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

https://doi.org/10.1016/j.amjcard.2010.10.013Get rights and content

Depression is prevalent in patients with heart failure and is associated with a significant increase in hospitalizations and death. Primary results of the Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF) trial revealed that sertraline and placebo had comparable effects on depression and cardiovascular outcomes. In this study, we explored whether remission from depression was associated with better survival and aimed to characterize participants who remitted during the trial. Based on 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, and (2) nonremission, defined as participants whose last measured HDRS score was ≥8. Patients who dropped out before having any repeat HDRS were not included. Baseline characteristics and survival differences up to 5 years were evaluated between the remission and nonremission 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 fewer cardiovascular events than those in the nonremission group (1.34 ± 1.86 vs 1.93 ± 2.71, adjusted p = 0.01). Men patients were more likely to remit than women patients (56.5 vs 44.8%, p = 0.02). The remission group had milder depressive symptoms at baseline compared to the nonremission group (HDRS 17.0 ± 5.4 vs 19.6 ± 5.5, Beck Depression Inventory scale 17.9 ± 6.5 vs 20.3 ± 7.2, p <0.001 for the 2 comparisons). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of patients with heart failure.

Section snippets

Methods

The SADHART-CHF database was used for this analysis. A detailed method of the SADHART-CHF trial has been previously published.10, 13 SADHART-CHF was a randomized double-blind study of sertraline versus matching placebo in patients with HF and co-morbid major depression. In addition, all participants received nurse-facilitated support (NFS). Primary end points of the SADHART-CHF trial were change across time in severity of depression as measured by the Hamilton Depression Rating Scale (HDRS)

Results

In total 469 participants were enrolled in SADHART-CHF at Duke University Medical Center and 3 Duke Health System affiliates from August 13, 2003 to March 3, 2008. The primary analysis of SADHART-CHF has been previously reported.13 Of the 469 SADHART-CHF participants, 208 patients (44.3%) had HDRS scores that improved to <8, whereas 194 (41.4%) patients had a HDRS ≥8 at the end of 12-week intervention. There were 67 subjects (14.3%) who did not have any repeat HDRS during the 12-week acute

Discussion

This analysis of the SADHART-CHF trial demonstrated an association of depression remission during the 12-week active intervention and significantly decreased fatal and nonfatal cardiovascular events. Such findings support the hypothesis that successful depression treatment may be associated with a cardiac benefit in patients with HF. Carney et al11 performed a post hoc analysis in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study to examine whether depression remission at 6

Acknowledgment

We thank Pfizer, Inc., New York, New York, for supplying the study drug.

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    The SADHART-CHF study was funded by the National Institute of Mental Health, Bethesda, Maryland.

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