finding of this study was that the hazard ratio for death or hospitalization among patients taking antidepressants was even higher (1.75). However, the authors caution against interpreting this finding too literally, pointing to the small study size, lack of propensity matching, and absence of information on the duration of antidepressant use or the course of the patients’ depression.
Until randomized controlled trials can establish the safety of antidepressants in HF patients, close monitoring may be warranted, they note.