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Prognosis in heart failure and the value of {beta}-blockers are altered by the use of antidepressants and depend on the type of antidepressants used.
Circ Heart Fail. 2009 Nov; 2(6):582-90.CH

Abstract

BACKGROUND

Depression worsens the prognosis in patients with cardiac disease, and treatment with antidepressants may improve survival. Guidelines recommend use of selective serotonin reuptake inhibitors (SSRIs), but knowledge of the prognostic effect of different classes of antidepressants is sparse.

METHODS AND RESULTS

We studied 99 335 patients surviving first hospitalization for heart failure (HF) from 1997 to 2005. Use of HF medication and antidepressants (divided into tricyclic antidepressants [TCA] and SSRI) was determined by prescription claims. Risk of overall and cardiovascular death associated with antidepressants, HF medication, and coadministration of these 2 drug classes was estimated by Cox proportional hazard analyses. Propensity adjusted models were performed as sensitivity analysis. During the study period, there were 53 988 deaths, of which 83.0% were due to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of beta-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and beta-blockers was associated with a higher risk of overall and cardiovascular death compared with coadministration of beta-blockers and TCA (P for interaction <0.01).

CONCLUSIONS

Use of antidepressants in patients with HF was associated with worse prognosis. Coadministration of SSRIs and beta-blockers was associated with increased risk of overall death and cardiovascular death compared with coadministration of TCAs and beta-blockers. To further clarify this, clinical trials testing the optimal antidepressant strategy in patients with HF are warranted.

Authors+Show Affiliations

Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark. elf@heart.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19919983

Citation

Fosbøl, Emil Loldrup, et al. "Prognosis in Heart Failure and the Value of {beta}-blockers Are Altered By the Use of Antidepressants and Depend On the Type of Antidepressants Used." Circulation. Heart Failure, vol. 2, no. 6, 2009, pp. 582-90.
Fosbøl EL, Gislason GH, Poulsen HE, et al. Prognosis in heart failure and the value of {beta}-blockers are altered by the use of antidepressants and depend on the type of antidepressants used. Circ Heart Fail. 2009;2(6):582-90.
Fosbøl, E. L., Gislason, G. H., Poulsen, H. E., Hansen, M. L., Folke, F., Schramm, T. K., Olesen, J. B., Bretler, D. M., Abildstrøm, S. Z., Sørensen, R., Hvelplund, A., Køber, L., & Torp-Pedersen, C. (2009). Prognosis in heart failure and the value of {beta}-blockers are altered by the use of antidepressants and depend on the type of antidepressants used. Circulation. Heart Failure, 2(6), 582-90. https://doi.org/10.1161/CIRCHEARTFAILURE.109.851246
Fosbøl EL, et al. Prognosis in Heart Failure and the Value of {beta}-blockers Are Altered By the Use of Antidepressants and Depend On the Type of Antidepressants Used. Circ Heart Fail. 2009;2(6):582-90. PubMed PMID: 19919983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognosis in heart failure and the value of {beta}-blockers are altered by the use of antidepressants and depend on the type of antidepressants used. AU - Fosbøl,Emil Loldrup, AU - Gislason,Gunnar H, AU - Poulsen,Henrik Enghusen, AU - Hansen,Morten Lock, AU - Folke,Fredrik, AU - Schramm,Tina Ken, AU - Olesen,Jonas Bjerring, AU - Bretler,Ditte-Marie, AU - Abildstrøm,Steen Z, AU - Sørensen,Rikke, AU - Hvelplund,Anders, AU - Køber,Lars, AU - Torp-Pedersen,Christian, Y1 - 2009/09/22/ PY - 2009/11/19/entrez PY - 2009/11/19/pubmed PY - 2009/12/16/medline SP - 582 EP - 90 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 2 IS - 6 N2 - BACKGROUND: Depression worsens the prognosis in patients with cardiac disease, and treatment with antidepressants may improve survival. Guidelines recommend use of selective serotonin reuptake inhibitors (SSRIs), but knowledge of the prognostic effect of different classes of antidepressants is sparse. METHODS AND RESULTS: We studied 99 335 patients surviving first hospitalization for heart failure (HF) from 1997 to 2005. Use of HF medication and antidepressants (divided into tricyclic antidepressants [TCA] and SSRI) was determined by prescription claims. Risk of overall and cardiovascular death associated with antidepressants, HF medication, and coadministration of these 2 drug classes was estimated by Cox proportional hazard analyses. Propensity adjusted models were performed as sensitivity analysis. During the study period, there were 53 988 deaths, of which 83.0% were due to cardiovascular causes (median follow-up, 1.9 years; 5, 95% fractiles, 0.04 to 7.06 years). Use of beta-blockers was associated with decreased risk of cardiovascular death (hazard ratio [HR], 0.77; 95% CI, 0.75 to 0.79). Antidepressants were prescribed to 19 411 patients, and both TCA and SSRI were associated with increased risk of overall and cardiovascular death (TCA: HR, 1.33; CI, 1.26 to 1.40; and HR, 1.25; CI, 1.17 to 1.32; SSRI: HR, 1.37; CI, 1.34 to 1.40; and HR, 1.34; CI, 1.30 to 1.38, respectively). Coadministration of SSRI and beta-blockers was associated with a higher risk of overall and cardiovascular death compared with coadministration of beta-blockers and TCA (P for interaction <0.01). CONCLUSIONS: Use of antidepressants in patients with HF was associated with worse prognosis. Coadministration of SSRIs and beta-blockers was associated with increased risk of overall death and cardiovascular death compared with coadministration of TCAs and beta-blockers. To further clarify this, clinical trials testing the optimal antidepressant strategy in patients with HF are warranted. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/19919983/Prognosis_in_heart_failure_and_the_value_of_{beta}_blockers_are_altered_by_the_use_of_antidepressants_and_depend_on_the_type_of_antidepressants_used_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.109.851246?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -